Optimization of adherence to fixed-dose combination therapy in the treatment of cardiovascular risk factors in primary care

IF 0.9 Q4 PRIMARY HEALTH CARE Medicina de Familia-SEMERGEN Pub Date : 2025-01-01 DOI:10.1016/j.semerg.2024.102337

F.J. Alonso Moreno , J. Espinosa García , F. López Simarro , L. Aliaga Gutiérrez , C. Montero Peña , A. Manzano Vilches , M. Ricote Belinchón , P. Panero Hidalgo , C. Escobar Cervantes

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Abstract

Objective

Provide consensus recommendations for the optimal management of fixed-dose combination therapies (FCT) in patients with cardiovascular risk factors (CVRF) in primary care (PC).

Material and methods

A modified Delphi technique was used. A scientific committee wrote 80 statements addressing controversial issues regarding adherence and the use of FCT in patients with CVRF. A panel of 52 PC specialists, experts in CVRF management and adherence evaluated the questionnaire in two rounds. The work was promoted by the Network of Experts in Adherence in Primary Care (REAAP).

Results

Agreement was reached on 66 of the 80 issues (82.5%). The panellists considered that the adherence of patients with CVRF treated in PC was inadequate, which could have clinical implications. The use of FCT might increase adherence compared to separate treatments. FCT usage promotion in PC was considered necessary, especially in polymedicated patients. Measures such as establishing specific protocols or improving the training of professionals in the FTC use are necessary. The FTC use was recommended as a reduction in long-term cardiovascular events in hypertension was observed, together with changes of the concept of high-intensity statins to high-intensity lipid-lowering therapy in dyslipidemia, or considering the use of FCT if the option was available in type 2 diabetes mellitus.

Conclusions

The expert consensus recommendations from this work may facilitate the use of FCT in patients with CVRF in PC.

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在初级保健中优化固定剂量联合疗法在心血管风险因素治疗中的依从性。

摘要为基层医疗机构（PC）对具有心血管风险因素（CVRF）的患者进行固定剂量联合疗法（FCT）的最佳管理提供共识建议：材料与方法：采用改良德尔菲技术。一个科学委员会针对心血管风险因素患者在坚持治疗和使用 FCT 方面的争议问题撰写了 80 份声明。由 52 名 PC 专家、CVRF 管理专家和依从性专家组成的小组对问卷进行了两轮评估。这项工作由初级保健依从性专家网络（REAAP）推动：结果：在 80 个问题中，有 66 个（82.5%）达成了一致意见。小组成员认为，在 PC 中接受治疗的 CVRF 患者的依从性不足，这可能会对临床产生影响。与单独治疗相比，使用 FCT 可提高依从性。他们认为有必要在 PC 中推广 FCT 的使用，尤其是在使用多种药物的患者中。有必要采取措施，如制定具体方案或加强对专业人员使用 FTC 的培训。由于观察到高血压患者的长期心血管事件有所减少，因此建议使用 FTC，同时改变高强度他汀类药物的概念，对血脂异常患者进行高强度降脂治疗，或考虑在 2 型糖尿病患者可以选择的情况下使用 FCT：本研究提出的专家共识建议有助于在 PC 中的 CVRF 患者中使用 FCT。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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