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The Burden of Non-Adherence to Cardiovascular Medications Among the Aging Population in Australia: A Meta-Analysis

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Abstract

Background

Non-adherence to cardiovascular medications is a problem worldwide, even in Australia, which has a socialized medical system, Medicare.

Objective

The aim of this systematic review was to evaluate the burden of non-adherence to cardiovascular medications and factors thereof in Australia.

Data Sources

Pubmed, Embase, CINAHL, PsycInfo, Cochrane Library databases were searched.

Eligibility Criteria

Articles were included if they were in English, peer-reviewed and provided empirical data on adherence to cardiovascular medication for an Australian cohort.

Methods

A meta-analysis of prevalence of medication non-adherence using the double arcsine square root transformed proportion was undertaken. Studies were pooled in homogenous prevalence groups and factors that differed across groups were ascertained.

Results

Five studies, including eight datasets and 76,867 subjects were analyzed. Three more or less homogenous prevalence categories were discernable: low [19 %, 95 % confidence interval (CI) 15–24], moderate (26 %, 95 % CI 23–29) and high (43 %, 95 % CI 43–44; this was a single study) prevalence of non-adherence. There were minimal clear patterns across groups in relation to typical factors of non-adherence (patient, condition, healthcare system or socioeconomic factors). Measurements used for non-adherence were similar for six of the eight included datasets, suggesting this did not affect prevalence of non-adherence or inclusion in a prevalence group.

Conclusions

Non-adherence to cardiovascular medications is a serious problem in the aging Australian setting with an overall prevalence of between 14 and 43 %. The lack of patterns in the typical factors of non-adherence suggests that another factor, such as patients’ beliefs about their conditions and medications, may be playing a stronger role in their non-adherence than clinical or sociodemographic factors. This is an area for further research.

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References

  1. Australian Institute of Health and Welfare (AIHW). Australia’s health 2010, Cat. no. AUS122. Canberra: AIHW; 2010.

  2. Australian Institute of Health and Welfare (AIHW). Australia’s health 2008, Cat. no. AUS 99. Canberra: AIHW; 2008.

  3. McElduff P, Dobson AJ. Trends in coronary heart disease: has the socio-economic differential changed? Aust N Z J Public Health. 2000;24(5):465–73.

    Article  CAS  PubMed  Google Scholar 

  4. Holme I, Szarek M, Cater NB, et al. Adherence-adjusted efficacy with intensive versus standard statin therapy in patients with acute myocardial infarction in the IDEAL study. Eur J Cardiovasc Prev Rehabil. 2009;16(3):315–20. doi:10.1097/HJR.0b013e32832130f5.

    Article  PubMed  Google Scholar 

  5. Ho PM, Magid DJ, Masoudi FA, et al. Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease. BMC Cardiovasc Disord. 2006;6:48. doi:10.1186/1471-2261-6-48.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Thompson AM, Hu T, Eshelbrenner CL, et al. Antihypertensive treatment and secondary prevention of cardiovascular disease events among persons without hypertension. JAMA. 2011;305(9):913–22. doi:10.1001/jama.2011.250.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Shalev V, Chodick G, Silber H, et al. Continuation of statin treatment and all-cause mortality. Arch Intern Med. 2009;169(3):260–8.

    Article  PubMed  Google Scholar 

  8. Bouchard MH, Dragomir A, Blais L, et al. Impact of adherence to statins on coronary artery disease in primary prevention. Br J Clin Pharmacol. 2007;63(6):698–708. doi:10.1111/j.1365-2125.2006.02828.x.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Mazzaglia G, Ambrosioni E, Alacqua M, et al. Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation. 2009;120(16):1598–605. doi:10.1161/circulationaha.108.830299.

    Article  CAS  PubMed  Google Scholar 

  10. Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44–7. doi:10.1111/j.1524-4733.2007.00213.x.

    Article  PubMed  Google Scholar 

  11. Nieuwlaat R, Wilczynski N, Navarro T, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014. CD000011. doi:10.1002/14651858.CD000011.pub4.

  12. Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. Br Med J. 2003;326(7404):1423. doi:10.1136/bmj.326.7404.1423.

    Article  CAS  Google Scholar 

  13. Penning-Van Beest FJA, Termorshuizen F, Goettsch WG, et al. Adherence to evidence-based statin guidelines reduces the risk of hospitalizations for acute myocardial infarction by 40 %: a cohort study. Eur Heart J. 2007;28(2):154–9.

    Article  CAS  PubMed  Google Scholar 

  14. Hippisley-Cox J, Coupland C. Effect of statins on the mortality of patients with ischaemic heart disease: population based cohort study with nested case-control analysis. Heart. 2006;92(6):752–8.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Koval PG, Kochis EM. Maximum antihypertensive effect from different classes of antihypertensives. Arch Fam Med. 2000;9(6):557–9. doi:10.1001/archfami.9.6.557.

