Chronic medication intake in patients with stable coronary heart disease across Europe: Evidence from the daily clinical practice. Results from the ESC EORP European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE IV) Registry

  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Delphine De Smedt
    Correspondence
    Corresponding author at: Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    ,
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    2 ESC fellow.
    Tine De Backer
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    2 ESC fellow.
    Affiliations
    Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium

    Ghent University Hospital, Ghent, Belgium
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Mirko Petrovic
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Affiliations
    Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium

    Ghent University Hospital, Ghent, Belgium
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    Guy De Backer
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
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    Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    ,
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    2 ESC fellow.
    David Wood
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    2 ESC fellow.
    Affiliations
    National Heart & Lung Institute, Imperial College London, London, UK

    National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    ,
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    2 ESC fellow.
    Kornelia Kotseva
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    2 ESC fellow.
    Affiliations
    National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland

    Imperial College Healthcare NHS Trust, London, UK
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    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    ,
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    2 ESC fellow.
    Dirk De Bacquer
    Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    2 ESC fellow.
    Affiliations
    Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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  • Author Footnotes
    1 This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
    2 ESC fellow.
Published:September 07, 2019DOI:https://doi.org/10.1016/j.ijcard.2019.09.015

      Highlights

      • Nearly all stable coronary patients are on some kind of cardiovascular drug.
      • Despite the use of cardiovascular drugs, a large proportion of patients is still not on risk factor target.
      • In patients with comorbidities, the recommended medication uptake is often not achieved.
      • Physicians should seek for a benefit-risk balance in prescribing medication.

      Abstract

      Background

      As advised by the European guidelines on cardiovascular prevention, medication intake is a major component of secondary prevention. The aim of this study is to provide an in-depth overview of the medication intake in stable European coronary heart disease (CHD) patients.

      Methods

      Analyses are based on the EUROASPIRE IV survey, including CHD patients (18 to 80 years) who were hospitalized for a coronary event. These patients were interviewed and examined 6 months to 3 years after their hospitalization. Information on cardiovascular medication intake is available for 7953 patients.

      Results

      About 99.2% of patients were on any kind of cardiovascular medication and 67.6% of patients were taking at least 5 different cardiovascular drugs. Overall, even when patients are taking the recommended drug combination as advised by the European guidelines - accounting for their disease profile - a large proportion of patients is still not on blood pressure, LDL-C or HbA1c target. In addition, huge variations were seen in medication dose intake across countries. Comparing the dose intake to the defined daily dose (DDD as published by the WHO) indicated a substantial deviation from the DDDs for a large proportion of patients.

      Conclusion

      This study provides a unique overview of the cardiovascular medication intake in CHD patients. Overall, even when patients are taking the advised drug combination, a large proportion of patients is still not on risk factor target. Physicians should seek for a balance in medication intake and appropriate dose, accounting both for the benefits and risks of chronic drug intake.

