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Published on: February 26, 2013
TREATMENT COMPLETION AND IMPLEMENTATION BY PATIENTS INITIATING TICAGRELOR
Jean-Pierre Grégoire1,2, Paul Poirier1,3, Norma Perez4
1Laval University Faculty of Pharmacy.
Insights
Most patients with acute coronary syndrome do not complete 12 months of ticagrelor treatment, but those who do show high adherence. Identifying factors associated with ticagrelor completion can improve secondary prevention strategies.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Ticagrelor is crucial for secondary prevention after acute coronary syndrome (ACS).
- Adherence to ticagrelor treatment is vital for reducing adverse events and mortality in ACS patients.
Purpose of the Study:
- To assess the 12-month treatment completion rate for new ticagrelor users.
- To identify factors influencing ticagrelor treatment completion.
- To evaluate treatment implementation among patients who completed 12 months of ticagrelor.
Main Methods:
- Retrospective cohort study of Quebec residents aged 18+ initiating ticagrelor (2012-2014).
- Treatment completion defined as continuous use for 12 months.
- Log-binomial regression used to identify factors associated with completion.
- Treatment implementation assessed by proportion of days covered (PDC).
Main Results:
- 62.1% (2,235/3,600) of patients completed 12 months of ticagrelor.
- Factors associated with higher completion included GP visits, PCI, statin/fibrate, and antihypertensive use.
- Older patients, those with atrial fibrillation, frequent physician visits, and anticoagulant use were less likely to complete.
- Median PDC was 96.2% among completers.
Conclusions:
- Ticagrelor treatment completion rates may require improvement.
- Treatment implementation was high among patients who completed the 12-month course.
- Identifying factors linked to completion can guide interventions to optimize adherence and secondary prevention in ACS.
Background:
In secondary prevention of adverse events and death following acute coronary syndrome, patients may benefit from adhering to a ticagrelor treatment.
Objectives:
The authors assessed the proportion of new ticagrelor users who completed 12 months of treatment, explored the factors associated with treatment completion and, among the completers, evaluated the 12-month treatment implementation.
Methods:
A retrospective administrative health database inception cohort study was conducted in a population that included Quebec residents ≥18 years of age who initiated ticagrelor between January 1, 2012 and March 31, 2014. A patient still on ticagrelor at the end of the 12-month period after treatment initiation was considered to have completed the treatment. Factors associated with treatment completion were identified using log-binomial regression. Implementation was assessed using the proportion of days covered (PDC).
Results:
Of the 3,600 patients, 2,235 (62.1%) completed 12 months of treatment. The patients who were more likely to complete their treatment included those who had visited a general practitioner, had a percutaneous coronary intervention, used a statin or fibrate, and those who used an antihypertensive drug during the year preceding the ticagrelor treatment initiation. Older patients, those with atrial fibrillation, those who had ≥ 6 physician visits and those who used an anticoagulant were less likely to complete the 12-month treatment. The median PDC was 96.2%.
Conclusion:
Treatment completion might be improved. Among patients who completed the treatment, implementation was high. The factors associated with completion could help to identify patients who might benefit from interventions that aim to optimize treatment completion.
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