Perceptions of Patients with Primary Nonadherence to Statin Medications

Abstract

Background: Despite emphasis on efforts to prevent cardiovascular disease (CVD), 13% to 34% of people never fill a prescribed statin (primary nonadherence). This study determined perceptions of adults with primary nonadherence to statins.Methods: Ten focus groups were conducted with 61 adults reporting primary nonadherence to statins (93% without known CVD). Participants were recruited from an academic medical center and nationwide Internet advertisements.Results: Major themes related to primary nonadherence were 1) desire to pursue alternatives before starting a statin (eg, diet and/or exercise, dietary supplements), 2) worry about risks and adverse effects of statins, 3) perceptions of good personal health (suggesting that a statin was not needed), and 4) doubt about the benefits of statins in the absence of disease. Additional themes included mistrust of the pharmaceutical industry, mistrust of prescribing providers, inadequate provider communication about statins, and negative prior experiences with medication. Although rare, a few patients said that high cholesterol does not require treatment if it is genetic. One third noted during focus group discussions that they did not communicate their decision not to take a statin to providers.Conclusions: Adults with primary nonadherence to statins describe seeking alternatives, avoiding perceived risks of statins, poor acceptance/understanding of CVD risk estimates, and doubts about the benefits of statins. Many do not disclose their decisions to providers, thus highlighting the need for provider awareness of the potential for primary nonadherence at the point of prescribing, and the need for future work to develop strategies to identify patients with potential primary nonadherence.

Statin‐associated muscle symptoms—A review: Individualizing the approach to optimize care

“…A goal is to address any underlying concerns and provide clear and explicit counseling on the risk and benefits of statin therapy, in hopes of ultimately reducing ASCVD. Two recent studies conducted focus groups or semi‐structured interviews among stain users and statin candidates 68,69 . Notable themes among the patient groups included fear about the risks and AEs of statins, doubt regarding the benefits of statins, and poor understanding of ASCVD risk.…”

“…Two recent studies conducted focus groups or semi-structured interviews among stain users and statin candidates. 68,69 Notable themes among the patient groups included fear about the risks and AEs of statins, doubt regarding the benefits of statins, and poor understanding of ASCVD risk. Nearly all 6).…”

Predictors of Informed People’s Preferences for Statin Therapy to Reduce Cardiovascular Disease Risk: an Internet Survey Study

“…Understanding how patients approach the statin decision for primary prevention is critical to addressing the problem of primary and secondary nonadherence to prescribed statins. Between 13 and 34% of patients prescribed a statin never fill it (primary nonadherence), 13 while 25-50% of patients who initiate a statin discontinue it over the first year (secondary nonadherence). 14 A number of qualitative studies addressing reasons for statin nonadherence identify a variety of factors, but patient doubts about the benefits of statins in the absence of manifest CVD is a common denominator.…”

“…14 A number of qualitative studies addressing reasons for statin nonadherence identify a variety of factors, but patient doubts about the benefits of statins in the absence of manifest CVD is a common denominator. 13,15 The broad distribution of informed patient preferences for statins across the spectrum of CVD risk 4 suggests shared decision-making (SDM) between clinicians and patients may be a better approach than choosing arbitrary cut-points on the CVD risk distribution to recommend clinicians prescribe a statin in practice guidelines. 16,17 Moreover, in other chronic conditions, such as prediabetes and asthma, shared decisionmaking around treatment has increased adherence.…”