Skip to main content
SpringerLink
Log in

Representativeness of the “Fiesole Misurata” study database for use in pharmaco-epidemiological investigations on adherence to antihypertensive medications

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background and aims

Poor adherence to medications is a major health concern especially among older subjects. To plan future studies to improve adherence, an epidemiological study, called “Fiesole Misurata”, was conducted. The aim of the present paper was to verify the representativeness of the database in evaluating the AntiHyperTensives (AHTs)-taking behaviour.

Methods

Demographic records of all subjects aged ≥65 years (n = 2,228) living in the community of Fiesole (Florence, Italy) was retrieved from the Registry Office of Fiesole Municipality. The corresponding healthcare records were obtained from administrative archives of the Local Health Authority (claim dataset). Moreover, a cohort of subjects aged ≥65 years (n = 385) living in the community was screened by means of a multidimensional geriatric evaluation (cross-sectional dataset).

Results

In claim dataset, biyearly prevalences of hospitalization for ischemic cardiomyopathy, heart failure, and stroke were 3.7, 3.0, and 3.2 %, respectively. In the cross-sectional dataset, prevalences were 11.2, 6.7, and 7.1 %, respectively. The most used drugs were angiotensin-converting enzyme inhibitors (43.6 % in the claim dataset, 45.3 % in the cross-sectional dataset) and diuretics (35.6 % and 47.0 %, respectively). Among the incident users of AHTs, 63.5 % was highly adherent (≥80 %) over the first 6 months of follow-up, while 14.3 and 22.2 % were intermediate (40–79 %) and low (<40 %) adherent. The percentage of high adherers decreased with time and reached 31.2 % at the 24th month.

Conclusions

These findings indicate that “Fiesole Misurata” study database can be used to develop future strategies aimed at improving the adherence to AHTs in older individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Cutler DM, Everett W (2010) Thinking outside the pillbox—medication adherence as a priority for health care reform. N Engl J Med 362(17):1553–1555

    Article  PubMed  CAS  Google Scholar 

  2. Doggrell SA (2010) Adherence to medicines in the older-aged with chronic conditions: does intervention by an allied health professional help? Drugs Aging 27(3):239–254

    Article  PubMed  Google Scholar 

  3. Puddu PE, Menotti A, Tolonen H, Nedeljkovic S, Kafatos AG (2011) Determinants of 40-year all-cause mortality in the European cohorts of the Seven Countries Study. Eur J Epidemiol 26(8):595–608

    Article  PubMed  Google Scholar 

  4. Konig HH, Heider D, Lehnert T, Riedel-Heller SG, Angermeyer MC, Matschinger H et al (2010) Health status of the advanced elderly in six European countries: results from a representative survey using EQ-5D and SF-12. Health Qual Life Outcomes 8:143

    Article  PubMed  Google Scholar 

  5. Kim AS, Johnston SC (2011) Global variation in the relative burden of stroke and ischemic heart disease. Circulation 124(3):314–323

    Article  PubMed  Google Scholar 

  6. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J (2005) Global burden of hypertension: analysis of worldwide data. Lancet 365(9455):217–223

    PubMed  Google Scholar 

  7. Wild SH, Fischbacher C, Brock A, Griffiths C, Bhopal R (2007) Mortality from all causes and circulatory disease by country of birth in England and Wales 2001–2003. J Public Health (Oxf) 29(2):191–198

    Article  CAS  Google Scholar 

  8. Palmieri L, Barchielli A, Cesana G, de Campora E, Goldoni CA, Spolaore P et al (2007) The Italian register of cardiovascular diseases: attack rates and case fatality for cerebrovascular events. Cerebrovasc Dis 24(6):530–539

    Article  PubMed  CAS  Google Scholar 

  9. Mayor S (2011) Hypertension diagnosis should be based on ambulatory blood pressure monitoring. NICE recommends. BMJ 343:d5421

    Article  PubMed  Google Scholar 

  10. Mazzaglia G, Ambrosioni E, Alacqua M, Filippi A, Sessa E, Immordino V et al (2009) Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation 120(16):1598–1605

    Article  PubMed  CAS  Google Scholar 

  11. Choudhry NK, Fischer MA, Avorn J, Liberman JN, Schneeweiss S, Pakes J et al (2011) The implications of therapeutic complexity on adherence to cardiovascular medications. Arch Intern Med 171(9):814–822

    Article  PubMed  Google Scholar 

  12. Gellad WF, Grenard JL, Marcum ZA (2011) A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. Am J Geriatr Pharmacother 9(1):11–23

    Article  PubMed  Google Scholar 

  13. Dietlein G, Schroder-Bernhardi D (2002) Use of the mediplus patient database in healthcare research. Int J Clin Pharmacol Ther 40(3):130–133

    PubMed  CAS  Google Scholar 

  14. Andersohn F, Garbe E (2008) Pharmacoepidemiological research with large health databases. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 51(10):1135–1144