      Keywords

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      References

        • WHO
        • Wilkins E.
        • Wickramasinghe K.
        • Bhatnagar P.
        • et al.
        European cardiovascular disease statistics.
        • Nichols M.
        • Townsend N.
        • Scarborough P.
        • Rayner M.
        Cardiovascular disease in Europe 2014: epidemiological update.
        Eur. Heart J. 2014; 35: 2929
        • Graham I.
        • Atar D.
        • Borch-Johnsen K.
        • et al.
        European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts).
        Eur. J. Cardiovasc. Prev. Rehabil. 2007; 14: S1-113
        • Perk J.
        • De Backer G.
        • Gohlke H.
        • et al.
        European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts).
        Eur. Heart J. 2012; 33: 1635-1701
        • Piepoli M.F.
        • Hoes A.W.
        • 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: 2315-2381
        • Pflieger M.
        • Winslow B.T.
        • Mills K.
        • Dauber I.M.
        Medical management of stable coronary artery disease.
        Am. Fam. Physician. 2011; 83: 819-826
        • Kumar A.
        • Fonarow G.C.
        • Eagle K.A.
        • et al.
        Regional and practice variation in adherence to guideline recommendations for secondary and primary prevention among outpatients with atherothrombosis or risk factors in the United States: a report from the REACH Registry.
        Crit. Pathw. Cardiol. 2009; 8: 104-111
        • Vedin O.
        • Hagström E.
        • Stewart R.
        • et al.
        Secondary prevention and risk factor target achievement in a global, high-risk population with established coronary heart disease: baseline results from the STABILITY study.
        Eur. J. Prev. Cardiol. 2013; 20: 678-685
        • Yusuf S.
        • Islam S.
        • Chow C.K.
        • et al.
        Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE study): a prospective epidemiological survey.
        Lancet. 2011; 378: 1231-1243
        • Kotseva K.
        • Wood D.
        • De Bacquer D.
        • et al.
        EUROASPIRE IV: a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries.
        Eur. J. Prev. Cardiol. 2016; 23: 636-648
        • Levey A.S.
        • Stevens L.A.
        • Schmid C.H.
        • et al.
        A new equation to estimate glomerular filtration rate.
        Ann. Intern. Med. 2009; 150: 604-612
        • WHO
        Defined Daily Dose Index 2019.
        • Tang L.
        • Patao C.
        • Chuang J.
        • Wong N.D.
        Cardiovascular risk factor control and adherence to recommended lifestyle and medical therapies in persons with coronary heart disease (from the National Health and Nutrition Examination Survey 2007–2010).
        Am. J. Cardiol. 2013; 112: 1126-1132
        • EUROASTAT
        Prescribed medication statistics.
        (Available from:)
        • Halvorsen S.
        • Jortveit J.
        • Hasvold P.
        • Thuresson M.
        • Øie E.
        Initiation of and long-term adherence to secondary preventive drugs after acute myocardial infarction.
        BMC Cardiovasc. Disord. 2016; 16: 115
        • Arnold S.V.
        • Spertus J.A.
        • Masoudi F.A.
        • et al.
        Beyond medication prescription as performance measures: optimal secondary prevention medication dosing after acute myocardial infarction.
        J. Am. Coll. Cardiol. 2013; 62: 1791-1801
        • van der Laan D.M.
        • Elders P.J.M.
        • Boons C.C.L.M.
        • Nijpels G.
        • Krska J.
        • Hugtenburg J.G.
        The impact of cardiovascular medication use on patients' daily lives: a cross-sectional study.
        Int. J. Clin. Pharm. 2018; 40: 412-420
        • Albarqouni L.
        • Doust J.
        • Glasziou P.
        Patient preferences for cardiovascular preventive medication: a systematic review.
        Heart. 2017; 103: 1578-1586
        • Trewby P.N.
        • Reddy A.V.
        • Trewby C.S.
        • Ashton V.J.
        • Brennan G.
        • Inglis J.
        Are preventive drugs preventive enough? A study of patients' expectation of benefit from preventive drugs.
        Clin. Med. (Lond.). 2002; 2: 527-533
        • Rossello X.
        • Pocock S.J.
        • Julian D.G.
        Long-term use of cardiovascular drugs: challenges for research and for patient care.
        J. Am. Coll. Cardiol. 2015; 66: 1273-1285
        • Abolbashari M.
        • Macaulay T.E.
        • Whayne T.F.
        • Mukherjee D.
        • Saha S.
        Polypharmacy in cardiovascular medicine: problems and promises!.
        Cardiovasc. Hematol. Agents Med. Chem. 2017; 15: 31-39
        • Fuller R.H.
        • Perel P.
        • Navarro-Ruan T.
        • Nieuwlaat R.
        • Haynes R.B.
        • Huffman M.D.
        Improving medication adherence in patients with cardiovascular disease: a systematic review.
        Heart. 2018; 104: 1238-1243