Abstract
Objectives
The purpose of this study was to describe levels of adherence to guideline-based medical
management in patients with aortic aneurysms, using an analogous population with coronary
artery disease as a comparator. Adherence among those with aortic aneurysms has never
been studied.
Methods
Adult patients with an aortic aneurysm or coronary artery disease diagnosed between
2004 and 2018 in the Optum Clinformatics deidentified Datamart were queried. Aneurysms
were subclassified as thoracic, abdominal, or both. Receipt of an antihypertensive
or antihyperlipidemic was determined through pharmacy claims. Adherence was determined
as receipt of the indicated pharmacologic(s) after a diagnosis of aneurysm or coronary
artery disease. Adherence was compared between those with aneurysms and coronary disease
using univariable logistic regression.
Results
After exclusions, 194,144 patients with an aortic aneurysm and 3,946,782 with coronary
artery disease were identified. Overall adherence was low (45.0%) and differed significantly
by aneurysm subtype: highest in isolated thoracic (45.9%) and lowest in isolated abdominal
aneurysms (42.6%). Adherence levels declined significantly after 1 year by about 15%
in each aneurysm subtype. All subtypes of aneurysm had a significantly lower odds
of adherence compared to those with coronary disease with odds ranging from 0.61 in
those with isolated abdominal aneurysms to 0.80 with isolated thoracic aneurysms.
Conclusions
Adherence among those with aortic aneurysms is very low, differs by subtype, and declines
with time. Levels of adherence in those with aortic aneurysms is significantly lower
compared to those with coronary artery disease. This should prove a reasonable target
for implementation initiatives.
Graphical Abstract
Graphical Abstract
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults.JAMA. 2012; 307: 1273-1283https://doi.org/10.1001/jama.2012.339
- Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association.Circulation. 2011; 123: 933-944https://doi.org/10.1161/CIR.0b013e31820a55f5
- Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm.BMJ. 2004; 329: 1259https://doi.org/10.1136/bmj.38272.478438.55
- The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial.Lancet. 2002; 360: 1531-1539https://doi.org/10.1016/s0140-6736(02)11522-4
- Incidence and prevalence of thoracic aortic aneurysms: a systematic review and meta-analysis of population-based studies.Semin Thorac Cardiovasc Surg. 2022; 34: 1-16https://doi.org/10.1053/j.semtcvs.2021.02.029
Centers for Disease Control and Prevention, National Center for Health Statistics. CDC WONDER Online Database. Available at: https://wonder.cdc.gov/. Accessed November 3, 2022.
- 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease.J Am Coll Cardiol. 2012; 60: e44-e164https://doi.org/10.1016/j.jacc.2012.07.013
- 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine.Circulation. 2010; 121: 1544-1579https://doi.org/10.1161/CIR.0b013e3181d4739e
- 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult.Eur Heart J. 2014; 35: 2873-2926https://doi.org/10.1093/eurheartj/ehu281
- The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.J Vasc Surg. 2018; 67 (e2): 2-77https://doi.org/10.1016/j.jvs.2017.10.044
- Medication adherence in cardiovascular disease.Circulation. 2010; 121: 1455-1458https://doi.org/10.1161/CIRCULATIONAHA.109.904003
- Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease.Circulation. 2006; 113: 203-212https://doi.org/10.1161/CIRCULATIONAHA.105.505636
- Adherence with statin therapy in elderly patients with and without acute coronary syndromes.JAMA. 2002; 288: 462-467https://doi.org/10.1001/jama.288.4.462
- Stable coronary artery disease: treatment.Am Fam Physician. 2018; 97: 376-384
- 2013 ESC guidelines on the management of stable coronary artery disease. The Task Force on the management of stable coronary artery disease of the European Society of Cardiology.Rev Esp Cardiol. 2014; 67: 135https://doi.org/10.1016/j.rec.2013.11.008
- Adherence to coronary artery disease secondary prevention medicines: exploring modifiable barriers.Open Heart. 2019; 6e000997https://doi.org/10.1136/openhrt-2018-000997
- Non-adherence to cardiovascular medications.Eur Heart J. 2014; 35: 3267-3276https://doi.org/10.1093/eurheartj/ehu364
- Impact of medication therapy discontinuation on mortality after myocardial infarction.Arch Intern Med. 2006; 166: 1842-1847https://doi.org/10.1001/archinte.166.17.1842
- Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction.Circulation. 2008; 117: 1028-1036https://doi.org/10.1161/CIRCULATIONAHA.107.706820
Article Info
Publication History
Published online: July 08, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: The National Institutes of Health ( T32HL007843 ) provided funding to William L. Patrick.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