    Article  PubMed  CAS  Google Scholar 

  15. ISTAT (2010) http://www.comuni-italiani.it/048/015/

  16. Quantin C, Allaert FA, Avillach P, Fassa M, Riandey B, Trouessin G et al (2008) Building application-related patient identifiers: what solution for a European country? Int J Telemed Appl 678302

  17. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K et al (2009) Heart disease and stroke statistics-2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119(3):480–486

    Article  PubMed  Google Scholar 

  18. Landi F, Russo A, Cesari M, Barillaro C, Onder G, Zamboni V et al (2005) The ilSIRENTE study: a prospective cohort study on persons aged 80 years and older living in a mountain community of Central Italy. Aging Clin Exp Res 17(6):486–493

    PubMed  Google Scholar 

  19. Spolaore P, Brocco S, Fedeli U, Visentin C, Schievano E, Avossa F et al (2005) Measuring accuracy of discharge diagnoses for a region-wide surveillance of hospitalized strokes. Stroke 36(5):1031–1034

    Article  PubMed  Google Scholar 

  20. Barchielli A, Balzi D, Naldoni P, Roberts AT, Profili F, Dima F et al (2012) Hospital discharge data for assessing myocardial infarction events and trends, and effects of diagnosis validation according to MONICA and AHA criteria. J Epidemiol Community Health 66(5):462–467

    Google Scholar 

  21. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A (1994) Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 90(1):583–612

    Article  PubMed  CAS  Google Scholar 

  22. Ferrucci L, Guralnik JM, Bandinelli S, Salani B, Del Lungo I, Antonini E et al (1995) The development of disability in older persons: relationship with mortality and quality of life. In: Ferrucci L, Heikkinen E, Waters WE, Baroni A (eds) Health and quality of life in older Europeans. INCRAÐ- WHO, Florence, pp 31–66

  23. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198

    Article  PubMed  CAS  Google Scholar 

  24. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M et al (1982) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17(1):37–49

    Article  PubMed  Google Scholar 

  25. Di Bari M, Salti F, Nardi M, Pahor M, De Fusco C, Tonon E et al (1999) Undertreatment of hypertension in community-dwelling older adults: a drug-utilization study in Dicomano, Italy. J Hypertens 17(11):1633–1640

    Article  PubMed  Google Scholar 

  26. Benvenuto LJ, Krakoff LR (2011) Morbidity and mortality of orthostatic hypotension: implications for management of cardiovascular disease. Am J Hypertens 24(2):135–144

    Article  PubMed  Google Scholar 

  27. Di Bari M, Virgillo A, Matteuzzi D, Inzitari M, Mazzaglia G, Pozzi C et al (2006) Predictive validity of measures of comorbidity in older community dwellers: the Insufficienza Cardiaca negli Anziani Residenti a Dicomano Study. J Am Geriatr Soc 54(2):210–216

    Article  PubMed  Google Scholar 

  28. Di Bari M, Balzi D, Roberts AT, Barchielli A, Fumagalli S, Ungar A et al (2010) Prognostic stratification of older persons based on simple administrative data: development and validation of the “Silver Code”, to be used in emergency department triage. J Gerontol A Biol Sci Med Sci 65(2):159–164

    Article  PubMed  Google Scholar 

  29. Prugger C, Keil U, Wellmann J, de Bacquer D, de Backer G, Ambrosio GB et al (2011) Blood pressure control and knowledge of target blood pressure in coronary patients across Europe: results from the EUROASPIRE III survey. J Hypertens 29(8):1641–1648

    Article  PubMed  CAS  Google Scholar 

  30. Ritchie LD, Campbell NC, Murchie P (2011) New NICE guidelines for hypertension. BMJ 343:d5644

    Article  PubMed  CAS  Google Scholar 

  31. Scullard P, Abdelhamid A, Steel N, Qureshi N (2011) Does the evidence referenced in NICE guidelines reflect a primary care population? Br J Gen Pract 61(584):e112–e117

    Article  PubMed  Google Scholar 

  32. Corrao G, Parodi A, Nicotra F, Zambon A, Merlino L, Cesana G et al (2011) Better compliance to antihypertensive medications reduces cardiovascular risk. J Hypertens 29(3):610–618

    Article  PubMed  CAS  Google Scholar 

  33. ISTAT (2011) Previsioni della popolazione residente per sesso, età e regione dal 1.1.2001 al 1.1.2051. 2011

  34. Landi F, Liperoti R, Russo A, Capoluongo E, Barillaro C, Pahor M et al (2010) Disability, more than multimorbidity, was predictive of mortality among older persons aged 80 years and older. J Clin Epidemiol 63(7):752–759

