Persistence and Compliance with Cardiovascular Drug Therapy Among Seniors

Abstract

what drives patients' choice and behavior regarding patterns of long-term medication use. Using a large heterogeneous cohort of patients, we aimed to investigate the patterns and predictors of switch and discontinuation among patients initiating NOACs. Methods: We performed a retrospective cohort analysis using a large U.S. commercial insurance database, OptumLabs Data Warehouse. We identified 10,147 privately insured and Medicare Advantage patients with nonvalvular atrial fibrillation who initiated apixaban, dabigatran and rivaroxaban in 2013 and 2014, the time period when all three NOACs had become available in the U.S. Discontinuation of anticoagulation was defined as having at least 3 months of gap in days of supply of any oral anticoagulants. Two multivariable logistic regression models were performed to assess the risk factors related switch and discontinuation, respectively. Results: Within one year of NOACs initiation, 13% of the patients switched to another oral anticoagulant, among whom the majority (64%) switched to warfarin. Nearly 40% of patients discontinued oral anticoagulants. Patients initiating apixaban were less likely to switch or discontinue compared to those initiating dabigatran or rivaroxaban. Other risk factors for switch include high out-of-pocket costs, prior warfarin use, and a stroke during follow up. Risk factors for discontinuation include high out-of-pocket costs, no prior warfarin exposure, and a major bleeding during follow up. ConClusions: Medication discontinuation and switching are common among patients treated with NOACs in routine clinical practice. Medication use may be affected by the choice of initial medication, out-of-pocket costs, and clinical events occurring during follow up.

Effects of the Two-Dimensional Structure of Trust on Patient Adherence to Medication and Non-pharmaceutical Treatment: A Cross-Sectional Study of Rural Patients With Essential Hypertension in China

“…Non-pharmaceutical treatment based on lifestyle changes, including tobacco control, alcohol restriction, moderate physical exercise, and mental stress relief, has also received increasing attention (10)(11)(12). A number of experiments show that lifestyle intervention therapies have a clear antihypertensive effect (11)(12)(13), and a recent study also proved that a healthy lifestyle can reverse the genetic high risk of hypertension in rural people (12). Therefore, it is necessary to evaluate and improve people's adherence to Non-pharmaceutical treatment.…”

“…This helps us understand that patients who trust doctors are more likely to accept their doctor's advice (14,15,18). Studies on the relationship between patient trust and patient adherence (8,13,19) have expressed the role of patient trust in promoting patient adherence. In other words, trusting doctors plays an active role in both medication and Non-pharmaceutical treatment adherence behaviors of patients.…”