    Article  CAS  PubMed  Google Scholar 

  16. Tu KR, Anderson LN, Butt DA, et al. Antihypertensive drug prescribing and persistence among new elderly users: implications for persistence improvement interventions. Can J Cardiol. 2014;30(6):647–52. doi:10.1016/j.cjca.2014.03.017.

    Article  PubMed  Google Scholar 

  17. Jackevicius CA, Li P, Tu JV. Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction. Circulation. 2008;117(8):1028–36. doi:10.1161/circulationaha.107.706820.

    Article  PubMed  Google Scholar 

  18. Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA. 2002;288(4):462–7 (pii:joc12190).

    Article  PubMed  Google Scholar 

  19. Poluzzi E, Piccinni C, Carta P, et al. Cardiovascular events in statin recipients: impact of adherence to treatment in a 3-year record linkage study. Eur J Clin Pharmacol. 2011;67(4):407–14. doi:10.1007/s00228-010-0958-3.

    Article  PubMed  Google Scholar 

  20. Haynes RB, Ackloo E, Sahota N, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;2:CD000011. doi:10.1002/14651858.CD000011.pub3.

    PubMed  Google Scholar 

  21. Chan DC, Shrank WH, Cutler D, et al. Patient, physician, and payment predictors of statin adherence. Med Care. 2010;48(3):196–202. doi:10.1097/MLR.0b013e3181c132ad.

    Article  PubMed  Google Scholar 

  22. Australian Government Department of Health and Ageing. Pharmaceutical Benefits Scheme—About the PBS. 2014. http://www.pbs.gov.au/info/about-the-pbs. Accessed 10 Dec 2014.

  23. Simons LA, Ortiz M, Calcino G. Persistence with antihypertensive medication: Australia-wide experience, 2004–2006. Med J Aust. 2008;188(4):224–7.

    PubMed  Google Scholar 

  24. Simons LA, Ortiz M, Calcino G. Long term persistence with statin therapy—experience in Australia 2006–2010. Aust Fam Physician. 2011;40(5):319–22.

    PubMed  Google Scholar 

  25. Roughead EE, Vitry AI, Preiss AK, et al. Assessing overall duration of cardiovascular medicines in veterans with established cardiovascular disease. Eur J Cardiovasc Prev Rehabil. 2010;17(1):71–6. doi:10.1097/HJR.0b013e32832f3b56.

    Article  PubMed  Google Scholar 

  26. Hoy D, Brooks P, Woolf A, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934–9.

    Article  PubMed  Google Scholar 

  27. Doi SAR, Barendregt JJ. Meta-analysis I. In: Doi SAR, Williams GM, editors. Methods of clinical epidemiology. Springer Series on Epidemiology and Public Health: Springer Berlin Heidelberg; 2013. p. 229–52.

  28. Hunter JP, Saratzis A, Sutton AJ, et al. In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias. J Clin Epidemiol. 2014;67(8):897–903. doi:10.1016/j.jclinepi.2014.03.003.

    Article  PubMed  Google Scholar 

  29. Sterne JA, Gavaghan D, Egger M. Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol. 2000;53(11):1119–29.

    Article  CAS  PubMed  Google Scholar 

  30. Onitilo AA, Doi SAR, Barendregt JJ. Meta-analysis II: interpretation and use of outputs. In: Doi SAR, Williams GM, editors. Methods of clinical epidemiology. Springer Series on Epidemiology and Public Health: Springer Berlin Heidelberg; 2013. p. 253–66.

  31. Doi SAR, Barendregt JJ, Mozurkewich EL. Meta-analysis of heterogeneous clinical trials: an empirical example. Contemp Clin Trials. 2011;32(2):288–98. doi:10.1016/j.cct.2010.12.006.

    Article  PubMed  Google Scholar 

  32. Doi SAR, Thalib L. A quality-effects model for meta-analysis. Epidemiology. 2008;19(1):94–100. doi:10.1097/EDE.0b013e31815c24e7.

    Article  PubMed  Google Scholar 

  33. Gallagher R, Warwick M, Chenoweth L, et al. Medication knowledge, adherence and predictors among people with heart failure and chronic obstructive pulmonary disease. J Nurs Healthc Chronic Illn. 2011;3(1):30–40. doi:10.1111/j.1752-9824.2010.01077.x.

    Article  Google Scholar 

  34. Gujral G, Winckel K, Nissen LM, et al. Impact of community pharmacist intervention discussing patients’ beliefs to improve medication adherence. Int J Clin Pharm. 2014;36:1048–58.

