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Persistence and Adherence to Cardiovascular Medicines in Australia

Background The burden of cardiovascular disease is increasing, with many people treated for multiple cardiovascular conditions. We examined persistence and adherence to medicines for cardiovascular disease treatment or prevention in Australia. Methods and Results Using national dispensing claims for...

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Published in:Journal of the American Heart Association 2023-07, Vol.12 (13), p.e030264-e030264
Main Authors: de Oliveira Costa, Juliana, Lin, Jialing, Pearson, Sallie-Anne, Buckley, Nicholas A, Schaffer, Andrea L, Falster, Michael O
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container_title Journal of the American Heart Association
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creator de Oliveira Costa, Juliana
Lin, Jialing
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Schaffer, Andrea L
Falster, Michael O
description Background The burden of cardiovascular disease is increasing, with many people treated for multiple cardiovascular conditions. We examined persistence and adherence to medicines for cardiovascular disease treatment or prevention in Australia. Methods and Results Using national dispensing claims for a 10% random sample of people, we identified adults (≥18 years) initiating antihypertensives, statins, oral anticoagulants, or antiplatelets in 2018. We measured persistence to therapy using a 60-day permissible gap, and adherence using the proportion of days covered up to 3 years from initiation, and from first to last dispensing. We reported outcomes by age, sex, and cardiovascular multimedicine use. We identified 83 687 people initiating antihypertensives (n=37 941), statins (n=34 582), oral anticoagulants (n=15 435), or antiplatelets (n=7726). Around one-fifth of people discontinued therapy within 90 days, with 50% discontinuing within the first year. Although many people achieved high adherence (proportion of days covered ≥80%) within the first year, these rates were higher when measured from first to last dispensing (40.5% and 53.2% for statins; 55.6% and 80.5% for antiplatelets, respectively). Persistence was low at 3 years (17.5% antiplatelets to 37.3% anticoagulants). Persistence and adherence increased with age, with minor differences by sex. Over one-third of people had cardiovascular multimedicine use (reaching 92% among antiplatelet users): they had higher persistence and adherence than people using medicines from only 1 cardiovascular group. Conclusions Persistence to cardiovascular medicines decreases substantially following initiation, but adherence remains high while people are using therapy. Cardiovascular multimedicine use is common, and people using multiple cardiovascular medicines have higher rates of persistence and adherence.
doi_str_mv 10.1161/JAHA.122.030264
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We examined persistence and adherence to medicines for cardiovascular disease treatment or prevention in Australia. Methods and Results Using national dispensing claims for a 10% random sample of people, we identified adults (≥18 years) initiating antihypertensives, statins, oral anticoagulants, or antiplatelets in 2018. We measured persistence to therapy using a 60-day permissible gap, and adherence using the proportion of days covered up to 3 years from initiation, and from first to last dispensing. We reported outcomes by age, sex, and cardiovascular multimedicine use. We identified 83 687 people initiating antihypertensives (n=37 941), statins (n=34 582), oral anticoagulants (n=15 435), or antiplatelets (n=7726). Around one-fifth of people discontinued therapy within 90 days, with 50% discontinuing within the first year. Although many people achieved high adherence (proportion of days covered ≥80%) within the first year, these rates were higher when measured from first to last dispensing (40.5% and 53.2% for statins; 55.6% and 80.5% for antiplatelets, respectively). Persistence was low at 3 years (17.5% antiplatelets to 37.3% anticoagulants). Persistence and adherence increased with age, with minor differences by sex. Over one-third of people had cardiovascular multimedicine use (reaching 92% among antiplatelet users): they had higher persistence and adherence than people using medicines from only 1 cardiovascular group. Conclusions Persistence to cardiovascular medicines decreases substantially following initiation, but adherence remains high while people are using therapy. Cardiovascular multimedicine use is common, and people using multiple cardiovascular medicines have higher rates of persistence and adherence.