Perception of pharmacological prevention and subsequent non-adherence to medication in patients with ischaemic heart disease: a population-based cohort study

Christina Boesgaard Graversen; Jan Brink Valentin; Mogens Lytken Larsen; Sam Riahi; Teresa Holmberg; Line Zinckernagel; Søren Paaske Johnsen

doi:10.1136/bmjopen-2021-054362

Perception of pharmacological prevention and subsequent non-adherence to medication in patients with ischaemic heart disease: a population-based cohort study

Christina Boesgaard Graversen^*, Jan Brink Valentin, Mogens Lytken Larsen, Sam Riahi, Teresa Holmberg, Line Zinckernagel, Søren Paaske Johnsen

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

OBJECTIVE: A patient-focused approach is advocated to embody risk of non-adherence to medication and subsequent adverse clinical outcomes following ischaemic heart disease (IHD). This study aimed to explore how patient perceived information on pharmacological prevention was associated with subsequent non-adherence to medication (measured by non-initiation, non-implementation and non-persistence) in patients with incident IHD.

DESIGN: Cohort study.

SETTING: Denmark.

PARTICIPANTS: Register-based cohort of 829 patients with incident IHD in 2013.

MEASURES: Perception covered whether patients' experienced being adequately informed about their pharmacological prevention. Information on such was obtained from a survey and divided into 'Well informed', 'Moderately informed' and 'Poorly informed'. Information on baseline characteristics, and reimbursed prescriptions of medication (antiplatelets, statins, ACE-inhibitors/angiotensin receptor blockers and β-blockers) during follow-up were obtained by linkage to nationwide public registers. Non-initiation and non-implementation of medication, measured as proportion of days covered, were analysed by Poisson regression. Non-persistence to medication, measured as risk of discontinuation, was analysed by multivariable Cox proportional hazard regression.

PRIMARY AND SECONDARY OUTCOME MEASURES: Non-implementation and non-persistence to medication up to 365 days of follow-up were primary outcomes. Secondary outcomes included non-initiation as well as non-implementation and non-persistence to medication at 180 days of follow-up.

RESULTS: A dose-response association was in general found between perception of pharmacological prevention and risk of non-implementation and non-persistence. For example, the hazard of non-persistence to antiplatelets was 1.18 (95% CI 0.71 to 1.96) times higher for patients reporting 'Moderately informed' and 1.89 (95% CI 1.10 to 3.25) times higher for patients reporting 'Poorly informed', compared with patients reporting 'Well informed of perception of pharmacological prevention' up to 365 days of follow-up.

CONCLUSION: Lower levels of perception of pharmacological prevention were associated with subsequent non-implementation and non-persistence to medication in patients with incident IHD.

Original language	English
Article number	e054362
Journal	BMJ Open
Volume	12
Issue number	1
ISSN	2044-6055
DOIs	https://doi.org/10.1136/bmjopen-2021-054362
Publication status	Published - 4 Jan 2022

Bibliographical note

Keywords

Epidemiology
Ischaemic heart disease
Rehabilitation medicine
Angiotensin-Converting Enzyme Inhibitors/therapeutic use
Medication Adherence
Humans
Myocardial Ischemia/drug therapy
Perception
Retrospective Studies
Cohort Studies

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Graversen et al. (2022). Perception of pharmacological prevention and subsequent non-adherence to medication in patients with ischaemic heart disease - a population-based cohort studyFinal published version, 1.39 MBLicence: CC BY-NC 4.0

