Long-term patiromer adherence and renin-angiotensin aldosterone system inhibitor utilization: A retrospective study

Table 1 Baseline population characteristics

	Count	Mean or percent	SD
Number of patients taking patiromer	13447
Female	5527	41%
Average age1		62	13
Age < 45	1293	10%
45 ≤ age < 55	1963	15%
55 ≤ age < 65	3388	25%
65 ≤ age < 75	3825	28%
75 ≤ age < 85	2978	22%
Pharmacy benefit manager plan	1568	12%
Health insurance exchange commercial plan	74	1%
Other commercial plan	444	3%
Cash plan	334	2%
Employer group plan	1092	8%
Medicaid plan	1045	8%
Medicare plan	7567	56%
Other plan	1323	10%
Number of unique daily-use medications in pre-index period		9.5	5.3
Avg total pre-index out-of-pocket cost per month any prescription ($)		45.6	82
Community census information from patient’s 3-digit ZIP code
Unemployment		7%	0.019
White		78%	0.221
Other race		22%	0.221
Poverty		14%	0.046
Disabled		10%	0.030
Not high school graduate		14%	0.058
High school graduate		27%	0.061
Some college		29%	0.042
Bachelors		19%	0.052
At least masters		12%	0.049
Per capita income		$30327	$7770
Population per square mile		2498	6772

¹Age based only on year of birth.

Years before 1940 were set to 1940 by Symphony Health. ZIP: Zone improvement plan.

Table 2 Renin-angiotensin aldosterone system inhibitor outcomes by patiromer adherence¹

	Adherent patiromer patients (patiromer PDC > 80%)			Lower adherence patiromer patients (patiromer PDC ≤ 80%)			Difference	P value
	Count	Mean (95%CI) or percent	SD	Count	Mean (95%CI) or percent	SD
Number of patients	3323	24.7%		10124	75.3%
Patients with ACEi	870	26.2%		2395	23.7%		2.5%	0.0032
Patients with ARB	790	23.8%		2324	23.0%		0.8%	0.3319
Patients with MRA	209	6.3%		586	5.8%		0.5%	0.2877
Patients with DRi	4	0.1%		4	0.0%		0.1%	0.0972
Average ACEi 6-month days supply		122.8 (120.0-125.6)	42.2		111.2 (109.4-113.1)	45.8	11.6	< 0.0001
Average ARB 6-month days supply		121.2 (118.2-124.3)	43.8		111.8 (110.0-113.7)	45.7	9.4	< 0.0001
Average MRA 6-month days supply		114.5 (108.1-121.0)	47.5		105.0 (101.2-108.7)	46.5	9.6	0.0122
Average DRi 6-month days supply		104.0 (48.7-159.3)	56.4		101.3 (56.3-146.2)	45.8	2.7	0.9426
Average ACEi 6-month PDC2		88.8% (87.5%-90.0%)	0.19		84.2% (83.3%-85.1%)	0.23	4.6%	< 0.0001
Average ARB 6-month PDC2		90.9% (89.8%-92.1%)	0.17		85.5% (84.6%-86.3%)	0.22	5.5%	< 0.0001
Average MRA 6-month PDC2		87.2% (84.3%-90.1%)	0.22		79.1% (77.0%-81.2%)	0.26	8.1%	< 0.0001
Average DRi 6-month PDC2		65.0% (30.2%-99.9%)	0.36		63.1% (36.3%-89.9%)	0.27	1.9%	0.9344
Percent of patients with ACEi PDC > 80%	689	79.2%		1694	70.7%		8.5%	< 0.0001
Percent of patients with ARB PDC > 80%	660	83.5%		1693	72.8%		10.7%	< 0.0001
Percent of patients with MRA PDC > 80%	165	78.9%		371	63.3%		15.6%	< 0.0001
Percent of patients with DRi PDC > 80%	2	50.0%		1	25.0%		25.0%	0.4652

¹Patiromer adherence determined by proportion of days covered threshold of 80%.

²Renin-angiotensin-aldosterone system inhibitor proportion of days measured from 1^st post-index renin-angiotensin-aldosterone system inhibitor prescription through 6 months after index patiromer or sodium polystyrene sulfonate prescription.

PDC: Proportion of days covered; CI: Confidence interval; ACEi: Angiotensin-converting enzyme inhibitor; ARB: Angiotensin II receptor blocker; MRA: Mineralocorticoid receptor antagonist; Dri: Direct renin inhibitor.