Statin treatment after acute coronary syndrome: Adherence and reasons for non-adherence in a randomized controlled intervention trial

Abstract

Studies of secondary prevention for cardiovascular disease show low fulfilment of guideline-recommended targets. This study explored whether nurse-led follow-up could increase adherence to statins over time and reasons for discontinuation. All patients admitted for acute coronary syndrome at Östersund hospital between 2010–2014 were screened for the randomized controlled NAILED-ACS trial. The trial comprises two groups, one with nurse-led annual follow-up and medical titration by telephone to reach set intervention targets and one with usual care. All discontinuations of statins were recorded prospectively for at least 36 months and categorized as avoidable or unavoidable. Kaplan-Meier estimates were conducted for first and permanent discontinuations. Predictors for discontinuation were analysed using multivariate Cox regression, statin type and mean LDL-C at end of follow-up. Female gender was a predictor for discontinuation. Allocation in the intervention group predicted increased risk for a first but decreased risk for permanent discontinuation. A nurse-led telemedical secondary prevention programme in a relatively unselected ACS cohort leads to increased adherence to statins over time, greater percentage on potent treatment and lower LDL-C compared to usual care. An initially increased tendency toward early discontinuation in the intervention group stresses the importance of a longer duration of structured follow-up.

Nurse-based secondary preventive follow-up by telephone reduced recurrence of cardiovascular events: a randomised controlled trial

“…Analysis of adherence to lipid-lowering medication in this subgroup showed that discontinuation at some point during follow-up was common in both treatment groups, and that adverse symptoms with a non-compelling relationship to treatment was the dominating cause. In the control group, this was also the most common reason for permanent discontinuation 31 .…”

Low‐density lipoprotein cholesterol lowering in real‐world patients treated with evolocumab

“…21 Multiple factors are thought to underpin this unmet treatment need, with suboptimal dosing, high rates of treatment discontinuation, and low rates of lipid-lowering therapy (LLT) adherence commonly observed. [22][23][24][25][26][27] Evolocumab is a PCSK9 inhibitor antibody approved to reduce the risk of MI, stroke, and coronary revascularization in adults with established CVD. 28 The efficacy of evolocumab is well established from clinical trials, with significant lowering of LDL-C and reduction of major CV events.…”

“…12,29 However, there are limited data on LDL-C lowering with evolocumab in real-world healthcare settings, where patient-, physician-, and payer-related treatment hurdles are common. 17,[22][23][24][25][26][27][30][31][32][33] Historically, these hurdles have included treatment discontinuation, educational needs for providers, prior authorization requirements, costs, and formulary restrictions. [30][31][32][33] In the current study, we characterized the population and assessed LDL-C lowering during 1 year of evolocumab therapy in realworld patients with LDL-C ≥ 70 mg/dL (≥ 1.8 mmol/L), including a patient subgroup with elevated risk hospitalized for MI within 12 months prior to starting evolocumab.…”

Effects of a pharmaceutical care intervention on clinical outcomes and patient adherence in coronary heart disease: the MIMeRiC randomized controlled trial

“…This intervention was found effective for LDL-C at the one-year follow-up [ 76 ], and after a mean 3.9 years of follow-up intervention group patients had mean LDL-C 2.0 mmol/L compared to 2.4 mmol/L in the control group. Patients in the intervention group were also more likely to stay on statin treatment, even though they also had a more intensive regimen [ 77 ]. The authors conclude that the continual patient-centered follow-up enables a joint trust and understanding of symptoms and causes, which can help prevent discontinuation of statin treatment.…”

“…This increases the need for pharmaceutical care and individualized follow-up assessing both clinical outcomes and the patient’s medication experience [ 91 ]. A continual patient-centered follow-up enables a joint trust and understanding of symptoms and causes, which can help prevent discontinuation of treatment [ 77 ]. Our study shows that including clinical pharmacists trained in motivational interviewing is one option to deliver support for patients in their management of medicines; and when this is based on patients’ individual needs, they commonly need two-five contacts attributed to therapeutic problems, their attitude towards medicines and their experiences of using them in daily life.…”