Fatores do paciente na adesão às estatinas - uma revisão sistemática

Abstract

Purpose : Statins are one of the main tools in cardiovascular disease prevention, yet, long-term adherence is low, severely limiting its effectiveness. Non-adherence to statins is a crucial modifiable cardiovascular risk factor. This review aims to identify all patient factors in adherence to statins. Patients and Methods : We searched PubMed and Scopus databases using the query ("statins" OR "Hydroxymethylglutaryl-CoA Reductase Inhibitors") AND ("medication adherence" OR "compliance" OR "persistence" OR "discontinuation"), and systematically reviewed all original studies which measured adherence to statins and its determinants in the patient dimension. Results : Of the 3388 reports identified, 50 were included for qualitative synthesis. Included as patient-related factors were psychometric traits, health beliefs, attitudes, expectations, behaviors, and experiences of the patient. Of the psychometric characteristics, conscientiousness, cognitive ability, self-efficacy, autonomous self-regulation, risk aversion, and a locus of control in powerful others, all increase adherence. A belief in the causal role of dyslipidemia in cardiovascular disease, the perception of cardiovascular risk, and a belief in statin's necessity, effectiveness, and safety, as well as the expectation of its long-term use, increased adherence. When intake was associated with a daily routine, patients missed fewer doses. Previous adherence to statins and other medications are strong predictors of adherence to current medication. Adherent patients participate more in preventative medicine and have fewer accidents. Patients who use the internet to research statins are less adherent. Feeling uncertain or confused by the information on statins, either from the media or their physician, increased discontinuation rates. Those who trusted their physician and felt they had adequate knowledge to answer their questions, were more adherent. Conclusion : We have identified several patient factors in non-adherence to statins which are both prevalent and modifiable. This work helps the clinician identify and understand the non-adherent patient, as well as provide guidance for its improvement.