Key result
Discontinuation rates of cardiovascular therapies were 7.2% for lipid-lowering agents, 9.1% for RAS blockers, 10% for antiplatelets, and 20% for beta-blockers over a median 37.4 months.
Why the study?
What factors are associated with the discontinuation of evidence-based cardiovascular therapies in patients with stable coronary artery disease in primary care?
Cross-Sectional (n=8,817)
Yes
What factors are associated with the discontinuation of evidence-based cardiovascular therapies in patients with stable coronary artery disease in primary care?
In primary care, discontinuation of evidence-based cardiovascular therapies after a coronary event is relatively low and primarily driven by adverse events and the development of new comorbidities.
Adverse events and new comorbidities drive discontinuation in primary care CAD; hypothesis-generating for adherence interventions.
BACKGROUND: To identify factors associated with the discontinuation of evidence-based cardiovascular therapies after hospital discharge for a coronary event. DESIGN: Cross-sectional study carried out between June and October 2004 in 1799 primary care centers throughout Spain. PATIENTS AND METHODS: Eight thousand eight hundred and seventeen patients (73.7% males; 65.4 years) admitted for coronary disease causes in the past 6 months to 10 years and attending primary care postdischarge from hospital. Current medications, those prescribed at hospital discharge, and the development of adverse events, new risk factors, and comorbidities during follow-up, were collected from clinical records. RESULTS: After a median follow-up of 37.4 months, discontinuation rate of lipid-lowering agents, angiotensin renin system blockers, antiplatelet drugs, and beta-blockers were 7.2, 9.1, 10, and 20%, respectively. Of these, 10.8, 16.5, 9.9, and 20.1%, respectively, were because of adverse events. Factors associated with the discontinuation of lipid-lowering agents were the development of hypertension and diabetes during the follow-up. Discontinuation of antiplatelet drug was associated with an earlier history, or with de-novo occurrence, of atrial fibrillation. Discontinuation of angiotensin renin system blockers was associated with the development of atrial fibrillation, diabetes and hypercholesterolemia, and discontinuation of beta-blockers with de-novo appearance of peripheral artery disease, cerebrovascular disease, and heart failure. CONCLUSION: In patients followed-up in primary care, the discontinuation rate of cardiovascular disease medications was low and was mainly related to the development of adverse events together with new risk factors and comorbidities arising after hospital discharge.
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Mostaza et al. (2009) conducted a cross-sectional in stable coronary artery disease (n=8,817). Evidence-based cardiovascular therapies was evaluated on Discontinuation rate of lipid-lowering agents, angiotensin renin system blockers, antiplatelet drugs, and beta-blockers. Discontinuation rates of cardiovascular therapies were 7.2% for lipid-lowering agents, 9.1% for RAS blockers, 10% for antiplatelets, and 20% for beta-blockers over a median 37.4 months.
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