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title = "Perception of pharmacological prevention and subsequent non-adherence to medication in patients with ischaemic heart disease: a population-based cohort study",

abstract = "OBJECTIVE: A patient-focused approach is advocated to embody risk of non-adherence to medication and subsequent adverse clinical outcomes following ischaemic heart disease (IHD). This study aimed to explore how patient perceived information on pharmacological prevention was associated with subsequent non-adherence to medication (measured by non-initiation, non-implementation and non-persistence) in patients with incident IHD.DESIGN: Cohort study.SETTING: Denmark.PARTICIPANTS: Register-based cohort of 829 patients with incident IHD in 2013.MEASURES: Perception covered whether patients' experienced being adequately informed about their pharmacological prevention. Information on such was obtained from a survey and divided into 'Well informed', 'Moderately informed' and 'Poorly informed'. Information on baseline characteristics, and reimbursed prescriptions of medication (antiplatelets, statins, ACE-inhibitors/angiotensin receptor blockers and β-blockers) during follow-up were obtained by linkage to nationwide public registers. Non-initiation and non-implementation of medication, measured as proportion of days covered, were analysed by Poisson regression. Non-persistence to medication, measured as risk of discontinuation, was analysed by multivariable Cox proportional hazard regression.PRIMARY AND SECONDARY OUTCOME MEASURES: Non-implementation and non-persistence to medication up to 365 days of follow-up were primary outcomes. Secondary outcomes included non-initiation as well as non-implementation and non-persistence to medication at 180 days of follow-up.RESULTS: A dose-response association was in general found between perception of pharmacological prevention and risk of non-implementation and non-persistence. For example, the hazard of non-persistence to antiplatelets was 1.18 (95% CI 0.71 to 1.96) times higher for patients reporting 'Moderately informed' and 1.89 (95% CI 1.10 to 3.25) times higher for patients reporting 'Poorly informed', compared with patients reporting 'Well informed of perception of pharmacological prevention' up to 365 days of follow-up.CONCLUSION: Lower levels of perception of pharmacological prevention were associated with subsequent non-implementation and non-persistence to medication in patients with incident IHD.",

keywords = "Epidemiology, Ischaemic heart disease, Rehabilitation medicine, Angiotensin-Converting Enzyme Inhibitors/therapeutic use, Medication Adherence, Humans, Myocardial Ischemia/drug therapy, Perception, Retrospective Studies, Cohort Studies",

author = "Graversen, {Christina Boesgaard} and Valentin, {Jan Brink} and Larsen, {Mogens Lytken} and Sam Riahi and Teresa Holmberg and Line Zinckernagel and Johnsen, {S{\o}ren Paaske}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2022",

month = jan,

day = "4",

doi = "10.1136/bmjopen-2021-054362",

language = "English",

volume = "12",

journal = "BMJ Open",

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Perception of pharmacological prevention and subsequent non-adherence to medication in patients with ischaemic heart disease: a population-based cohort study. / Graversen, Christina Boesgaard; Valentin, Jan Brink; Larsen, Mogens Lytken et al.
In: BMJ Open, Vol. 12, No. 1, e054362, 04.01.2022.

Research output: Contribution to journal › Journal article › Research › peer-review

TY - JOUR

T1 - Perception of pharmacological prevention and subsequent non-adherence to medication in patients with ischaemic heart disease

