Incident prescriptions for common cardiovascular medications: comparison of recent versus pre-2020 medication adherence and discontinuation in three universal health care systems
Abstract Background Health system disruptions since onset of the COVID-19 pandemic may have adversely impacted adherence to medications for common cardiovascular risk factors. Methods We examined adherence to and discontinuation of incident prescriptions for medications treating hypertension, dyslip...
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BMC
2025-02-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-025-04492-3 |
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| author | Candace D. McNaughton Peter C. Austin Cynthia A. Jackevicius Anna Chu Jessalyn K. Holodinsky Michael D. Hill Colleen M. Norris Mukesh Kumar Noreen Kamal Douglas S. Lee Nadia Khan Manav V. Vyas Raed A. Joundi Moira K. Kapral Amy Y. X. Yu |
| author_facet | Candace D. McNaughton Peter C. Austin Cynthia A. Jackevicius Anna Chu Jessalyn K. Holodinsky Michael D. Hill Colleen M. Norris Mukesh Kumar Noreen Kamal Douglas S. Lee Nadia Khan Manav V. Vyas Raed A. Joundi Moira K. Kapral Amy Y. X. Yu |
| author_sort | Candace D. McNaughton |
| collection | DOAJ |
| description | Abstract Background Health system disruptions since onset of the COVID-19 pandemic may have adversely impacted adherence to medications for common cardiovascular risk factors. Methods 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. Results 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. Conclusions 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. |
| format | Article |
| id | doaj-art-3d170fee6ab04d17be06bb5df41bb61d |
| institution | Kabale University |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-3d170fee6ab04d17be06bb5df41bb61d2025-02-09T12:11:18ZengBMCBMC Cardiovascular Disorders1471-22612025-02-0125111110.1186/s12872-025-04492-3Incident prescriptions for common cardiovascular medications: comparison of recent versus pre-2020 medication adherence and discontinuation in three universal health care systemsCandace D. McNaughton0Peter C. Austin1Cynthia A. Jackevicius2Anna Chu3Jessalyn K. Holodinsky4Michael D. Hill5Colleen M. Norris6Mukesh Kumar7Noreen Kamal8Douglas S. Lee9Nadia Khan10Manav V. Vyas11Raed A. Joundi12Moira K. Kapral13Amy Y. X. Yu14ICESICESICESICESDepartments of Emergency Medicine, Cumming School of Medicine, University of CalgaryDepartment of Community Health Sciences, Cumming School of Medicine, University of CalgaryFaculty of Nursing, Faculty of Medicine & School of Public Health, University of AlbertaDepartment of Industrial Engineering, Dalhousie UniversityDepartment of Industrial Engineering, Dalhousie UniversityICESDepartment of Medicine, University of British ColumbiaICESDepartment of Medicine, Division of Neurology, McMaster University, and Population Health Research InstituteICESICESAbstract Background Health system disruptions since onset of the COVID-19 pandemic may have adversely impacted adherence to medications for common cardiovascular risk factors. Methods 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. Results 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. Conclusions 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.https://doi.org/10.1186/s12872-025-04492-3Cardiovascular risk factorsHypertensionDiabetesDyslipidemiaAtrial fibrillationMedication adherence |
| spellingShingle | Candace D. McNaughton Peter C. Austin Cynthia A. Jackevicius Anna Chu Jessalyn K. Holodinsky Michael D. Hill Colleen M. Norris Mukesh Kumar Noreen Kamal Douglas S. Lee Nadia Khan Manav V. Vyas Raed A. Joundi Moira K. Kapral Amy Y. X. Yu Incident prescriptions for common cardiovascular medications: comparison of recent versus pre-2020 medication adherence and discontinuation in three universal health care systems BMC Cardiovascular Disorders Cardiovascular risk factors Hypertension Diabetes Dyslipidemia Atrial fibrillation Medication adherence |
| title | Incident prescriptions for common cardiovascular medications: comparison of recent versus pre-2020 medication adherence and discontinuation in three universal health care systems |
| title_full | Incident prescriptions for common cardiovascular medications: comparison of recent versus pre-2020 medication adherence and discontinuation in three universal health care systems |
| title_fullStr | Incident prescriptions for common cardiovascular medications: comparison of recent versus pre-2020 medication adherence and discontinuation in three universal health care systems |
| title_full_unstemmed | Incident prescriptions for common cardiovascular medications: comparison of recent versus pre-2020 medication adherence and discontinuation in three universal health care systems |
| title_short | Incident prescriptions for common cardiovascular medications: comparison of recent versus pre-2020 medication adherence and discontinuation in three universal health care systems |
| title_sort | incident prescriptions for common cardiovascular medications comparison of recent versus pre 2020 medication adherence and discontinuation in three universal health care systems |
| topic | Cardiovascular risk factors Hypertension Diabetes Dyslipidemia Atrial fibrillation Medication adherence |
| url | https://doi.org/10.1186/s12872-025-04492-3 |
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