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    A pragmatic randomized trial of a polypill-based strategy to improve use of indicated preventive treatments in people at high cardiovascular disease risk

    Access Status
    Fulltext not available
    Authors
    Patel, A.
    Cass, A.
    Peiris, D.
    Usherwood, T.
    Brown, A.
    Jan, S.
    Neal, B.
    Hillis, G.
    Rafter, N.
    Tonkin, A.
    Webster, R.
    Billot, L.
    Bompoint, S.
    Burch, C.
    Burke, H.
    Hayman, N.
    Molanus, B.
    Reid, Christopher
    Shiel, L.
    Togni, S.
    Rodgers, A.
    Date
    2015
    Type
    Journal Article
    
    Metadata
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    Citation
    Patel, A. and Cass, A. and Peiris, D. and Usherwood, T. and Brown, A. and Jan, S. and Neal, B. et al. 2015. A pragmatic randomized trial of a polypill-based strategy to improve use of indicated preventive treatments in people at high cardiovascular disease risk. European Journal of Preventive Cardiology. 22 (7): pp. 920-930.
    Source Title
    European Journal of Preventive Cardiology
    DOI
    10.1177/2047487314530382
    ISSN
    2047-4873
    School
    Department of Health Policy and Management
    URI
    http://hdl.handle.net/20.500.11937/21215
    Collection
    • Curtin Research Publications
    Abstract

    Background: Most individuals at high cardiovascular disease (CVD) risk worldwide do not receive any or optimal preventive drugs. We aimed to determine whether fixed dose combinations of generic drugs (‘polypills’) would promote use of such medications. Methods: We conducted a randomized, open-label trial involving 623 participants from Australian general practices. Participants had established CVD or an estimated five-year CVD risk of ≥15%, with indications for antiplatelet, statin and ≥2 blood pressure lowering drugs (‘combination treatment’). Participants randomized to the ‘polypill-based strategy’ received a polypill containing aspirin 75 mg, simvastatin 40 mg, lisinopril 10 mg and either atenolol 50 mg or hydrochlorothiazide 12.5 mg. Participants randomized to ‘usual care’ continued with separate medications and doses as prescribed by their doctor. Primary outcomes were self-reported combination treatment use, systolic blood pressure and total cholesterol. Results: After a median of 18 months, the polypill-based strategy was associated with greater use of combination treatment (70% vs. 47%; relative risk 1.49, (95% confidence interval (CI) 1.30 to 1.72) p < 0.0001; number needed to treat = 4.4 (3.3 to 6.6)) without differences in systolic blood pressure (−1.5 mmHg (95% CI −4.0 to 1.0) p = 0.24) or total cholesterol (0.08 mmol/l (95% CI −0.06 to 0.22) p = 0.26). At study end, 17% and 67% of participants in polypill and usual care groups, respectively, were taking atorvastatin or rosuvastatin. Conclusion: Provision of a polypill improved self-reported use of indicated preventive treatments. The lack of differences in blood pressure and cholesterol may reflect limited study power, although for cholesterol, improved statin use in the polypill group counter-balanced use of more potent statins with usual care.

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    • The Effect of a Cardiovascular Polypill Strategy on Pill Burden.
      Truelove, M.; Patel, A.; Bompoint, S.; Brown, A.; Cass, A.; Hillis, G.; Peiris, D.; Rafter, N.; Reid, Christopher; Rodgers, A.; Tonkin, A.; Usherwood, T.; Webster, R.; Kanyini GAP Collaboration (2015)
      AIMS: Recent trials of cardiovascular polypills in high-risk populations show improvements in use of cardiovascular preventive treatments, compared to usual care. We describe patterns of pill burden in Australian practice, ...
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      Liu, H.; Patel, A.; Brown, A.; Eades, S.; Hayman, N.; Jan, S.; Ring, I.; Stewart, G.; Tonkin, A.; Weeramanthri, T.; Wade, V.; Rodgers, A.; Usherwood, T.; Neal, B.; Peiris, D.; Burke, H.; Reid, Christopher; Cass, A. (2010)
      Background. The Kanyini Guidelines Adherence with the Polypill (Kanyini-GAP) Study aims to examine whether a polypill-based strategy (using a single capsule containing aspirin, a statin and two blood pressure-lowering ...
    • Reaching cardiovascular prevention guideline targets with a polypill-based approach: A meta-Analysis of randomised clinical trials
      Selak, V.; Webster, R.; Stepien, S.; Bullen, C.; Patel, A.; Thom, S.; Arroll, B.; Bots, M.; Brown, A.; Crengle, S.; Dorairaj, P.; Elley, C.; Grobbee, D.; Harwood, M.; Hillis, G.; Laba, T.; Neal, B.; Peiris, D.; Rafter, N.; Reid, Christopher; Stanton, A.; Tonkin, A.; Usherwood, T.; Wadham, A.; Rodgers, A. (2019)
      Objective: The aim of this study was to determine the effect of polypill-based care on the achievement of 2016 European Society of Cardiology (ESC) guideline targets for blood pressure (BP), low-density lipoprotein (LDL) ...
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