影响冠心病患者PCSK9抑制剂治疗依从性相关因素分析

Analysis of related factors of adherence to PCSK9 inhibitor therapy in patients with coronary heart disease

目的:了解冠状动脉粥样硬化性心脏病(冠心病)患者应用PCSK9抑制剂治疗依从性现状并探索影响依从性的相关因素。方法:本研究为一项回顾性队列研究,入选2019年3月至2021年3月,就诊于北京安贞医院使用PCSK9抑制剂治疗的冠心病患者。通过平均(463.05±204.61)d的随访结果,分析患者药物依从性及相关影响因素。结果:130例冠心病患者使用PCSK9抑制剂,但PCSK9抑制剂药物依从性差,依从组仅为23.1%。患者经济支持、患者教育及患者监督是影响PCSK9抑制剂药物依从性的三个重要因素。38.0%的患者因“价格太贵”而停药,35%的患者因“自觉无需用药”而停药。然而,76.2%的患者除医院宣教外未接受过其他任何途径的患者教育。多因素Cox回归分析表明获得药物经济援助(HR=0.262,P<0.001)和定期医院复诊(HR=0.516,P=0.012)是提高患者应用PCSK9抑制剂治疗的因素。结论:PCSK9抑制剂药物依从性很低,药物经济援助及定期医院复诊为提高药物依从性的因素。

Objective:To evaluate the adherence with PCSK9 inhibitors in patients with coronary heart disease and to determine the factors affecting adherence.Methods:This was a retrospective cohort study enrolling patients with coronary heart disease treated with PCSK9 inhibitors at Beijing Anzhen Hospital from March 2019 to March 2021.Each patient underwent medical teleconsultation to collect current clinical conditions and adherence to medication treatments after a mean period of(463.05±204.61)days of follow-up.Results:The study population consisted of 130 patients,of whom 30(23.1%)reported adherence to the PCSK9inhibitors therapy for a mean period of 345(300,605)days.Financial support,supervision,and education were three important aspects affecting PCSK9 inhibitors adherence.The non-adherent group was more likely to be female(24.0%vs.3.3%,P=0.009),and elder(57.52±11.19)vs.(52.57±10.15)(P=0.032)compared to the adherent group.Causes of interruption included"too expensive"(38.0%)and"felt that they did not need to take the drug"(35.0%).However,76.2%of patients did not receive any patient education except hospital education.Multivariate cox regression analysis found that access to drug economic assistance(HR=0.262,P<0.001)and regular hospital visits(HR=0.516,P=0.012)were independent factors that increased patients’use of PCSK9 inhibitors therapy.Conclusions:Patients’Adherence to PCSK9 Inhibitors Therapy is low.Financial assistance and regular hospital follow-up are independent factors in improving medication adherence.