Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Br J Clin Pharmacol. 2019 Jan;85(1):227-235. doi: 10.1111/bcp.13797. Epub 2018 Nov 8.
The aim of this study was to examine the level of and predictors of statin nonadherence and discontinuation among older adults.
Among 22 340 Australians aged ≥65 years who initiated statin therapy from January 2014 to December 2015, we estimated the first-year nonadherence (proportion of days covered [PDC] <0.80) and discontinuation (≥90 days without statin coverage) rates. Predictors of nonadherence and discontinuation were examined via multivariable logistic regression. Analyses were performed separately for general beneficiaries (with a higher co-payment; n = 4841) and concessional beneficiaries (with a lower co-payment; n = 17 499).
During the one-year follow-up, 55.1% were nonadherent (concessional 52.6%; general beneficiaries 64.2%) and 44.7% discontinued statins (concessional 43.1%; general beneficiaries 50.4%). Among concessional beneficiaries, those aged 75-84 years and ≥85 years were more likely to discontinue than people aged 65-74 years (odds ratio 1.11, 95% confidence interval 1.04-1.19 and 1.38, 1.23-1.54, respectively). Diabetes was associated with an increased likelihood of nonadherence and discontinuation, while hypertension, angina and congestive heart failure were associated with a lower likelihood of nonadherence and discontinuation. Anxiety was associated with an increased likelihood of discontinuation, but polypharmacy (concurrent use of five or more drugs) was associated with a lower likelihood of nonadherence and discontinuation. Statin initiation by a general medical practitioner was associated with both increased likelihood of nonadherence and discontinuation. Similar predictors of nonadherence and discontinuation were identified for the general beneficiaries.
Among older adults prescribed statins, first-year nonadherence and discontinuation are high. Specific population subgroups such as people aged ≥85 years, those with diabetes or anxiety may require additional attention to improve statin adherence.
本研究旨在探讨老年人群他汀类药物不依从和停药的程度及预测因素。
在 2014 年 1 月至 2015 年 12 月期间开始接受他汀类药物治疗的 22340 名年龄≥65 岁的澳大利亚人中，我们估计了第一年的不依从率（用药天数覆盖率[PDC]＜0.80）和停药率（≥90 天未服用他汀类药物）。通过多变量逻辑回归分析来确定不依从和停药的预测因素。分别对普通受益人和优惠受益人（较高共付额；n=4841）和优惠受益人（较低共付额；n=17499）进行了分析。
在一年的随访期间，有 55.1%的患者不依从（优惠受益人为 52.6%，普通受益人为 64.2%），44.7%的患者停药（优惠受益人为 43.1%，普通受益人为 50.4%）。在优惠受益人群中，75-84 岁和≥85 岁的患者停药的可能性大于 65-74 岁的患者（比值比 1.11，95%置信区间 1.04-1.19 和 1.38，1.23-1.54）。糖尿病与不依从和停药的可能性增加相关，而高血压、心绞痛和充血性心力衰竭与不依从和停药的可能性降低相关。焦虑与停药的可能性增加相关，而同时使用五种或更多药物与不依从和停药的可能性降低相关。普通医生开始使用他汀类药物与不依从和停药的可能性增加均相关。普通受益人群中也发现了不依从和停药的类似预测因素。
在服用他汀类药物的老年人群中，第一年的不依从和停药率很高。≥85 岁、患有糖尿病或焦虑症的特定人群可能需要额外关注以提高他汀类药物的依从性。
