Abstract 20354: Rurality Predicts Long-Term Adherence to Statins but Not Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in High-Risk Patients
Introduction: Rural populations experience greater cardiovascular morbidity and mortality compared to urban populations. It is unknown whether regional differences in adherence to cardiovascular medications may contribute to this health disparity. We sought to determine the effects of rurality on patient adherence to statins and ACE Inhibitors/ARBs.
Hypothesis: Rural patients have poorer adherence than urban patients.
Methods: We conducted a follow-up cohort study via telephone of patients who attended a single tertiary centre for coronary angiography from 2009 to 2013. Adherence was assessed via self-reported average consumption of these medications on a week-to-week basis. Consumption >6/7 days per week as instructed by the prescribing physician was considered adherent and ≤5/7 days or discontinuation without physician approval was considered non-adherent. Patients were stratified into Remoteness Areas (RA) based on the Australian Standard Geographical Classification (RA1 corresponds to Major Cities, RA2 to Inner Regional Areas, RA3 to Outer Regional Areas).
Results: Of 528 patients contacted, 69% were male, mean age was 64 years and 34% were from RA1, 45% RA2 and 21% RA3. Mean follow-up duration was 5.3 years. Statins and ACEI/ARBs were consumed by 77% and 69% of patients. Rurality predicted adherence to statins (p=0.05) but not ACEI/ARBs (p=0.38). In univariate analysis RA3 patients had greater statin adherence than RA1 patients (OR:3.0 P=0.016, 95% CI:1.2-7.8) and RA2 patients (OR:2.6 P=0.04 95% CI:1.7-3.7). Multivariate-adjusted modelling showed living in RA3 remained a strong independent predictor of greater statin adherence (OR:1.9 P=0.009, 95%CI:1.2-3.1), as did CAD on angiography (OR:2.3 P=0.004, 95% CI:1.3-4.1) and a history of diabetes (OR:2.1 P=0.04, 95% CI:1.0-4.1). No univariate or multivariate predictors of adherence to ACEI/ARBs were found.
Conclusion: Long-term statin and ACEI/ARB adherence was greater in our study than previous studies in high-risk patients. Rurality predicted adherence to statins but not ACEI/ARBs, as did CAD and a history of diabetes. In conclusion, differences in adherence to statin medications are unlikely to explain the disparities in cardiovascular outcomes between rural and urban patients.
Author Disclosures: M. Peverelle: None. R. Sultani: None. S. Paleri: None. Y. Lee: None. J. Lovell: None. J. Garlick: None. A. Wilson-O’Brien: None. A. Wilson: None.
- © 2016 by American Heart Association, Inc.