Perfil de utilização de estatinas e adesão ao tratamento em pacientes com doença arterial coronariana de um ambulatório de cardiologia de um hospital de ensino

Abstract

GROIA-VELOSO, R.C.S. Pattern of statin utilization and adherence treatment of patients with coronary artery disease at cardiology outpatient clinic of a teaching hospital 2019. 117 f. Master Degree Dissertation. Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, 2019.

Statins are characterized by the reduction of LDL cholesterol, decreasing the incidence of cardiovascular events, and a significant beneficial effect in patients with coronary artery disease (CAD). Studies on the use of medicines in the real-world and on adherence are essential for the elaboration of strategies aimed at qualifying health care. The objective of this research was to describe the pattern of the use of statins and adherence to treatment in patients with CAD at a cardiology outpatient clinic of a public hospital in Belo Horizonte. Cross-sectional study in a multidisciplinary cardiology outpatient clinic of a teaching hospital in Belo Horizonte, Minas Gerais with a sample of 148 patients with CAD and statin use, selected from April 2018 to February 2019. The prescribed statin, medications used concomitantly, adherence to treatment and access were identified. Therapy intensity was identified by analyzing the type of statin and the prescribed dose. The level of adherence to the recommendations of intensity of the statin therapy of Brazilian and American dyslipidemia guidelines was established. Adherence to statin therapy was determined by the Measurement of Adherence to Treatment (MAT), Visual Analog Adherence Scale (EVA) of adherence and 7-days recall. Access to statin was analyzed through the availability and acquisition capacity realms. The clinicallyrelevant drug interactions with statins were verified per the American Heart Association. We performed a descriptive analysis and determination of the level of agreement between the adherence scales by the Kappa Cohen coefficient. We identified that 90.6% of the patients used moderate-intensity statin, and simvastatin was the most common. The level of adherence to the recommendations of Brazilian and American dyslipidemia guidelines for statin use was 9.4% and 21.6%, respectively. Regarding the availability of access, 44.6% of respondents reported total access to statin through the public sector, and 16.2% reported having stopped buying something important to cover expenses with statin treatment. No patient had access to atorvastatin or rosuvastatin in the public system. We verified that 98.1% of the patients used some beta-blocker, 86.5% acetylsalicylic acid, 68.3% an agent that acts on the renin angiotensin system, and 65.5% clopidogrel. The frequency of clinically-relevant interactions with statin was 43.2%. Adherence to statin treatment was 98.6% using MAT, 95.9% through EVA adherence and 95.3% with the 7-days recall. The agreement levels between MAT and EVA (0.277) and MAT and 7-days recall (0.241) were low. A high level of agreement was found between EVA and 7days recall (0.759). The reliability (internal consistency) of MAT measured by Cronbach's alpha of the instrument was 0.66. The level of adherence to the recommendations of U.S. and Brazilian guidelines of dyslipidemia for statin use was low. Most patients used moderate-intensity statin, despite having a high cardiovascular risk. Simvastatin was the most prescribed statin. EVA adherence and 7-days recall were shown to be easy to apply and low-cost adherence measurements to identify statin adherence in patients with CAD. The MAT adequate reliability and may be used additionally to provide information regarding the specific reasons for non-adherent behavior.