Adherence to Antiplatelet Medications among Persistent and Non-Persistent Older Patients with Peripheral Arterial Disease

Q: What are the key findings of this study?

Non-persistent older PAD patients had a higher rate of antiplatelet non-adherence before discontinuation compared to persistent patients (26.9% vs 15.3%, p<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Peripheral arterial disease (PAD) (n=9178). Intervention: Non-persistence with antiplatelet medication (aspirin, clopidogrel, ticlopidine) defined as a treatment gap >= 6 months vs. Persistence with antiplatelet medication over the 5-year follow-up. Primary outcome: Non-adherence to antiplatelet medication (defined as proportion of days covered [PDC] < 80%) during the persistent treatment phase (p=<0.001).

Q: What does this research mean for the field?

Non-persistent older patients with peripheral arterial disease exhibit a higher rate of antiplatelet non-adherence prior to discontinuation compared to persistent patients, though the majority remain adherent until rapid discontinuation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate antiplatelet adherence using the proportion of days covered (PDC) index separately in persistent and non-persistent older patients with peripheral arterial disease and identify factors associated with non-adherence.

Martin Wawruch; Ján Murín; Tomáš Tesař; Martina Padúchová; Miriam Petrová; Denisa Čelovská; Petra Matalová; Beata Havelkova; Michal Trnka; Emma Aarnio

doi:10.3390/biomedicines9121800

November 30, 2021BiomedicinesOpen Access

Adherence to Antiplatelet Medications among Persistent and Non-Persistent Older Patients with Peripheral Arterial Disease

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Key result

Non-persistence in older PAD patients is linked to ~12 percentage points higher prior antiplatelet non-adherence.

P<0.001
n=9,178

Why the study?

Adherence to antiplatelet agents is required for effective secondary prevention of PAD, but adherence patterns and characteristics associated with non-adherence needed evaluation separately in persistent and non-persistent patients.

Does medication non-adherence (PDC < 80%) differ between persistent and non-persistent older patients taking antiplatelet agents for peripheral arterial disease?

Key Points

To evaluate antiplatelet adherence using the proportion of days covered (PDC) index separately in persistent and non-persistent older patients with peripheral arterial disease and identify factors associated with non-adherence.
Retrospective cohort analysis of 9178 patients aged ≥ 65 years diagnosed with peripheral arterial disease in 2012, divided into 6146 persistent and 3032 non-persistent patients over a 5-year follow-up.
Non-adherence was defined as a PDC < 80%, and factors associated with non-adherence were evaluated using binary logistic regression models.
Non-adherence was identified in 15.3% (942/6146) of persistent patients compared to 26.9% (817/3032) of non-persistent patients (p < 0.001), with mean PDC values of 90.7 ± 12.1% and 87.4 ± 15.7%, respectively (p = 0.007).
Over 70% of non-persistent patients maintained adherence (mean PDC > 80%) across all 12-month periods prior to stopping their medication, with the highest non-adherence rate (44.2%) occurring between months 13 and 24.
Dual antiplatelet therapy (aspirin and clopidogrel) and having a general practitioner as the index prescriber were significantly associated with medication adherence in both patient cohorts.

Study Design

Type

Cohort (n=9,178)

Structured PICO

Does medication non-adherence (PDC < 80%) differ between persistent and non-persistent older patients taking antiplatelet agents for peripheral arterial disease?

P

Population

9,178 older adults (aged >= 65 years) diagnosed with peripheral arterial disease in 2012 and using antiplatelet agents (6,146 persistent and 3,032 non-persistent patients) in Slovakia, followed for 5 years.

E

Exposure

Non-persistence with antiplatelet therapy (aspirin once daily, clopidogrel once daily, or ticlopidine twice daily), defined as a treatment gap period of >= 6 months without antiplatelet prescription over a 5-year follow-up.

C

Comparator

Persistence with antiplatelet therapy throughout the 5-year follow-up period.

O

Outcome

Medication non-adherence during the implementation phase (persistent period), defined as a proportion of days covered (PDC) < 80% over the 5-year follow-up.surrogate

Main Result

Absolute Event Rate: 26.9% vs 15.3%

p-value: p=<0.001

Over 70% of older PAD patients who eventually discontinue antiplatelet therapy actually maintain good adherence (PDC >= 80%) prior to stopping, indicating abrupt treatment cessation rather than gradual poor implementation and highlighting the need for ongoing patient education on lifelong secondary prevention.

Limitations

The health insurance database was not created for research purposes and cannot distinguish whether the physician or the patient was responsible for medication discontinuation.
It is impossible to determine whether dispensed medications were truly taken by the patients as prescribed.
The database lacked information on the clinical grade and severity of peripheral arterial disease.
The study focused solely on antiplatelet agents and did not concurrently evaluate adherence to ACE inhibitors/ARBs or statins within this specific analysis.
Health insurance claims database was not originally created for research purposes
Inability to distinguish whether medication discontinuation was initiated by the physician or the patient
Inability to verify whether prescribed and dispensed medications were actually ingested by the patients
Lack of clinical data on the grade and severity of peripheral arterial disease
Analysis was restricted solely to antiplatelet medications without incorporating concurrent ACEi/ARB adherence

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Answers are grounded in this paper and cite their sources.

Implication

Highlights abrupt cessation over gradual non-adherence in older PAD; leaves open whether targeted interventions improve long-term persistence.

Abstract

Secondary prevention of peripheral arterial disease (PAD) includes administration of antiplatelet agents, and adherence to medication is a requirement for an effective treatment. The aim of this study was to analyse adherence measured using the proportion of days covered (PDC) index separately in persistent and non-persistent patients, and to identify patient- and medication-related characteristics associated with non-adherence in these patient groups. The study cohort of 9178 patients aged ≥ 65 years in whom PAD was diagnosed in 1/-12/2012 included 6146 persistent and 3032 non-persistent patients. Non-adherence was identified as PDC < 80%. Characteristics associated with non-adherence were determined using the binary logistic regression model. In the group of persistent patients, 15.3% of subjects were identified as non-adherent, while among non-persistent patients, 26.9% of subjects were non-adherent to antiplatelet medication. Administration of dual antiplatelet therapy (aspirin and clopidogrel) and a general practitioner as index prescriber were associated with adherence in both patient groups. Our study revealed a relatively high proportion of adherent patients not only in the group of persistent patients but also in the group of non-persistent patients before discontinuation. These results indicate that most non-persistent PAD patients discontinue antiplatelet treatment rapidly after a certain period of adherence.

Discussion

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Cite This Study

Wawruch et al. (2021) conducted a cohort in Peripheral arterial disease (PAD) (n=9,178). Non-persistence with antiplatelet medication (aspirin, clopidogrel, ticlopidine) defined as a treatment gap >= 6 months vs. Persistence with antiplatelet medication over the 5-year follow-up was evaluated on Non-adherence to antiplatelet medication (defined as proportion of days covered [PDC] < 80%) during the persistent treatment phase (p=<0.001). Non-persistent older PAD patients had a higher rate of antiplatelet non-adherence before discontinuation compared to persistent patients (26.9% vs 15.3%, p<0.001).

synapsesocial.com/papers/6a749038508d802509f5417e https://doi.org/10.3390/biomedicines9121800

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Adherence to Antiplatelet Medications among Persistent and Non-Persistent Older Patients with Peripheral Arterial Disease

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Adherence to Antiplatelet Medications among Persistent and Non-Persistent Older Patients with Peripheral Arterial Disease

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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