</description><identifier>ISSN: 2047-9980</identifier><identifier>EISSN: 2047-9980</identifier><identifier>DOI: 10.1161/JAHA.122.030264</identifier><identifier>PMID: 37382104</identifier><language>eng</language><publisher>England: John Wiley and Sons Inc</publisher><subject>Adult ; anticoagulants ; Anticoagulants - therapeutic use ; antihypertensive agents ; Antihypertensive Agents - therapeutic use ; Australia - epidemiology ; cardiovascular agents ; Cardiovascular Diseases - drug therapy ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - prevention &amp; control ; cardiovascular system ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; hypolipidemic agents ; Medication Adherence ; Original Research ; Retrospective Studies</subject><ispartof>Journal of the American Heart Association, 2023-07, Vol.12 (13), p.e030264-e030264</ispartof><rights>2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c460t-8340958677fed6881facd38ec5a759b0f9de24586914114713ee236ff0341a7d3</citedby><cites>FETCH-LOGICAL-c460t-8340958677fed6881facd38ec5a759b0f9de24586914114713ee236ff0341a7d3</cites><orcidid>0000-0002-8355-023X ; 0000-0002-0643-9191 ; 0000-0002-6326-4711 ; 0000-0001-6444-7272 ; 0000-0001-7137-6855 ; 0000-0002-3701-4997</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10356067/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10356067/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37382104$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>de Oliveira Costa, Juliana</creatorcontrib><creatorcontrib>Lin, Jialing</creatorcontrib><creatorcontrib>Pearson, Sallie-Anne</creatorcontrib><creatorcontrib>Buckley, Nicholas A</creatorcontrib><creatorcontrib>Schaffer, Andrea L</creatorcontrib><creatorcontrib>Falster, Michael O</creatorcontrib><title>Persistence and Adherence to Cardiovascular Medicines in Australia</title><title>Journal of the American Heart Association</title><addtitle>J Am Heart Assoc</addtitle><description>Background The burden of cardiovascular disease is increasing, with many people treated for multiple cardiovascular conditions. We examined persistence and adherence to medicines for cardiovascular disease treatment or prevention in Australia. Methods and Results Using national dispensing claims for a 10% random sample of people, we identified adults (≥18 years) initiating antihypertensives, statins, oral anticoagulants, or antiplatelets in 2018. We measured persistence to therapy using a 60-day permissible gap, and adherence using the proportion of days covered up to 3 years from initiation, and from first to last dispensing. We reported outcomes by age, sex, and cardiovascular multimedicine use. We identified 83 687 people initiating antihypertensives (n=37 941), statins (n=34 582), oral anticoagulants (n=15 435), or antiplatelets (n=7726). Around one-fifth of people discontinued therapy within 90 days, with 50% discontinuing within the first year. Although many people achieved high adherence (proportion of days covered ≥80%) within the first year, these rates were higher when measured from first to last dispensing (40.5% and 53.2% for statins; 55.6% and 80.5% for antiplatelets, respectively). Persistence was low at 3 years (17.5% antiplatelets to 37.3% anticoagulants). Persistence and adherence increased with age, with minor differences by sex. Over one-third of people had cardiovascular multimedicine use (reaching 92% among antiplatelet users): they had higher persistence and adherence than people using medicines from only 1 cardiovascular group. Conclusions Persistence to cardiovascular medicines decreases substantially following initiation, but adherence remains high while people are using therapy. Cardiovascular multimedicine use is common, and people using multiple cardiovascular medicines have higher rates of persistence and adherence.</description><subject>Adult</subject><subject>anticoagulants</subject><subject>Anticoagulants - therapeutic use</subject><subject>antihypertensive agents</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Australia - epidemiology</subject><subject>cardiovascular agents</subject><subject>Cardiovascular Diseases - drug therapy</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Cardiovascular Diseases - prevention &amp; control</subject><subject>cardiovascular system</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</subject><subject>hypolipidemic agents</subject><subject>Medication Adherence</subject><subject>Original Research</subject><subject>Retrospective Studies</subject><issn>2047-9980</issn><issn>2047-9980</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNpVkTtPHDEURi1EBIhQp0NT0uzi96NCw4oEIqJQkNry2NdgNDsGe2al_PvMsgSBG78-n3utg9A3gpeESHL-s71ul4TSJWaYSr6HjijmamGMxvsf1ofopNYnPA9JFRPmAB0yxTQlmB-hyzsoNdURBg-NG0LThkcor7sxNytXQsobV_3Uu9L8gpB8GqA2aWjaqY7F9cl9RV-i6yucvM3H6M_3q_vV9eL294-bVXu78FzicaEZx0ZoqVSEILUm0fnANHjhlDAdjiYA5XPAEE4IV4QBUCZjxIwTpwI7Rjc7bsjuyT6XtHblr80u2deDXB6sK2PyPVhmtAy-i9LzjrtOaMwZlh4LHU3n6ZZ1sWM9T90agodh-5dP0M83Q3q0D3ljCWZCYqlmwtkboeSXCepo16l66Hs3QJ6qpZoRarSgYo6e76K-5FoLxPc6BNutSbs1aWeTdmdyfnH6sb33_H9v7B_57pha</recordid><startdate>20230704</startdate><enddate>20230704</enddate><creator>de Oliveira Costa, Juliana</creator><creator>Lin, Jialing</creator><creator>Pearson, Sallie-Anne</creator><creator>Buckley, Nicholas A</creator><creator>Schaffer, Andrea L</creator><creator>Falster, Michael O</creator><general>John Wiley and Sons