Slide 1: Educational purposes disclaimer
This presentation is offered for educational purposes only, intended to serve as continuing medical education for health care professionals. The content of the presentation represents the views and opinions of the original creators of such content and does not necessarily represent the views or opin
Slide 2: Acting on the unseen: How do we help patients to remain adherent when they are asymptomatic?
A:CARE CONGRESS Acting on the unseen: How do we help patients to remain adherent when they are asymptomatic? Prof. Markus Schlaich Prof. S. Lale Tokgözoğlu Dr. Sheri Pruitt Dobney Chair in Clinical Research, Professor of Cardiology Clinical Psychologist and Behavioral Dobney Hypertension Centre, Sch
Slide 3: Is Doctor's prescribing the first step in setting the asymptomatic patient up for failure?
ACTING ON THE UNSEEN: HOW DO WE HELP PATIENTS TO REMAIN ADHERENT WHEN THEY ARE ASYMPTOMATIC? Is Doctor’s prescribing the first step in setting the asymptomatic patient up for failure? – Lessons from management of hypertension Prof. Markus Schlaich, MD, FAHA, FESC, ISHF University of Western Australi
Slide 4: Adherence with prescribed medication in randomized controlled trials
Adherence with prescribed medication in randomized controlled trials (RCTs): What percentage of patients do you think 100% 90% 75% 50-60% <50% are adherent with medication in RCTs? To participate in polling please exit full screen mode GLO2208854 | Nov-21 | 4
Slide 5: Non-adherence with prescribed antihypertensive drug in clinical studies
Non-adherence with prescribed antihypertensive drug in clinical studies 70 60 30 to 50% non-adherence rate 50 44% is consistent between clinical 40 trials and medical practice 30 Poor and dynamic adherence 20 17% introduces variability to trial endpoints 10 Not easily controlled, even 0 Ceral Xxx (2
Slide 6: Adherence to antihypertensive medication and incident CV events in young adults
Adherence to antihypertensive medication and incident CV events in young adults with hypertension COMPOSITE CVD EVENTS Group Events Person-yrs Rate1 HR (95% CI) Adherence group Adherent 855 447,564 191.0 1.00 (reference) Nonadherent 2,147 761,129 282.1 1.58 (1.45-1.71) Proportion of days covered, qu
Slide 7: ~30% of Adults Would Rather Die Early than Take Lifelong Polypharmacy
~30% of Adults Would Rather Die Early than Take Lifelong Polypharmacy 8.2% OF ADULTS WOULD GIVE UP 2 YEARS OF THEIR LIFE TO AVOID ADDING 1 DAILY PILL 80% N = 1000 69.7 60% Patients 40% 20% 5.5 8.2 3.1 4.1 2.2 2.5 3.7 0.5 0.5 0% 0,00 1,00 2,00 4,35 13,04 26,09 39,13 52,18 78,27 104,36 Number of weeks
Slide 8: Adherence is a Behavior ... Adherence to Placebo is a good Behavior!
Adherence is a Behavior ... Adherence to Placebo is a good Behavior! Good adherence was associated with The adjusted HR for good adherence lower all-cause mortality in all patients was similar in the candesartan (0·66) HR 0·65, 95% CI 0·57–0·75) and placebo (0·64) groups. Numbers at risk A Candersar
Slide 9: Reasons for poor adherence to antihypertensive therapy – Patient perspective
Reasons for poor adherence to antihypertensive therapy – Patient perspective PATIENT • Lack of symptoms • Lack of understanding of disease and of treatment need • Fear of possible/experienced adverse effects • Actual/perceived lack of treatment benefits • Fear of stigma associated with disease • Tre
Slide 10: Reasons for poor adherence – Practitioner and Health Care perspective
Reasons for poor adherence to antihypertensive therapy – Practitioner and Health Care perspective PRACTITIONER • Physician inertia • Inadequate prescription/Regimen complexity • Lack of guideline knowledge/lack of training for hypertension treatment • Communication skills • Patient-provider relation
Slide 11: Time spent discussing use of medication in hypertension centers
Time spent discussing use of medication in hypertension centers: How much time do you think doctors in hypertension 15 10 5 1-5 1 centers on average spend minutes minutes minutes minutes minute discussing use of medication with patients? To participate in polling please exit full screen mode GLO2208
Slide 12: Time spent by physicians talking with patients about their use of medications
Time spent by physicians talking with patients about their use of medications - a survey of ESH Centers of Excellence 60 50 40 30 20 10 0 no time at all <1 minute 1-5 minutes 6-10 minutes 11-15 minutes >15 minutes Global Males Females Burnier M, Prejbisz A, Weber T, et al. Hypertension healthcare pr
Slide 13: Interventions to improve adherence
Interventions to improve adherence Assess each patient’s needs and offer individualized solutions Make pill-taking easier for the patient Improve patient-practitioner communication in a blame-free environment Educate patients Offer motivational interviewing Involve patient in decision-making/empower
Slide 14: Relevance of timing of antihypertensive therapy
Relevance of timing of antihypertensive therapy 30 In Morning In Evening At Variable times Percentage of study days without intake 25 20 15 DRUG TAKEN 10 5 0 Monday Tuesday Wednesday Thursday Friday Saturday Sunday Day Vrijens B, Vincze G, Kristanto P, Urquhart J, Burnier M. Adherence to prescribed
Slide 15: Patients prefer to take less pills
