Insani, Widya Norma;
(2024)
Impact of Adverse Drug Reactions of Cardiovascular Drugs in the Primary Care Setting:The United Kingdom and Indonesia Perspectives.
Doctoral thesis (Ph.D), UCL (University College London).
Abstract
Background: Adverse drug reactions (ADRs) represent a significant clinical problem in healthcare. Current knowledge on ADRs has largely focused on the frequency, with limited studies investigating the impact of ADRs on patients. Objectives: i.) To investigate multidimensional impacts of ADRs of cardiovascular drugs on subsequent cardiovascular disease (CVD) events and all-cause mortality, medication adherence, and health-related quality of life (HRQoL). ii.) To examine treatment pattern changes following the occurrence of ADRs and compare subsequent outcomes between different treatment groups. Methods: A descriptive study was conducted to examine the burden of cardiovascular drug-related ADRs. Two retrospective cohort studies were conducted to investigate the impact of ADRs related to i.) statin and ii) angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARBs) on subsequent CVD events and all-cause mortality. Lastly, a cross-sectional survey study was conducted to examine the association between ADRs, medication adherence, and HRQoL. Results: The prevalence of cardiovascular drugs-related ADRs was 13.50 (95%CI.13.30, 13.70) per 1000 patients. Statin-related ADRs were associated with CVD events in both CVD primary and secondary prevention cohort, with adjusted hazard ratio (aHR) of 1.39 (95%CI.1.23,1.57) and 1.34 (95%CI.1.25,1.42), respectively. Continued lipid lowering treatment (LLT), either using any statin or other LLT was associated with a reduced risk of CVD events and mortality compared to discontinuation of all LLT altogether. ACEI/ARB-related ADRs were associated with CVD events and mortality in both primary (aHR 1.22, 95%CI.1.05,1.43 and 1.14, 95%CI.1.05,1.21) and secondary prevention cohort (1.13, 95%CI.1.05,1.21 and 1.15, 95%CI.1.09,1.21). Continued ACEI/ARB was associated with a reduced risk of mortality. Lastly, ADRs were associated with decreased medication adherence and HRQoL. Conclusions: Patients with ADRs were more likely to have suboptimal treatment outcomes, poor medication adherence, and reduced HRQoL, indicating closer clinical monitoring is of importance for patients affected by ADRs. The findings may help in determining appropriate treatment strategies following the occurrence of ADRs.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Impact of Adverse Drug Reactions of Cardiovascular Drugs in the Primary Care Setting:The United Kingdom and Indonesia Perspectives |
| Language: | English |
| Additional information: | Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10186793 |
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