T2 - a population-based cohort study

AU - Graversen, Christina Boesgaard

AU - Valentin, Jan Brink

AU - Larsen, Mogens Lytken

AU - Riahi, Sam

AU - Holmberg, Teresa

AU - Zinckernagel, Line

AU - Johnsen, Søren Paaske

PY - 2022/1/4

Y1 - 2022/1/4

N2 - OBJECTIVE: A patient-focused approach is advocated to embody risk of non-adherence to medication and subsequent adverse clinical outcomes following ischaemic heart disease (IHD). This study aimed to explore how patient perceived information on pharmacological prevention was associated with subsequent non-adherence to medication (measured by non-initiation, non-implementation and non-persistence) in patients with incident IHD.DESIGN: Cohort study.SETTING: Denmark.PARTICIPANTS: Register-based cohort of 829 patients with incident IHD in 2013.MEASURES: Perception covered whether patients' experienced being adequately informed about their pharmacological prevention. Information on such was obtained from a survey and divided into 'Well informed', 'Moderately informed' and 'Poorly informed'. Information on baseline characteristics, and reimbursed prescriptions of medication (antiplatelets, statins, ACE-inhibitors/angiotensin receptor blockers and β-blockers) during follow-up were obtained by linkage to nationwide public registers. Non-initiation and non-implementation of medication, measured as proportion of days covered, were analysed by Poisson regression. Non-persistence to medication, measured as risk of discontinuation, was analysed by multivariable Cox proportional hazard regression.PRIMARY AND SECONDARY OUTCOME MEASURES: Non-implementation and non-persistence to medication up to 365 days of follow-up were primary outcomes. Secondary outcomes included non-initiation as well as non-implementation and non-persistence to medication at 180 days of follow-up.RESULTS: A dose-response association was in general found between perception of pharmacological prevention and risk of non-implementation and non-persistence. For example, the hazard of non-persistence to antiplatelets was 1.18 (95% CI 0.71 to 1.96) times higher for patients reporting 'Moderately informed' and 1.89 (95% CI 1.10 to 3.25) times higher for patients reporting 'Poorly informed', compared with patients reporting 'Well informed of perception of pharmacological prevention' up to 365 days of follow-up.CONCLUSION: Lower levels of perception of pharmacological prevention were associated with subsequent non-implementation and non-persistence to medication in patients with incident IHD.

AB - OBJECTIVE: A patient-focused approach is advocated to embody risk of non-adherence to medication and subsequent adverse clinical outcomes following ischaemic heart disease (IHD). This study aimed to explore how patient perceived information on pharmacological prevention was associated with subsequent non-adherence to medication (measured by non-initiation, non-implementation and non-persistence) in patients with incident IHD.DESIGN: Cohort study.SETTING: Denmark.PARTICIPANTS: Register-based cohort of 829 patients with incident IHD in 2013.MEASURES: Perception covered whether patients' experienced being adequately informed about their pharmacological prevention. Information on such was obtained from a survey and divided into 'Well informed', 'Moderately informed' and 'Poorly informed'. Information on baseline characteristics, and reimbursed prescriptions of medication (antiplatelets, statins, ACE-inhibitors/angiotensin receptor blockers and β-blockers) during follow-up were obtained by linkage to nationwide public registers. Non-initiation and non-implementation of medication, measured as proportion of days covered, were analysed by Poisson regression. Non-persistence to medication, measured as risk of discontinuation, was analysed by multivariable Cox proportional hazard regression.PRIMARY AND SECONDARY OUTCOME MEASURES: Non-implementation and non-persistence to medication up to 365 days of follow-up were primary outcomes. Secondary outcomes included non-initiation as well as non-implementation and non-persistence to medication at 180 days of follow-up.RESULTS: A dose-response association was in general found between perception of pharmacological prevention and risk of non-implementation and non-persistence. For example, the hazard of non-persistence to antiplatelets was 1.18 (95% CI 0.71 to 1.96) times higher for patients reporting 'Moderately informed' and 1.89 (95% CI 1.10 to 3.25) times higher for patients reporting 'Poorly informed', compared with patients reporting 'Well informed of perception of pharmacological prevention' up to 365 days of follow-up.CONCLUSION: Lower levels of perception of pharmacological prevention were associated with subsequent non-implementation and non-persistence to medication in patients with incident IHD.

KW - Epidemiology

KW - Ischaemic heart disease

KW - Rehabilitation medicine

KW - Angiotensin-Converting Enzyme Inhibitors/therapeutic use

KW - Medication Adherence

KW - Humans

KW - Myocardial Ischemia/drug therapy

KW - Perception

KW - Retrospective Studies

KW - Cohort Studies

U2 - 10.1136/bmjopen-2021-054362

DO - 10.1136/bmjopen-2021-054362

M3 - Journal article

C2 - 34983767

SN - 2044-6055

VL - 12

JO - BMJ Open

JF - BMJ Open

IS - 1

M1 - e054362

ER -

Perception of pharmacological prevention and subsequent non-adherence to medication in patients with ischaemic heart disease: a population-based cohort study

Abstract

Bibliographical note

Keywords

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