Inc</general><general>Wiley</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-8355-023X</orcidid><orcidid>https://orcid.org/0000-0002-0643-9191</orcidid><orcidid>https://orcid.org/0000-0002-6326-4711</orcidid><orcidid>https://orcid.org/0000-0001-6444-7272</orcidid><orcidid>https://orcid.org/0000-0001-7137-6855</orcidid><orcidid>https://orcid.org/0000-0002-3701-4997</orcidid></search><sort><creationdate>20230704</creationdate><title>Persistence and Adherence to Cardiovascular Medicines in Australia</title><author>de Oliveira Costa, Juliana ; Lin, Jialing ; Pearson, Sallie-Anne ; Buckley, Nicholas A ; Schaffer, Andrea L ; Falster, Michael O</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c460t-8340958677fed6881facd38ec5a759b0f9de24586914114713ee236ff0341a7d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>anticoagulants</topic><topic>Anticoagulants - therapeutic use</topic><topic>antihypertensive agents</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Australia - epidemiology</topic><topic>cardiovascular agents</topic><topic>Cardiovascular Diseases - drug therapy</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Cardiovascular Diseases - prevention &amp; control</topic><topic>cardiovascular system</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</topic><topic>hypolipidemic agents</topic><topic>Medication Adherence</topic><topic>Original Research</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>de Oliveira Costa, Juliana</creatorcontrib><creatorcontrib>Lin, Jialing</creatorcontrib><creatorcontrib>Pearson, Sallie-Anne</creatorcontrib><creatorcontrib>Buckley, Nicholas A</creatorcontrib><creatorcontrib>Schaffer, Andrea L</creatorcontrib><creatorcontrib>Falster, Michael O</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Journal of the American Heart Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>de Oliveira Costa, Juliana</au><au>Lin, Jialing</au><au>Pearson, Sallie-Anne</au><au>Buckley, Nicholas A</au><au>Schaffer, Andrea L</au><au>Falster, Michael O</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Persistence and Adherence to Cardiovascular Medicines in Australia</atitle><jtitle>Journal of the American Heart Association</jtitle><addtitle>J Am Heart Assoc</addtitle><date>2023-07-04</date><risdate>2023</risdate><volume>12</volume><issue>13</issue><spage>e030264</spage><epage>e030264</epage><pages>e030264-e030264</pages><issn>2047-9980</issn><eissn>2047-9980</eissn><abstract>Background The burden of cardiovascular disease is increasing, with many people treated for multiple cardiovascular conditions. We examined persistence and adherence to medicines for cardiovascular disease treatment or prevention in Australia. Methods and Results Using national dispensing claims for a 10% random sample of people, we identified adults (≥18 years) initiating antihypertensives, statins, oral anticoagulants, or antiplatelets in 2018. We measured persistence to therapy using a 60-day permissible gap, and adherence using the proportion of days covered up to 3 years from initiation, and from first to last dispensing. We reported outcomes by age, sex, and cardiovascular multimedicine use. We identified 83 687 people initiating antihypertensives (n=37 941), statins (n=34 582), oral anticoagulants (n=15 435), or antiplatelets (n=7726). Around one-fifth of people discontinued therapy within 90 days, with 50% discontinuing within the first year. Although many people achieved high adherence (proportion of days covered ≥80%) within the first year, these rates were higher when measured from first to last dispensing (40.5% and 53.2% for statins; 55.6% and 80.5% for antiplatelets, respectively). Persistence was low at 3 years (17.5% antiplatelets to 37.3% anticoagulants). Persistence and adherence increased with age, with minor differences by sex. Over one-third of people had cardiovascular multimedicine use (reaching 92% among antiplatelet users): they had higher persistence and adherence than people using medicines from only 1 cardiovascular group. Conclusions Persistence to cardiovascular medicines decreases substantially following initiation, but adherence remains high while people are using therapy. Cardiovascular multimedicine use is common, and people using multiple cardiovascular medicines have higher rates of persistence and adherence.</abstract><cop>England</cop><pub>John Wiley and Sons Inc</pub><pmid>37382104</pmid><doi>10.1161/JAHA.122.030264</doi><orcidid>https://orcid.org/0000-0002-8355-023X</orcidid><orcidid>https://orcid.org/0000-0002-0643-9191</orcidid><orcidid>https://orcid.org/0000-0002-6326-4711</orcidid><orcidid>https://orcid.org/0000-0001-6444-7272</orcidid><orcidid>https://orcid.org/0000-0001-7137-6855</orcidid><orcidid>https://orcid.org/0000-0002-3701-4997</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adult
anticoagulants
Anticoagulants - therapeutic use
antihypertensive agents
Antihypertensive Agents - therapeutic use
Australia - epidemiology
cardiovascular agents
Cardiovascular Diseases - drug therapy
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - prevention & control
cardiovascular system
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
hypolipidemic agents
Medication Adherence
Original Research
Retrospective Studies
title Persistence and Adherence to Cardiovascular Medicines in Australia
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