    Article  PubMed  Google Scholar 

  35. Warren JR, Falster MO, Fox D, et al. Factors influencing adherence in long-term use of statins. Pharmacoepidemiol Drug Saf. 2013;22(12):1298–307. doi:10.1002/pds.3526.

    Article  CAS  PubMed  Google Scholar 

  36. Percival M, Cottrell WN, Jayasinghe R. Exploring the beliefs of heart failure patients towards their heart failure medicines and self care activities. Int J Clin Pharm. 2012;34(4):618–25.

    Article  PubMed  Google Scholar 

  37. Brockwell SE, Gordon IR. A comparison of statistical methods for meta-analysis. Stat Med. 2001;20(6):825–40. doi:10.1002/sim.650.

    Article  CAS  PubMed  Google Scholar 

  38. Noma H. Confidence intervals for a random-effects meta-analysis based on Bartlett-type corrections. Stat Med. 2011;30(28):3304–12. doi:10.1002/sim.4350.

    Article  PubMed  Google Scholar 

  39. Newby LK, LaPointe NMA, Chen AY, et al. Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease. Circulation. 2006;113(2):203–12. doi:10.1161/circulationaha.105.505636.

    Article  CAS  PubMed  Google Scholar 

  40. Lindgren P, Eriksson J, Buxton M, et al. The economic consequences of non-adherence to lipid-lowering therapy: results from the Anglo-Scandinavian-Cardiac Outcomes Trial. Int J Clin Pract. 2010;64(9):1228–34. doi:10.1111/j.1742-1241.2010.02445.x.

    Article  CAS  PubMed  Google Scholar 

  41. Rodriguez F, Cannon CP, Steg PG, et al. Predictors of long-term adherence to evidence-based cardiovascular disease medications in outpatients with stable atherothrombotic disease: findings from the REACH Registry. Clin Cardiol. 2013;36(12):721–7. doi:10.1002/clc.22217.

    Article  PubMed  Google Scholar 

  42. Horne R, Weinman J. Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999;47(6):555–67.

    Article  CAS  PubMed  Google Scholar 

  43. Allen LaPointe NM, Ou FS, Calvert SB, et al. Association between patient beliefs and medication adherence following hospitalization for acute coronary syndrome. Am Heart J. 2011;161(5):855–63. doi:10.1016/j.ahj.2011.02.009.

    Article  PubMed  Google Scholar 

  44. Mann DM, Allegrante JP, Natarajan S, et al. Predictors of adherence to statins for primary prevention. Cardiovasc Drugs Ther. 2007;21(4):311–6. doi:10.1007/s10557-007-6040-4.

    Article  PubMed  Google Scholar 

  45. Rashid MA, Edwards D, Walter FM, et al. Medication taking in coronary artery disease: a systematic review and qualitative synthesis. Ann Fam Med. 2014;12(3):224–32. doi:10.1370/afm.1620.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Broadbent E, Petrie KJ, Main J, et al. The brief illness perception questionnaire. J Psychosom Res. 2006;60(6):631–7. doi:10.1016/j.jpsychores.2005.10.020.

    Article  PubMed  Google Scholar 

  47. Chapman RH, Ferrufino CP, Kowal SL, et al. The cost and effectiveness of adherence-improving interventions for antihypertensive and lipid-lowering drugs. Int J Clin Pract. 2010;64(2):169–81. doi:10.1111/j.1742-1241.2009.02196.x.

    Article  CAS  PubMed  Google Scholar 

  48. Osterberg L, Blaschke T. Adherence to medication—reply. N Engl J Med. 2005;353(18):1973–4.

    CAS  Google Scholar 

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Acknowledgments

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. The authors had full control of all primary data and agreed to allow the journal to review the data if requested.This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

The manuscript contains data from previously published studies and does not contain original data collection.

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Authors and Affiliations

  1. The University of Queensland, School of Population Health, Herston Road, Herston, Brisbane, QLD, 4006, Australia

    Samantha J. McKenzie & Deirdre McLaughlin

  2. Australian Catholic University Library, Banyo, QLD, Australia

    Justin Clark

  3. Research School of Population Health, Australian National University, Mills Road, Acton, ACT, 2601, Australia

    Suhail A. R. Doi

Authors
  1. Samantha J. McKenzie
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  2. Deirdre McLaughlin
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Correspondence to Samantha J. McKenzie.

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McKenzie, S.J., McLaughlin, D., Clark, J. et al. The Burden of Non-Adherence to Cardiovascular Medications Among the Aging Population in Australia: A Meta-Analysis. Drugs Aging 32, 217–225 (2015). https://doi.org/10.1007/s40266-015-0245-1

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