    Article  PubMed  Google Scholar 

  35. Panico S, Palmieri L, Donfrancesco C, Vanuzzo D, Chiodini P, Cesana G et al (2010) Reduction of cardiovascular risk and body mass index: findings from the CUORE Project. G Ital Cardiol (Rome) 11(5 Suppl 3):43S–47S

    Google Scholar 

  36. Vanuzzo D, Lo NC, Pilotto L, Palmieri L, Donfrancesco C, Dima F et al (2010) Cardiovascular epidemiologic observatory 2008–2011: preliminary results. G Ital Cardiol (Rome) 11(5 Suppl 3):25S–30S

    Google Scholar 

  37. Kannel WB (2000) Incidence and epidemiology of heart failure. Heart Fail Rev 5(2):167–173

    Article  PubMed  CAS  Google Scholar 

  38. Avendano M, Kunst AE, Huisman M, Lenthe FV, Bopp M, Regidor E et al (2006) Socioeconomic status and ischaemic heart disease mortality in 10 western European populations during the 1990s. Heart 92(4):461–467

    Article  PubMed  CAS  Google Scholar 

  39. Huisani B, Cummings S, Kilbourne B, Roback H (2004) Group therapy for depressed elderly women. Group therapy for depressed elderly women. Int J Group Psychother 54(3):295–319

    Article  Google Scholar 

  40. EpiCentro (2010) http://www.epicentro.iss.it/focus/anziani/anziani.asp. Il portale dell’epidemiologia per la sanità pubblica

  41. Friedman O, McAlister FA, Yun L, Campbell N, Tu K (2010) Antihypertensive drug persistence and compliance among newly treated elderly hypertensives in Ontario. Am J Med 123(2):173–181

    Article  PubMed  Google Scholar 

  42. Jyrkka J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S (2011) Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population. Pharmacoepidemiol Drug Saf 20(5):514–522

    Article  PubMed  Google Scholar 

  43. Jyrkka J, Mursu J, Enlund Hand Lonnroos E (2012) Polypharmacy and nutritional status in elderly people. Curr Opin Clin Nutr Metab Care 15(1):1–6

    Google Scholar 

  44. Venturini CD, Engroff P, Ely LS, Zago LF, Schroeter G, Gomes I et al (2011) Gender differences, polypharmacy, and potential pharmacological interactions in the elderly. Clinics (Sao Paulo) 66(11):1867–1872

    Google Scholar 

  45. Lapi F, Pozzi C, Mazzaglia G, Ungar A, Fumagalli S, Marchionni N et al (2009) Epidemiology of suboptimal prescribing in older, community dwellers: a two-wave, population-based survey in Dicomano, Italy. Drugs Aging 26(12):1029–1038

    Article  PubMed  Google Scholar 

  46. OsMed (2009) Rapporto sul consumo dei farmaci in Italia

  47. OsMed (2010) Rapporto sul consumo dei farmaci in Italia

  48. Poluzzi E, Strahinja P, Vargiu A, Chiabrando G, Silvani MC, Motola D et al (2005) Initial treatment of hypertension and adherence to therapy in general practice in Italy. Eur J Clin Pharmacol 61(8):603–609

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This work was conducted with contribution of the Tuscany Region. The authors thank the School of Pharmacology and of Geriatrics Specialization for questionnaire administration and data recording, and Fiesole Municipality for data collection.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Preclinical and Clinical Pharmacology, Centre for Molecular Medicine (CIMMBA), University of Florence, viale G. Pieraccini 6, 50139, Florence, Italy

    Francesco Lapi, Ersilia Lucenteforte, Martina Moschini, Roberto Bonaiuti, Marina Di Pirro, Silvia Benemei, Raffaele Coppini, Alfredo Vannacci & Alessandro Mugelli

  2. Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC, Canada

    Francesco Lapi

  3. Department of Epidemiology Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada

    Francesco Lapi

  4. Department of Epidemiology, Local Health Authority, no 10, Florence, Italy

    Alessandro Barchielli

  5. Unit of Gerontology and Geriatrics, Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Maddalena Belladonna, Nicola Nesti & Andrea Ungar

  6. Fiesole Municipality, Fiesole (Florence), Italy

    Margherita Taras

Authors
  1. Francesco Lapi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ersilia Lucenteforte
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martina Moschini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roberto Bonaiuti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marina Di Pirro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alessandro Barchielli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Silvia Benemei
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maddalena Belladonna
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nicola Nesti
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Raffaele Coppini
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Margherita Taras
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Alfredo Vannacci
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Andrea Ungar
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Alessandro Mugelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ersilia Lucenteforte.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lapi, F., Lucenteforte, E., Moschini, M. et al. Representativeness of the “Fiesole Misurata” study database for use in pharmaco-epidemiological investigations on adherence to antihypertensive medications. Aging Clin Exp Res 25, 433–445 (2013). https://doi.org/10.1007/s40520-013-0060-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-013-0060-7

Keywords

Search

Navigation