Factors associated with non-adherence to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in older patients with peripheral arterial disease

Martin Wawruch; Miriam Petrova; Tomas Tesar; Jan Murin; Patricia Schnorrerova; Martina Paduchova; Denisa Celovska; Beata Havelkova; Michal Trnka; Sofa D Alfian; Emma Aarnio

doi:10.3389/fphar.2023.1199669

Factors associated with non-adherence to angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in older patients with peripheral arterial disease

Front Pharmacol. 2023 Aug 10:14:1199669. doi: 10.3389/fphar.2023.1199669. eCollection 2023.

Authors

Affiliations

¹ Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
² Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia.
³ 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
⁴ Department of Angiology, Health Centre, Trnava, Slovakia.
⁵ General Health Insurance Company, Bratislava, Slovakia.
⁶ Institute of Medical Physics, Biophysics, Informatics and Telemedicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
⁷ Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia.
⁸ Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.
⁹ School of Pharmacy, University of Eastern Finland, Kuopio, Finland.

Abstract

Introduction: As in other chronic conditions, medication adherence is important in the treatment of peripheral arterial disease (PAD). Our study aimed at a) analysing non-adherence to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in groups of older ACEI and ARB users with PAD, and b) identifying characteristics associated with non-adherence. Methods: We focused on the implementation phase of adherence (i.e., after treatment initiation and before possible discontinuation of treatment). The study cohort included ACEI/ARB users aged ≥65 years in whom PAD was newly diagnosed during 2012. Non-adherence was defined as Proportion of Days Covered (PDC) < 80%. Results: Among 7,080 ACEI/ARB users (6,578 ACEI and 502 ARB users), there was no significant difference in the overall proportion of non-adherent patients between ACEI and ARB users (13.9% and 15.3%, respectively). There were differences in factors associated with non-adherence between the groups of persistent and non-persistent (i.e., discontinued treatment at some point during follow-up) ACEI and ARB users. Increasing age, dementia and bronchial asthma were associated with non-adherence in persistent ACEI users. General practitioner as index prescriber was associated with adherence in the groups of non-persistent ACEI users and persistent ARB users. Conclusion: Identified factors associated with non-adherence may help in determining the groups of patients who require increased attention.

Keywords: Anxiety disorder; dementia; general practitioner; new user; non-adherence; non-persistence; peripheral arterial disease; polypharmacy.

Grants and funding

This research was funded by a grant from the Scientific Grant Agency of the Ministry of Education, Science, Research and Sport of the Slovak Republic VEGA 1/0024/21. EA has received funding from the Finnish Cultural Foundation. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.