Aspirin for Cardioprotection and Strategies to Improve Patient Adherence

Duffy, Danielle; Kelly, Erik; Trang, Amanda; Whellan, David J.; Mills, Geoffrey

doi:10.3810/pgm.2014.01.2721

Cited by 21 publications

(16 citation statements)

References 81 publications

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“…Indeed, when we searched for predictors of low adherence to LDA, the absence of a secondary indication for LDA use was the main predictor of being in the noadherent or delayed not-adherent versus persistent adherent group. The probability of being in the not-adherent group was also increased with female sex, low socioeconomic status or polymedication, which agreed with other studies 17,20,37,38 , and was decreased with other covariates that are associated with an increased rate of cardiovascular diseases. Finally, dementia was also associated with good adherence, which suggests that these individuals are in an advanced stage and might be relying on caregivers to administer medications and thus show good adherence behavior 47 .…”

Section: Gbtm Underlined the Presence Of 4 Distinct Profiles Of Adhersupporting

confidence: 90%

“…Still, previous studies have shown that adherence to LDA is suboptimal 17,18 , with the lowest rates among all cardiovascular preventive therapies (65%) 17 . Consequences of this poor adherence are decreased treatment effectiveness and increased cardiovascular morbidity and mortality [19][20][21] . Poor adherence is complex, given its multifactorial nature 22 , and needs to be well understood and described to be better managed.…”

Section: Introductionmentioning

confidence: 99%

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Trajectories of Adherence to Low-Dose Aspirin Treatment Among the French Population

Ajrouche

Estellat

Rycke

et al. 2019

J Cardiovasc Pharmacol Ther

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Background: Previous studies have shown that adherence to low-dose aspirin (LDA) is suboptimal. However, these studies were based on an average measure of adherence during follow-up, ignoring its dynamic process over time. We described the trajectories of adherence to LDA treatment among the French population over 3 years of follow-up. Methods: We identified a cohort of 11 793 new LDA users, aged ≥50 years in 2010, by using the French national health-care database. Patients included had at least 3 years of history in the database before study entry to exclude prevalent aspirin users and to assess baseline comorbidities. They were followed from the first date of LDA supply (the index date) until the first date among death, exit from the database, or 3 years after the index date. Adherence to LDA was assessed every 3 months by using the proportion of days covered (PDC) and dichotomized with a cutoff of PDC of 0.8. We used group-based trajectory modeling to identify trajectories of LDA adherence. Predictors of LDA adherence trajectory membership were identified by multinomial logistics regression. Results: We identified 4 trajectories of adherence among new LDA users: the not-adherents (4737 [40.2%]), the delayed not-adherents (gradual decrease in adherence probability, 1601 [13.6%]), the delayed adherents (gradual increase in adherence probability, 1137 [9.6%]), and the persistent adherents (4318 [36.6%]). The probability of belonging to the not-adherent group was increased with female sex, low socioeconomic status, and polymedication and was reduced with a secondary indication for LDA use, such as diabetes, hypertension, and dementia, at least 4 consultations in the previous year, or 1 hospitalization or a cardiologist consultation in the 3 months before the index date. Conclusion: This study provides a dynamic picture of adherence behaviors among new LDA users and underlines the presence of critical trajectories that intervention could target to improve adherence.

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Section: Gbtm Underlined the Presence Of 4 Distinct Profiles Of Adhersupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Trajectories of Adherence to Low-Dose Aspirin Treatment Among the French Population

Ajrouche

Estellat

Rycke

et al. 2019

J Cardiovasc Pharmacol Ther

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“…Duffy et al reported in their review that knowledge about aspirin and compliance were not optimal ranging between 72 and 92%. 25 Of the 12 included studies in this review, none of the studies were related to children. Specifically, in children, Lee and colleagues conducted a study among parents of 87 children waiting for organ transplantation.…”

Section: Knowledge About Aspirinmentioning

confidence: 99%

Compliance with aspirin in paediatric CHD post-percutaneous transcatheter occlusion: a cross-sectional study

et al. 2020

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Background: Predictors of compliance with aspirin in children following cardiac catheterisation have not been identified. The aim of this study is to identify the caregivers’ knowledge, compliance with aspirin medication, and predictors of compliance with aspirin in children with Congenital Heart Disease (CHD) post-percutaneous transcatheter occlusion. Methods: A cross-sectional explorative design was adopted using a self-administered questionnaire and conducted between May 2017 and May 2018. Recruited were 220 caregivers of children with CHD post-percutaneous transcatheter occlusion. Questionnaires included child and caregivers’ characteristics, a self-designed and tested knowledge about aspirin scale (scoring scale 0–2), and the 8-item Morisky Medication Adherence Scale (scoring scale 0–8). Data were analysed using multivariate binary logistic regression analysis to identify predictors of compliance with aspirin. Results: Of the 220 eligible children and caregivers, 210 (95.5%) responded and 209 surveys were included in the analysis. The mean score of knowledge was 7.25 (standard deviation 2.27). The mean score of compliance was 5.65 (standard deviation 1.36). Child’s age, length of aspirin use, health insurance policies, relationship to child, monthly income, and knowledge about aspirin of caregivers were independent predictors of compliance with aspirin (p < 0.05). Conclusion: Caregivers of children with CHD had an adequate level of knowledge about aspirin. Compliance to aspirin medication reported by caregivers was low. Predictors of medium to high compliance with aspirin were related to the child’s age and socio-economic reasons. Further studies are needed to identify effective strategies to improve knowledge, compliance with medication, and long-term outcomes of children with CHD.

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“…Despite these and numerous other studies showing the clinical efficacy of ASA use, clinical effectiveness is hindered substantially by underuse of these medications. Past studies have estimated ASA compliance to range from 72 to 92% [7] . Among patients who were prescribed ASA following hospitalization for an acute MI, patient adherence to the regimen was only 10% after 5 years, compared with 17% for statins, 31% for ACE inhibitors and 36% for β-blockers [8] .…”

Section: Overview and Unmet Needsmentioning

confidence: 99%

PA32540 for the secondary prevention of cardiovascular disease in patients at risk for aspirin-associated gastric ulcers

Duffy

Rooney

Adams

et al. 2014

Expert Review of Cardiovascular Therapy

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Prescribed in patients with a history of myocardial infarction, stroke, transient ischemic attack, coronary intervention or bypass surgery, aspirin is one of the medications most commonly used in the secondary prevention of cardiovascular diseases. It has become a mainstay of therapy after years of solid evidence supporting its efficacy in clinical trials. However, a number of risks and side effects accompany its benefits, including the notable risk of bleeding and gastrointestinal side effects. Numerous mechanisms have been proposed to attenuate these effects to promote adherence and to expand the population for which aspirin is a reasonable treatment option. A polypill or combination formulation that includes a proton pump inhibitor, a drug commonly prescribed alongside aspirin, is one potential avenue of therapy. One such combination pill, PA32540, has undergone Phase I and Phase III trials and shows promising safety and efficacy results in these preliminary trials.

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Aspirin for Cardioprotection and Strategies to Improve Patient Adherence

Cited by 21 publications

References 81 publications

Trajectories of Adherence to Low-Dose Aspirin Treatment Among the French Population

Trajectories of Adherence to Low-Dose Aspirin Treatment Among the French Population

Compliance with aspirin in paediatric CHD post-percutaneous transcatheter occlusion: a cross-sectional study

PA32540 for the secondary prevention of cardiovascular disease in patients at risk for aspirin-associated gastric ulcers

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