Patients prefer to take less pills Non-adherence to antihypertensive medicines in the real world- according to number of medicines PATIENTS PREFER TO TAKE 1 PILL 80 % of non-adherent individuals 60 40 20 0 1 2 3 4 5 6+ Number of prescribed antihypertensive medications UK Czech Republic Gupta P, et a
Slide 16: Monitoring adherence in chronic cardiovascular disease
ACTING ON THE UNSEEN: HOW DO WE HELP PATIENTS TO REMAIN ADHERENT WHEN THEY ARE ASYMPTOMATIC? Monitoring adherence in chronic cardiovascular disease Prof. S. Lale Tokgözoğlu MD, FACC, FESC Dept. of Cardiology Hacettepe University, Ankara, Turkey GLO2208854 | Nov-21 | 16
Slide 17: Disclosures
Disclosures SPEAKER/ ADVISORY BOARD Abbott Actelion Amgen Bayer Mylan Novartis Novo Nordisk Pfizer Recordati Sanofi Servier GLO2208854 | Nov-21 | 17
Slide 18: Relative risks for any cardiovascular disease in good vs. poor adherence
Relative risks for any cardiovascular disease in good vs. poor (<80%) adherence META-ANALYSIS OF 44 STUDIES, N= 1 978 919; 135 627 CVD EVENTS; 94 126 CASES OF ALL-CAUSE MORTALITY -15% Chowdhury R, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eu
Slide 19: Achieving treatment targets in patients with coronary artery disease
Achieving treatment targets in patients with coronary artery disease ATTAINING TARGETS IN CAD PATIENTS FROM 24 EUROPEAN EUROASPIRE IV STATIN THERAPY AT DISCHARGE: INSTEAD COUNTRIES1 EA IV OF ESCALATING RX TO GET TO GOAL, DE-ESCALATE AT FU 84 79 67 68 Prevalence (%) 49 42 44 40 30 26 BP ≥ 130/80 mmHg
Slide 20: How to measure adherence?
How to measure adherence ? Method Advantages Disadvantages • Simple • Subject to recall bias Self –report • Low cost • Poor-to-moderate correlation with objective measures • May reveal reasons for non- adherence • Only pertain to most recent dosing Physiologic or laboratory • May reflect only pharma
Slide 21: Self-reported measures tend to overestimate medication adherence
Self-reported measures tend to overestimate medication adherence NON-ADHERENCE HIGHER IN LMIC: EXPENSIVE MEASURES NOT REALISTIC Self-reported medication adherence measures vary in 100 their question phrasing, recall periods, and response 90 items. 80 Adherence to CV medication Tend to overestimate a
Slide 22: Medication Adherence Interventions for Cardiovascular Disease in Low- and Middle-Income Countries
Medication Adherence Interventions for Cardiovascular Disease in Low- and Middle-Income Countries: A Systematic Review Multi-component interventions were more effective than unifocal interventions. Interventions involving technology, such as mobile phone calls, electronic pillboxes, and interactive
Slide 23: Polypill: Possible to track by biomarkers; increases adherence significantly
Polypill: Possible to track by biomarkers; increases adherence significantly-Solution for LMIC ADHERENCE TO MEDICATION DUE TO FREQUENCY INDIAN POLYCAP STUDY UMPIRE IMPACT OF DOSES 100 10,0 100,0 P<0.01 90,0 P<0.001 90 81,0 86,0 Rate of Adherence (%) 9,0 90,0 80,0 80 7,8 Discontinuation of treatment
Slide 24: Pharmacy care improves adherence: FAME study
Pharmacy care improves adherence: In FAME, elderly patients with coronary risk factors were randomized to usual care vs. a multi-component program FAME STUDY RUN IN PHASE PHASE 1 (8 mo) PHASE 2 (24 mo) 21.7% (≥80% adherence to all Usual care Usual care Pharmacy care Usual care medications) Pharmacy
Slide 25: Patient engagement essential even for pharmacy care (1/2)
Patient engagement essential even for pharmacy care and for most other methods to work ! (1/2) TECHNOLOGY BASED PROGRAMS INCREASE PATIENT ENGAGEMENT Intervention Control Measurement P-value arm arm SMS and automated behavioral education ≥80% PDC 62.8% 49.4% <0.001 response SMS, automated education r
Slide 26: Patient engagement essential even for pharmacy care (2/2)
Patient engagement essential even for pharmacy care and for most other methods to work ! (2/2) STATIN COMPLIANCE OVER TIME Not filled -12% Not started -12% Not finished -29% 100% 88% 76% 47% • Understanding benefits • Perceived SE • Forgetfulness of therapy • Not Understanding • Side effects Common
Slide 27: Electronic monitoring systems show 97% accuracy
Electronic monitoring systems show 97% accuracy • Multicompartmental pillbox will transmit a signal to a receiver and into a computer shared with physician and emailed texted to patient showing date and time • Smart electronic packaging/device monitoring is 97% accurate, ahead of pill counts (60%),
Slide 28: Adherence measurement using ingestible sensor
Adherence measurement using ingestible sensor • The sensor emits a signal when it encounters the acidic environment of the stomach, detectable by an externally worn patch and linked software app. • Longitudinal adherence data in the form of daily progress charts for sensed dosing events as compared
Slide 29: You need patient motivation for even most sophisticated methods
You need patient motivation for even most sophisticated methods • New nucleic acid-based therapies with once yearly injections, new medications with less side effects or FDC and new Technologies are helpful • Shared decision making with the patient is the key! • Nothing about me without me! – Valeri
Slide 30: Which method to measure adherence would you prefer to use?
