Treatment completion and implementation by patients initiating ticagrelor

Abstract

Background In secondary prevention of adverse events and death following acute coronary syndrome, patients may benefit from adhering to a ticagrelor treatment. Objectives The authors assessed the proportion of new ticagrelor users who completed 12 months of treatment, explored the factors associated with treatment completion and, among the completers, evaluated the 12-month treatment implementation. Methods A retrospective administrative health database inception cohort study was conducted in a population that included Quebec residents ≥18 years of age who initiated ticagrelor between January 1, 2012 and March 31, 2014. A patient still on ticagrelor at the end of the 12-month period after treatment initiation was considered to have completed the treatment. Factors associated with treatment completion were identified using log-binomial regression. Implementation was assessed using the proportion of days covered (PDC). Results Of the 3,600 patients, 2,235 (62.1%) completed 12 months of treatment. The patients who were more likely to complete their treatment included those who had visited a general practitioner, had a percutaneous coronary intervention, used a statin or fibrate, and those who used an antihypertensive drug during the year preceding the ticagrelor treatment initiation. Older patients, those with atrial fibrillation, those who had ≥ 6 physician visits and those who used an anticoagulant were less likely to complete the 12-month treatment. The median PDC was 96.2%. Conclusion Treatment completion might be improved. Among patients who completed the treatment, implementation was high. The factors associated with completion could help to identify patients who might benefit from interventions that aim to optimize treatment completion.