The impact of polypharmacy on adherence to pharmacotherapy for coronary heart disease with comorbid conditions: insights from the EUROASPIRE V observational study in Ukraine
DOI:
https://doi.org/10.14739/mmt.2025.2.322403Keywords:
polypharmacy, drug interactions, coronary heart disease, CHD pharmacotherapy, pharmaceutical care, drug compatibilityAbstract
It is known that coronary heart disease (CHD) is the leading cause of mortality among non-communicable diseases worldwide, including in Ukraine. The results of the EUROASPIRE V observational study showed an insufficient level of adherence to treatment in patients with CHD and comorbid conditions across European countries and in Ukraine. Conducting a retrospective analysis of the pharmacotherapy for CHD in patients with hypertension, dyslipidemia, atrial fibrillation, heart failure, type 2 diabetes mellitus, and chronic kidney disease regarding the content, number, and compatibility of prescribed drugs is relevant to determine the impact of polypharmacy on treatment adherence.
Aim. To determine the prevalence of polypharmacy and identify gaps in the rational use of drugs in patients with CHD and comorbid conditions, and to assess the subsequent impact on treatment adherence in the Ukrainian cohort of the EUROASPIRE V study.
Materials and methods. Medical data of patients with CHD and comorbid conditions who participated in the EUROASPIRE V observational study in Ukraine were analysed. Retrospective, statistical, clinical-epidemiological, frequency, ABC analysis, content analysis, comparison, and generalization methods were used.
Results. A significant effect of the number of prescribed drugs on treatment adherence was established (U = 4.895; Z-value = -2.793 without correction; Z-value = -2.844 adjusted). The level of significance (p) without correction was 0.0052 and with correction was 0.0045, indicating the need for the use of fixed combinations. The lack of compatibility among prescribed drugs (Z = 1.71; p = 0.086) in the pharmacotherapy of CHD with comorbid conditions was reliably confirmed, indicating insufficient compliance among doctors, patients, and pharmacists due to the lack of interprofessional interaction within multidisciplinary teams. The relationship between adherence to pharmacotherapy for CHD with comorbid conditions and sex characteristics was also investigated: χ2 = 5.734; df = 1 (for groups of men and women); p ≈ 0.0167. Men (55 %) demonstrated greater adherence to treatment than women (45 %).
Conclusions. The prevalence of polypharmacy in the studied cohort of CHD patients with comorbid conditions was determined to be 76.47 % [CI 95 % 76.47 ± 0.03; p < 0.0001], which can be attributed to the predominantly complex drug model used in pharmacotherapy. The relationship between overall adherence to pharmacotherapy for CHD with comorbid conditions and the presence of drug interactions due to metabolism through the CYP450 isoenzyme 3A4 during the second visit of the studied cohort was reliably confirmed (χ² = 3.97; df = 1; p-value = 0.0462). However, there was a positive trend in the use of target doses of drugs after the correction of pharmacotherapy by the staff of the Department of Cardiology (1st visit – 27.57 % and 2nd visit – 13.57 %).
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