The Effect of a Cardiovascular Polypill Strategy on Pill Burden

Michael Truelove, Anushka Patel, Severine Bompoint, Alex Brown, Alan Cass, Graham Hillis, David Peiris, Natsha Rafter, Christopher Reid, Anthony Rodgers, Andrew Tonkin, Tim Usherwood, Ruth Webster

    Research output: Contribution to journalArticleResearchpeer-review

    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. 

    Original languageEnglish
    Pages (from-to)347-352
    Number of pages6
    JournalCardiovascular Therapeutics
    Volume33
    Issue number6
    DOIs
    Publication statusPublished - Dec 2015

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    Blood Pressure
    Guideline Adherence
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Platelet Aggregation Inhibitors
    Therapeutics
    Random Allocation
    Prescriptions
    Cardiovascular Diseases
    Cholesterol
    Physicians

    Cite this

    Truelove, M., Patel, A., Bompoint, S., Brown, A., Cass, A., Hillis, G., ... Webster, R. (2015). The Effect of a Cardiovascular Polypill Strategy on Pill Burden. Cardiovascular Therapeutics, 33(6), 347-352. https://doi.org/10.1111/1755-5922.12151
    Truelove, Michael ; Patel, Anushka ; Bompoint, Severine ; Brown, Alex ; Cass, Alan ; Hillis, Graham ; Peiris, David ; Rafter, Natsha ; Reid, Christopher ; Rodgers, Anthony ; Tonkin, Andrew ; Usherwood, Tim ; Webster, Ruth. / The Effect of a Cardiovascular Polypill Strategy on Pill Burden. In: Cardiovascular Therapeutics. 2015 ; Vol. 33, No. 6. pp. 347-352.
    @article{3422c22f08cb4983b6ee408599fe43ec,
    title = "The Effect of a Cardiovascular Polypill Strategy on Pill Burden",
    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. ",
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    author = "Michael Truelove and Anushka Patel and Severine Bompoint and Alex Brown and Alan Cass and Graham Hillis and David Peiris and Natsha Rafter and Christopher Reid and Anthony Rodgers and Andrew Tonkin and Tim Usherwood and Ruth Webster",
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    Truelove, M, Patel, A, Bompoint, S, Brown, A, Cass, A, Hillis, G, Peiris, D, Rafter, N, Reid, C, Rodgers, A, Tonkin, A, Usherwood, T & Webster, R 2015, 'The Effect of a Cardiovascular Polypill Strategy on Pill Burden', Cardiovascular Therapeutics, vol. 33, no. 6, pp. 347-352. https://doi.org/10.1111/1755-5922.12151

    The Effect of a Cardiovascular Polypill Strategy on Pill Burden. / Truelove, Michael; Patel, Anushka; Bompoint, Severine; Brown, Alex; Cass, Alan; Hillis, Graham; Peiris, David; Rafter, Natsha; Reid, Christopher; Rodgers, Anthony; Tonkin, Andrew; Usherwood, Tim; Webster, Ruth.

    In: Cardiovascular Therapeutics, Vol. 33, No. 6, 12.2015, p. 347-352.

    Research output: Contribution to journalArticleResearchpeer-review

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    T1 - The Effect of a Cardiovascular Polypill Strategy on Pill Burden

    AU - Truelove, Michael

    AU - Patel, Anushka

    AU - Bompoint, Severine

    AU - Brown, Alex

    AU - Cass, Alan

    AU - Hillis, Graham

    AU - Peiris, David

    AU - Rafter, Natsha

    AU - Reid, Christopher

    AU - Rodgers, Anthony

    AU - Tonkin, Andrew

    AU - Usherwood, Tim

    AU - Webster, Ruth

    PY - 2015/12

    Y1 - 2015/12

    N2 - 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. 

    AB - 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. 

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