Authors:

• Tjaša Furlan, University of Ljubljana, Faculty of Medicine
• Janez Bijec, University of Ljubljana, Faculty of Electrical Engineering 
• Petra Došenović Bonča, University of Ljubljana, School of Economics and Business
• Irena Ograjenšek, University of Ljubljana, School of Economics and Business
• Borut Jug, University of Ljubljana, Faculty of Medicine

Keywords:

adherence | mortality | peripheral artery disease (PAD) | practice guidelines | rehospitalization

Abstract:

Peripheral artery disease (PAD) is a common manifestation of systemic atherosclerosis associated with substantial cardiovascular risk. Although guideline-directed medical therapy (GDMT)—including antiplatelet agents, lipid-lowering drugs, and renin–angiotensin system inhibitors—has been shown to reduce adverse outcomes, long-term adherence in PAD populations remains insufficiently understood. This nationwide retrospective cohort study evaluated the prognostic impact of sustained GDMT adherence among patients hospitalized with PAD in Slovenia between January 1, 2015, and June 30, 2021.

Data from hospital discharge records, mortality registries, and medication reimbursement databases were linked, and adherence was measured using pharmacy dispensation data modeled as a time-varying covariate. The primary outcome was a composite of all-cause mortality or hospitalization for nonfatal myocardial infarction, ischemic stroke, or PAD-related events.

Among 8,811 patients, fewer than half (47.6%) filled prescriptions for all three GDMT classes within 120 days of discharge, and adherence declined over time. Higher adherence was independently associated with improved outcomes: each 10% increase in adherence reduced the risk of the composite endpoint across therapy classes. Patients adherent to all three therapies experienced a 29% lower hazard compared with those adherent to fewer classes, supporting a graded dose–response relationship.

Despite the absence of out-of-pocket medication costs, initiation and persistence with GDMT remained suboptimal, suggesting barriers beyond affordability, including health literacy and multimorbidity. Overall, sustained adherence to GDMT was strongly associated with reduced mortality and major cardiovascular events, highlighting adherence optimization as a critical opportunity to improve outcomes in this high-risk population

The Sustainable Development Goals (SDGs) addressed in the article are:

• SDG 3 – Good health and well-being
• SDG 10 – Reduced inequality

The article is published in:
Vascular medicine (Sage)

The content is freely accessible at:

The impact of long-term adherence to guideline-directed medical therapy on outcomes in peripheral artery disease