The Pharmaceutical Journal
Vol 269 No 7208 p121
27 July 2002

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Pharmacy records could be used to enhance statin compliance in elderly

Compliance with statin therapy among elderly patients declines substantially in as little as two years, suggesting that the benefits of treatment could be lost, according to two new studies. Researchers suggest that pharmacy records could be used to monitor patients' compliance.

Canadian researchers compared two-year adherence to statin treatment among three cohorts of patients aged over 66 years — 22,379 had acute coronary syndrome (ACS), 36,106 had chronic coronary artery disease (CAD), and 85,020 were undergoing primary prevention and had no coronary disease (JAMA 2002;288:462).

Compliance with medication decreased continuously from initiation of therapy and was lower in all three cohorts after two years follow-up — 40.1 per cent for those with ACS, 36.1 per cent for those with acute CAD and only 25.4 per cent among the primary prevention group.

Previous clinical trials have shown that statins reduce mortality and morbidity in patients with coronary artery disease, but only after one to two years of continuous treatment. Now the Canadian researchers, who believe their results are applicable to other, similar populations, say many patients given statins gain little benefit from them as a result of premature discontinuation of therapy. They suggest pharmacists could play an important role in improving compliance: "Initiation of therapy in the hospital is one possible step to ensuring patient adherence. Ongoing reminders during physician office visits or by community pharmacists, or detailed patient education programs, could also potentially increase adherence rates," they say.

Meanwhile, researchers in the United States followed up over 34,000 statin users aged 65 years or older and found the greatest drop in compliance with therapy occurred within the first six months of treatment (ibid, p455). They calculated that the proportion of days covered by statin therapy fell from 79 per cent in the first three months of treatment, to less than half (42 per cent) by 120 months. Poor long-term compliance was associated with lower socioeconomic status, older age, being of non-white race, depression, dementia, less cardiovascular morbidity or occurrence of coronary events after treatment initiation. The authors of this second study conclude that interventions are needed early on in the treatment, especially among high-risk groups such as those experiencing coronary events after treatment initiation.

In an accompanying editorial, Dr William Applegate, from Wake Forest University Health Sciences, North Carolina, suggests pharmacy records could be used to predict compliance. "This could be a useful screening tool to begin to detect problems with individual patients' persistence with chronic medication regimens," he says.