Interrupted time series analysis on first cardiovascular disease hospitalization for adherence to lipid-lowering
Feiyu Hu1, Jim Warren1, Daniel J Exeter2
1School of Computer Science, University of Auckland, Auckland, New Zealand.
Insights
Hospitalization for cardiovascular disease (CVD) significantly improves patient adherence to lipid-lowering medications. This enhanced adherence suggests a heightened awareness of disease severity following hospitalization, impacting long-term medication management.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Cardiovascular disease (CVD) poses a significant global health burden.
- Medication adherence is crucial for managing CVD and preventing adverse events.
- Hospitalization for CVD may serve as a critical juncture influencing patient behavior and treatment compliance.
Purpose of the Study:
- To analyze the impact of the first cardiovascular disease (CVD) hospitalization on patient adherence to lipid-lowering medications.
- To compare medication adherence rates in the periods before and after the initial CVD hospitalization.
Main Methods:
- A sub-cohort of 946 patients with primary CVD risk assessment was analyzed.
- Medication adherence was determined by the proportion of days covered (PDC) ≥ 80% using community dispensing records.
- An interrupted time series design with generalized estimating equations compared adherence rates pre- and post-hospitalization.
Main Results:
- Overall medication adherence significantly improved post-hospitalization (OR 2.49).
- Patients with diabetes showed higher pre-hospitalization adherence, but this difference diminished post-hospitalization.
- Quarterly adherence rates remained stable pre-hospitalization but showed a significant decreasing trend post-discharge.
Conclusions:
- First-time CVD hospitalization is associated with increased adherence to lipid-lowering therapy.
- This improvement may stem from patients' heightened perception of disease severity after hospitalization.
- Understanding these behavioral shifts can inform interventions to sustain medication adherence.
Purpose:
We analysed lipid-lowering medication adherence before and after the first hospitalization for cardiovascular disease (CVD) to explore the influence hospitalization has on patient medication adherence.
Methods:
We extracted a sub-cohort for analysis from 313,207 patients who had primary CVD risk assessment. Adherence was assessed as proportion of days covered (PDC) ≥ 80% based on community dispensing records. Adherence in the 4 quarters (360 days) before the first CVD hospitalization and 8 quarters (720 days) after hospital discharge was assessed for each individual in the sub-cohort. An interrupted time series design using generalized estimating equations was applied to compare the differences of population-level medication adherence rates before and after the first CVD hospitalization.
Results:
Overall, a significant improvement in medication adherence rate from before to after the hospitalization was observed (odds ratio (OR) 2.49 [1.74-3.57]) among the 946 patients included in the analysis. Patients having diabetes history had a higher OR of adherence before the hospitalization than patients without diabetes (1.50 [1.03-2.22]) but no significant difference after the hospitalization (OR 1.13 [0.89-1.43]). Before the first hospitalization, we observed that quarterly medication adherence rate was steady at around 55% (OR 0.97 [0.93-1.01), whereas the trend in adherence over the post-hospitalization period decreased significantly per quarter (OR 0.97 [0.94-0.99]).
Conclusions:
Patients were more likely to adhere to lipid-lowering therapy after experiencing a first CVD hospitalization. The change in medication adherence rate is consistent with patients having heightened perception of disease severity following the hospitalization.
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