Impact of adherence, patient perception, and knowledge to statin therapy – A cross-sectional study

Abstract

Background and Objective: Cardiovascular diseases and its risk factors, such as diabetes and hyperlipidemia, are common in Indian population. Statin utilization is high across the country and it is important to assess the adherence because it plays an important role in treatment outcome. Statin adherence is not studied well in India. This study aims at measuring the adherence, perception, and knowledge of individuals on statin therapy. Study Design: Cross-sectional observational study on 130 consented individuals visiting a tertiary care teaching hospital. Study was conducted for a duration of 9 months. Methods and Materials: After obtaining approval from the institutional ethics committee the study subjects were assessed for knowledge, perception, and adherence to statin therapy using a systematically developed interview questionnaire. Results: Good adherence was seen in 42.30% patients. Higher proportions of females were reported to have good adherence. Good adherence was observed in patients with a history of coronary heart disease and atorvastatin as monotherapy ( P = 0.0029) and fixed dose combination ( P = 0.0012), whereas lipid reduction was found directly related to type of adherence. Lack of knowledge, cost, re-fill issues, and adverse effects were some of the barriers identified. Interpretation and Conclusion: Knowledge and patient perception plays a very important role in determining the adherence to statin therapy. A history of coronary heart disease, choice of statin, and cost of therapy are the contributing factors to adherence. Patient counselling and improving the cost-effectiveness of statin therapy can be considered as interventional strategies to overcome adherence issues.

The Significance of Statin Associated Muscle Symptoms and Its Impact on Patients Adherence and Outcomes

“…24 In addition, the patient's knowledge and perceptions about their statin therapy significantly determined the patient's adherence. 25 However, it is important to mention that the recent National Lipid Association (NLA) guidelines estimated that the complete statin therapy intolerance is less than 5%. 19 Moreover, studies showed that low adherence to statins might be the main reason for inadequate LDL control and higher cardiovascular events risk.…”

Non adherence to lipid-lowering therapy and strategies to improve adherence

“…In this study higher proportions of females and those with a history of coronary heart disease and atorvastatin as monotherapy had better adherence to statins. 9 Long-term adherence to statin therapy is reported to decrease over time according to various studies done earlier. 10 Poor long-term adherence to statin therapy is not only associated with higher event rates but also increased hospitalisations which in turn put an additional strain on the health services and also increase the overall healthcare costs as compared with the good adherence to therapy over the first 2 years of use.…”

“…Common reasons for declining or discontinuing LLT use include a fear of actual or perceived side effects. 9 Although side effects with LLT are uncommon, statins may cause muscle symptoms and increase the risk of type 2 diabetes, use of ezetimibe may cause gastrointestinal side effects and muscle symptoms, and antiproprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies (mAbs) may cause a local site reaction, influenza-like symptoms, and nasopharyngitis., 17 In an analysis of data from the Patient and Provider Assessment of Lipid Management (PALM) registry, among 5693 adults recommended for statin therapy, 1511 (26.5 %) were not on statin therapy, including 153 patients who declined statin treatment and 464 who discontinued treatment. 18 Among untreated patients, fear of side effects (36.8 % of patients) was the most common reason cited for declining statin treatment, whereas perceived side effects (55.0 % of patients) was the most frequent reason reported for statin discontinuation.…”

Knowledge of HbA1c and LDL‐C treatment goals, subjective level of disease‐related information and information needs in patients with atherosclerotic cardiovascular disease

“…[10][11][12][13] Thus far, little is known about the potential role of patient knowledge of treatment goals of lipid-lowering therapy in cardiovascular disease, urging a further exploration and a comparison of dyslipidemia to DM. [14][15][16] In patient-centered health care, there are several interacting factors that can influence this level of implementation. 17 Physicians are challenged to indicate, inform about, prescribe, and maintain optimal therapy, while patients need to understand and use the information to manage and adhere to it.…”

“…In patients with DM, some evidence exists that better knowledge of disease management goals has been associated with better outcomes, including glycemic control 10–13 . Thus far, little is known about the potential role of patient knowledge of treatment goals of lipid‐lowering therapy in cardiovascular disease, urging a further exploration and a comparison of dyslipidemia to DM 14–16 …”