McNaughton Candace D, Austin Peter C, Jackevicius Cynthia A, Chu Anna, Holodinsky Jessalyn K, Hill Michael D, Norris Colleen M, Kumar Mukesh, Kamal Noreen, Lee Douglas S, Khan Nadia, Vyas Manav V, Joundi Raed A, Kapral Moira K, Yu Amy Y X
ICES, Toronto, ON, Canada.
Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Room V1 39, 2075 Bayview Ave, Toronto, ON, Canada.
BMC Cardiovasc Disord. 2025 Feb 5;25(1):82. doi: 10.1186/s12872-025-04492-3.
Health system disruptions since onset of the COVID-19 pandemic may have adversely impacted adherence to medications for common cardiovascular risk factors.
We examined adherence to and discontinuation of incident prescriptions for medications treating hypertension, dyslipidemia, diabetes, and atrial fibrillation in Ontario, Alberta, and Nova Scotia, Canada. We compared the recent period (April 1, 2020 through most recently available follow-up: September 30, 2021 for Ontario; March 31, 2021 for Alberta; and March 31, 2022 for Nova Scotia) to the baseline, pre-pandemic period (April 1, 2014 through March 31, 2019). In each province, people aged ≥66 years with a valid health number and corresponding incident prescription were included. For each medication class, adherence in the recent period, defined as ≥ 0.80 proportion-of-days-covered (PDC), was compared to the pre-pandemic period using modified Poisson regression with robust error variance, adjusted for patient characteristics. Similarly adjusted Cox proportional hazards models compared hazard of discontinuation over one year of follow-up between the two time periods.
In the recent period, PDC ranged from 48.9% for dyslipidemia medications in Alberta to 82.2% for anticoagulants in Nova Scotia. Adherence was not different between periods, with the following exceptions: higher adherence in the recent period for antihypertensives (adjusted risk ratios [aRR] 1.08, 95% CI 1.06-1.10) and dyslipidemics (aRR 1.07, 95% CI 1.04-1.09) in Nova Scotia, and for antihyperglycemics (aRR 1.10, 95% CI 1.08-1.14) and anticoagulants (1.15, 95% CI 1.12, 1.18) in Alberta. Adherence was lower in the recent period only for antihypertensives in Alberta (aRR 0.95, 95% CI 0.93, 0.97). One-year rates of discontinuation ranged from 20.9% for anticoagulants in the Alberta recent period to 56.7% for antihypertensives in the Ontario baseline period. The adjusted hazard of discontinuation was lower or unchanged in the recent period for all medication classes.
Despite significant health system disruptions since 2020, recent adherence to incident cardiovascular prescriptions was similar or better than before and rates of medication discontinuation were lower. However, interventions are still needed to improve existing, suboptimal adherence.
自新冠疫情爆发以来，卫生系统的中断可能对常见心血管危险因素药物的依从性产生了不利影响。
我们调查了加拿大安大略省、艾伯塔省和新斯科舍省治疗高血压、血脂异常、糖尿病和心房颤动药物的新发病例处方的依从性和停药情况。我们将近期（2020年4月1日至最近一次随访：安大略省为2021年9月30日；艾伯塔省为2021年3月31日；新斯科舍省为2022年3月31日）与疫情前的基线期（2014年4月1日至2019年3月31日）进行了比较。在每个省份，纳入了年龄≥66岁且有有效健康编号及相应新发病例处方的人群。对于每类药物，使用具有稳健误差方差的修正泊松回归，并根据患者特征进行调整，将近期定义为覆盖天数比例（PDC）≥0.80的依从性与疫情前时期进行比较。同样经过调整的Cox比例风险模型比较了两个时间段之间随访一年的停药风险。
在近期，PDC范围从艾伯塔省血脂异常药物的48.9%到新斯科舍省抗凝剂的82.2%。各时期之间的依从性没有差异，但有以下例外情况：新斯科舍省近期抗高血压药物（调整风险比[aRR]1.08，95%可信区间[CI]1.06 - 1.10）和血脂异常药物（aRR 1.07，95% CI 1.04 - 1.09）的依从性较高，艾伯塔省近期抗高血糖药物（aRR 1.10，95% CI 1.08 - 1.14）和抗凝剂（1.15，95% CI 1.12，1.18）的依从性较高。仅艾伯塔省近期抗高血压药物的依从性较低（aRR 0.95，95% CI 0.93，0.97）。一年停药率范围从艾伯塔省近期抗凝剂的20.9%到安大略省基线期抗高血压药物的56.7%。近期所有药物类别的调整停药风险较低或未改变。
尽管自2020年以来卫生系统出现了重大中断，但近期新发病例心血管处方的依从性与之前相似或更好，药物停药率较低。然而，仍需要采取干预措施来改善现有的、未达最佳水平的依从性。
