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Identification of Cardiovascular Patient Groups at Risk for Poor Medication Adherence: A Cluster Analysis
Insights
Identifying patients with cardiovascular diseases (CVDs) at risk for poor medication adherence is crucial for secondary prevention. Younger patients with unhealthy lifestyles, including smoking and poor diet, are more likely to be nonadherent to their medications.
Area of Science:
- Cardiology
- Public Health
- Behavioral Science
Background:
- Poor medication adherence significantly hinders secondary prevention of cardiovascular diseases (CVDs).
- This nonadherence leads to increased patient morbidity, mortality, and healthcare costs.
- Identifying at-risk patient groups is essential for targeted interventions.
Purpose of the Study:
- To identify homogeneous subgroups of cardiovascular outpatients based on risk factors.
- To examine medication adherence differences among these identified subgroups.
Main Methods:
- Retrospective, observational study including 530 patients with established CVD.
- Cluster analysis of cardiovascular risk factors (smoking, diet, exercise, lipids, blood pressure, BMI).
- Medication adherence assessed using the Modified Morisky Scale.
Main Results:
- Three distinct patient subgroups were identified through cluster analysis.
- One subgroup (cluster 3) showed significantly lower high adherence rates and higher medium adherence rates.
- This subgroup was characterized by younger age, fewer medications, and higher prevalence of smoking, unhealthy alcohol use, and poor diet.
Conclusions:
- Younger cardiovascular patients with unhealthy lifestyle factors are at higher risk for medication nonadherence.
- These findings highlight the need for tailored adherence interventions for specific patient profiles.
Background:
Poor medication adherence limits the secondary prevention of cardiovascular diseases (CVDs) and leads to increased morbidity, mortality, and costs. Identifying groups of patients at risk of poor adherence behavior could enable an intervention to be developed and target patients appropriately.
Objective:
The first aim of this study was to identify homogeneous subgroups of cardiovascular outpatients based on their cardiovascular risk factors. Subsequently, differences in medication adherence between these groups were examined.
Methods:
In this retrospective, observational study, patients with an established CVD were included. Well-known cardiovascular risk factors such as smoking, diet, exercise, blood lipid levels, blood pressure, and body mass index were collected. To identify patient subgroups, a 2-step cluster analytic procedure was performed. Differences between the groups on medication adherence were determined on the outcome of the Modified Morisky Scale. Data collection took place between October 2011 and January 2013.
Results:
Cardiovascular risk factors of 530 patients were included in the cluster analysis. Three groups were identified. Compared with other clusters (clusters 1 and 2), cluster 3 contained significantly fewer patients who could be classified as highly adherent and more patients classified as medium adherent (23% and 57%, respectively; P = .024). This group was characterized by a younger age (53% were <55 years old) and using a relatively low number of different medications (41% used <4 different medications). Besides, in this subgroup the most smokers (37%), unhealthy alcohol users (27%), and patients with unhealthy eating habits (14%) were present.
Conclusion:
This study showed that cardiovascular patients who are relatively young and have an unhealthy lifestyle are at risk for nonadherent behavior.
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