Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May 16:12:835-843.
doi: 10.2147/PPA.S150142. eCollection 2018.

Prior experience with cardiovascular medicines predicted longer persistence in people initiated to combinations of antihypertensive and lipid-lowering therapies: findings from two Australian cohorts

Louise E Bartlett  1 , Nicole L Pratt  1 , Elizabeth E Roughead  1
Affiliations

Prior experience with cardiovascular medicines predicted longer persistence in people initiated to combinations of antihypertensive and lipid-lowering therapies: findings from two Australian cohorts

Louise E Bartlett et al. Patient Prefer Adherence. .

Abstract

Purpose: Many studies of persistence involving fixed dose combinations (FDCs) of cardiovascular medicines have not adequately accounted for a user's prior experience with similar medicines. The aim of this research was to assess the effect of prior medicine experience on persistence to combination therapy.

Patients and methods: Two retrospective cohort studies were conducted in the complete Pharmaceutical Benefits Scheme prescription claims dataset. Initiation and cessation rates were determined for combinations of: ezetimibe/statin; and amlodipine/statin. Initiators to combinations of these medicines between April and September 2013 were classified according to prescriptions dispensed in the prior 12 months as either: experienced to statin or calcium channel blocker (CCB); or naïve to both classes of medicines. Cohorts were stratified according to formulation initiated: FDC or separate pill combinations (SPC). Cessation of therapy over 12 months was determined using Kaplan-Meier survival analysis. Risk of cessation, adjusted for differences in patient characteristics was assessed using Cox proportional hazard models.

Results: There were 12,169 people who initiated combinations of ezetimibe/statin; and 26,848 initiated combinations of amlodipine/statin. A significant proportion of each cohort were naïve initiators: ezetimibe/statin cohort, 1,964 (16.1%) of whom 81.9% initiated a FDC; and amlodipine/statin cohort, 5,022 (18.7%) of whom 55.4% initiated a FDC. Naïve initiators had a significantly higher risk of ceasing therapy than experienced initiators regardless of formulation initiated: ezetimibe/statin cohort, naïve FDC versus experienced FDC HR=3.0 (95% CI 2.8, 3.3) and naïve SPC versus experienced SPC HR=4.4 (95% CI 3.8, 5.2); and amlodipine/statin cohort naïve FDC versus experienced FDC HR=2.0 (95% CI 1.8, 2.2) and naïve SPC versus experienced SPC HR=1.5 (95% CI 1.4, 1.6).

Conclusion: Prescribers are initiating people to combinations of two cardiovascular medicines without prior experience to at least one medicine in the combination. This is associated with a higher risk of ceasing therapy than when combination therapy is initiated following experience with one component medicine. The use of FDC products does not overcome this risk.

Keywords: adherence; antihypertensive; lipid lowering therapy; persistence; polypill; statin.

PubMed Disclaimer

Conflict of interest statement

Disclosure Louise E Bartlett is a part-time employee of the Commonwealth Department of Health. Elizabeth E Roughead is supported by an NHMRC Fellowship (GNT1110139). Nicole Pratt is supported by an NHMRC Early Career Fellowship (Grant Number GNT1035889). The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Patient flow diagram for Cohort 1: ezetimibe and statin users. Abbreviations: FDC, fixed dose combinations; SPC, separate pill combinations.
Figure 2
Figure 2
Patient flow diagram for Cohort 2: amlodipine and statin users. Abbreviations: CCB, calcium channel blocker; FDC, fixed dose combinations; SPC, separate pill combinations.
Figure 3
Figure 3
Kaplan–Meier survival curves for persistence to any lipid-lowering therapy following initiation to combination ezetimibe and statin.
Figure 4
Figure 4
Kaplan–Meier survival curves for persistence to antihypertensive and statin therapy following initiation to combination amlodipine and statin. Abbreviation: CCB, calcium channel blocker.
See this image and copyright information in PMC

References

    1. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR) Eur Heart J. 2016;37(29):2315–2381. - PMC - PubMed
    1. National Vascular Disease Prevention Alliance . Guidelines for the Management of Absolute Cardiovascular Disease Risk. Canberra Australia: National Stroke Foundation; 2012. [Accessed January 28, 2018]. Available from: https://www.heartfoundation.org.au/images/uploads/publications/Absolute-....
    1. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (jnc 8) JAMA. 2014;311(5):507–520. - PubMed
    1. National Heart Foundation of Australia . Guideline for the diagnosis and management of hypertension in adults. Melbourne: National Heart Foundation of Australia; 2016. [Accessed January 28, 2018]. Available from: http://heartfoundation.org.au/for-professionals/clinical-information/hyp....
    1. NPS Medicinewise Key points on fixed dose combination medicines: NPS Medicinewise. 2013. [Accessed January 28, 2018]. [updated 20 Dec 2013]. Available from: http://www.nps.org.au/topics/combination-medicines/for-health-profession....

LinkOut - more resources