What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Statin therapy use (n=730). Intervention: High perceived 10-year cardiovascular risk (score 7-10) vs. Low perceived 10-year cardiovascular risk (score 0-2). Primary outcome: Statin non-adherence (Proportion of Days Covered < 80% over 12 months) (OR 0.51, 95% CI 0.26-0.996, p=<0.05).

February 8, 2018Open Access

Patient-reported adherence to statin therapy, barriers to adherence, and perceptions of cardiovascular risk

Q: What are the key findings of this study?

Patients with a high perceived 10-year risk of a heart attack were significantly less likely to be non-adherent to statin therapy compared to those with a low perceived risk (OR 0.51).

VFVicki FungHarvard University IGIlana GraetzEmory University MRMary ReedKaiser Permanente

Key Result

Patients with a high perceived 10-year risk of a heart attack were significantly less likely to be non-adherent to statin therapy compared to those with a low perceived risk (OR 0.51).

Study Design

Type

Cross-Sectional (n=730)

Multicenter

Structured PICO

Population

730 adults receiving statin therapy within an integrated delivery system, stratified by clinical risk category, whose adherence and perceived cardiovascular risk were assessed over 12 months.

Exposure

Statin therapy

Outcome

Proportion of days covered (PDC) by statins in the last 12 months, self-reported non-adherence behaviors, concerns about and barriers to taking statins, and perceived risk of having a heart attack in the next 10 yearspatient reported

Patient-reported adherence behaviors correlate with pharmacy fill data, and patients with lower perceived cardiovascular risk are more likely to be non-adherent to statin therapy, highlighting the need for targeted risk education.

Main Result

Odds Ratio: 0.51 (95% CI 0.26–0.996)

Absolute Event Rate: 20.1% vs 27.8%

p-value: p=<0.05

Limitations

Conducted prior to the release of the revised ACC-AHA guidelines and 2016 USPSTF recommendations
May not generalize to individuals newly recommended to receive statins, such as those without elevated LDL-c levels
Unable to calculate actual 10-year ASCVD risk levels using the ACC-AHA risk calculator due to missing information
Conducted within an integrated delivery system, so adherence levels and communication with providers could be higher than in other settings
Cross-sectional survey design limits the ability to assess causal relationships between actual and perceived risks and adherence

Abstract

BACKGROUND: Patient reports of their adherence behaviors, concerns about statins, and perceptions of atherosclerotic cardiovascular disease (ASCVD) risk could inform approaches for improving adherence to statin therapy. We examined these factors and their associations with adherence. METHODS: We conducted telephone interviews among a stratified random sample of adults receiving statins within an integrated delivery system (N = 730, 81% response rate) in 2010. We sampled equal numbers of individuals in three clinical risk categories: those with 1) coronary artery disease; 2) diabetes or other ASCVD diagnosis; and 3) no diabetes or ASCVD diagnoses. We assessed 15 potential concerns about and barriers to taking statins, and perceived risk of having a heart attack in the next 10 years (0-10 scale). We calculated the proportion of days covered (PDC) by statins in the last 12 months using dispensing data and used multivariate logistic regression to examine the characteristics associated with non-adherence (PDC<80%). Analyses were weighted for sampling proportions. RESULTS: Sixty-one percent of patients with PDC<50% reported not filling a new prescription, splitting or skipping statins, or stopping refilling statins in the last 12 months vs. 15% of those with PDC≥80% (p<0.05). The most commonly reported concerns about statins were preferring to lower cholesterol with lifestyle changes (66%), disliking medications in general (59%), and liver or kidney problems (31%); having trouble remembering to take statins (9%) was the most common reason for taking less than prescribed. In multivariate analyses, clinical risk categories were not significantly associated with odds of non-adherence; however, those with higher perceived risk of heart attack were less likely to be non-adherent. CONCLUSIONS: Patient-reported medication-taking behaviors were correlated with statin PDC and those with lower perceived cardiovascular risk were less likely to be adherent. These findings highlight the importance of eliciting from and educating patients on their adherence behaviors and ASCVD risks.

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