Which method to measure adherence would you prefer to use in your clinical practice? Self report Lab markers Pharmacy refill rates Pill count Electronic monitors To participate in polling please exit full screen mode GLO2208854 | Nov-21 | 30
Slide 31: Influencing Adherence to Hypertension Medications when Patients "Feel Fine"
ACTING ON THE UNSEEN: HOW DO WE HELP PATIENTS TO REMAIN ADHERENT WHEN THEY ARE ASYMPTOMATIC? Influencing Adherence to Hypertension Medications when Patients “Feel Fine” Dr. Sheri Pruitt, PhD Clinical Psychologist and Behavioral Science Consultant California, US GLO2208854 | Nov-21 | 31
Slide 32: Medications for hypertension are highly effective
Medications for hypertension are highly effective High adherence to antihypertensive medication is associated with 1 higher odds of blood pressure control1 Non-adherence to medications increases a patient’s risk of death from 2 50% to 80%1 Poor adherence to hypertension treatment is the most importa
Slide 33: Hypertension is increasing
Hypertension is increasing WHAT PERCENTAGE OF THE WORLD’S POPULATION WILL HAVE HYPERTENSION BY 2025? 18% 23% 29% 50% Hasan DM, Emeash AH, Mustafa SB, Abdelazim GE, El-din AA. Hypertension in Egypt: a systematic review. Curr Hypertens Rev. 2014;10(3):134-41. To participate in polling please exit full
Slide 34: 29% will have hypertension by 2025; only 50% will take their medicines as prescribed
29% will have hypertension by 2025 Only 50% will take their medicines as prescribed How can we do better with the hypertension medicines we have? Hasan DM, Emeash AH, Mustafa SB, Abdelazim GE, El-din AA. Hypertension in Egypt: a systematic review. Curr Hypertens Rev. 2014;10(3):134-41. GLO2208854 |
Slide 35: Serious complications from non-adherence to advice
Serious complications from non-adherence to advice Heart attack or stroke Aneurysm Heart failure Weakened and narrowed blood vessels in kidneys Thickened, narrowed or torn blood vessels in the eyes Metabolic syndrome Trouble with memory or understanding Why don’t patients do everything they can to D
Slide 36: Because there is a very long list of recommendations
Because there is a very long list of recommendations And, because patients 1 Eat a well-balanced diet, low salt diet • “Feel fine” 2 Limit alcohol • May not know about complications 3 Get regular physical activity • Think of complications as far off in the future 4 Manage stress • Can’t tell whether
Slide 37: Non-adherence goes up with complexity of regimen
Non-adherence goes up with complexity of regimen WHEN REGIMENS ARE COMPLEX AND/OR REQUIRE LIFESTYLE CHANGES AND THE MODIFICATION OF DAILY HABITS, NON-ADHERENCE CAN BE AS HIGH AS ________%? 50% 60% 70% 80% To participate in polling please exit full screen mode GLO2208854 | Nov-21 | 37
Slide 38: What can providers do to improve adherence to recommendations for hypertension control?
What can providers do to improve adherence to recommendations for hypertension control? Tailor advice and leverage patient’s emotions TAILOR: START SMALL, SELECT ONE THING, USE EMOTION/VALUES TO ENHANCE BE SURE IT IS A BEHAVIOR THE PATIENT CAN INTRINSIC MOTIVATION ACHIEVE Is the patient confident he
Slide 39: How to use patient's emotions/values to enhance intrinsic motivation
How to use patient’s emotions/values to enhance intrinsic motivation to adhere to advice Ask open-ended questions If you were to take this medicine, how might things be better for your family? What long-term benefits for you and your family do you see from taking this medicine? If you were taking th
Slide 40: Providers can absolutely influence adherence
Providers can absolutely influence adherence Effective two-way communication is critical Meet patients “where they are” in terms of what they can achieve Don’t tell patients what to do Use patient’s emotions/values to create intrinsic motivation to be healthy and follow your advice GLO2208854 | Nov-