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The Effect of a Cardiovascular Polypill Strategy on Pill Burden

Truelove, Michael, Patel, Anushka, Bompoint, Severine, Brown, Alex, Cass, Alan, Hillis, Graham S., Peiris, David, Rafter, Natsha, Reid, Christopher M., Rodgers, Anthony, Tonkin, Andrew, Usherwood, Tim and Webster, Ruth (2015). The Effect of a Cardiovascular Polypill Strategy on Pill Burden. Cardiovascular Therapeutics,33(6):347-352.

Document type: Journal Article
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IRMA ID 81144320xPUB72
Title The Effect of a Cardiovascular Polypill Strategy on Pill Burden
Author Truelove, Michael
Patel, Anushka
Bompoint, Severine
Brown, Alex
Cass, Alan
Hillis, Graham S.
Peiris, David
Rafter, Natsha
Reid, Christopher M.
Rodgers, Anthony
Tonkin, Andrew
Usherwood, Tim
Webster, Ruth
Journal Name Cardiovascular Therapeutics
Publication Date 2015
Volume Number 33
Issue Number 6
ISSN 1755-5914   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84945972329
Start Page 347
End Page 352
Total Pages 6
Place of Publication United Kingdom
Publisher Wiley-Blackwell Publishing Ltd.
Field of Research MEDICAL AND HEALTH SCIENCES
1102 - Cardiovascular Medicine and Haematology
HERDC Category C1 - Journal Article (DIISR)
Abstract Aims
Recent trials of cardiovascular polypills in high-risk populations show improvements in the use of cardiovascular preventive treatments, compared to usual care. We describe patterns of pill burden in Australian practice, define the impact of polypill therapy on pill burden, and explore how physicians add medication to polypill therapy.

Methods
The Kanyini Guidelines Adherence with the Polypill Study was an open-label trial involving 623 participants in Australia which randomized participants to a polypill strategy (containing a statin, antiplatelet agent, and two blood-pressure-lowering medications) or usual care. Participants either had established cardiovascular disease or were at high calculated risk (≥15% over 5 years). Current medications, daily pill burden, and self-reported use of combination treatment were recorded prior to randomization and at study end. Median pill burden at baseline and study end was compared in both arms. Subgroup analysis of the polypill strategy on trial primary outcomes was conducted by pill burden at baseline.

Results
Median total and cardiovascular pill burdens of the polypill group decreased from 7 to 5 and from 4 to 2, respectively (median change −2; IQR −3, 0), with no change in the usual care group (comparison of change; P < 0.001). No change was seen for noncardiovascular medications. Of those still using the polypill at study end, 43.8% were prescribed additional medications; 84.5% of these additional medications were blood-pressure-lowering medications. Within the polypill group, lower pill burden at baseline was associated with greater increases in the use of indicated cardiovascular preventive medications at study end compared to those with higher pill burdens. No trend was observed between the level of baseline pill burden and the effect of poylpill treatment on systolic blood pressure or total cholesterol.

Conclusion
A cardiovascular polypill in contemporary Australian practice reduces cardiovascular and total pill burdens, despite frequent prescription of additional medications.
DOI http://dx.doi.org/10.1111/1755-5922.12151   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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