Assessing Concurrent Adherence to Combined Essential Medication and Clinical Outcomes in Patients With Acute Coronary
Clara L Rodríguez-Bernal1,2, Francisco Sánchez-Saez1,2, Daniel Bejarano-Quisoboni1
1Health Services Research Unit, The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Valencia, Spain.
Insights
Identifying medication adherence patterns in acute coronary syndrome (ACS) patients reveals that specific non-adherent trajectories significantly increase adverse clinical outcomes. Understanding these patterns is crucial for improving patient adherence to multiple cardiovascular medications.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Adherence to multiple medications for cardiovascular secondary prevention is challenging.
- Acute coronary syndrome (ACS) patients require complex medication regimens for long-term management.
Purpose of the Study:
- To identify concurrent adherence patterns to multiple medications in ACS patients.
- To assess the impact of these adherence patterns on clinical outcomes.
Main Methods:
- A population-based retrospective cohort study of ACS patients discharged between 2009-2011.
- Group-based trajectory models were used to identify seven adherence patterns to ≥3 medications over the first year.
- Multivariable Cox proportional hazards models assessed the association between adherence patterns and clinical outcomes in the second year.
Main Results:
- Seven adherence trajectories were identified among 12,057 ACS patients initiated on ≥3 medications.
- The 'Adherent' group (52.94%) had the lowest risk.
- Early Gap, Late Decline, and Non-Adherent trajectories were associated with significantly higher risks of adverse clinical outcomes compared to the Adherent group.
Conclusions:
- Concurrent adherence patterns provide a more nuanced understanding of medication adherence than traditional metrics like Proportion of Days Covered (PDC).
- Three specific adherence trajectories are linked to increased adverse cardiovascular events.
- Targeted interventions based on identified adherence patterns can potentially improve medication adherence and patient outcomes.
Aim:
Adherence to multiple medications recommended for secondary prevention of cardiovascular conditions represents a challenge. We aimed to identify patterns of concurrent adherence to combined therapy and assess their impact on clinical outcomes in a cohort of patients with acute coronary syndrome (ACS).
Methods:
Population-based retrospective cohort of all patients discharged after hospitalization for ACS (2009-2011), prescribed ≥3 therapeutic groups within the first month. We assessed monthly concurrent adherence (≥24 days of medication out of 30) to ≥3 medications during the first year, and patterns were identified through group-based trajectory models. A composite clinical outcome during the second year was constructed. The association between adherence patterns and traditional refill adherence metrics [e.g., the proportion of days covered (PDC)], and outcomes were assessed through a multivariable Cox proportional hazards model.
Results:
Among 15,797 patients discharged alive, 12,057 (76.32%) initiated treatment with ≥3 therapeutic groups after discharge. We identified seven adherence trajectories to ≥3 medications: Adherent (52.94% of patients); Early Gap (6.64%); Middle Gap (5.67%); Late Decline (10.93%); Occasional Users (5.45%); Early Decline (8.79%); Non-Adherent (9.58%). Compared to the Adherent group, patients belonging to Early Gap (HR:1.30, 95%CI 1.07;1.60), Late decline (hazards ratio (HR): 1.31, 95% CI 1.1; 1.56), and Non-Adherent trajectories (HR: 1.36, 95% CI 1.14; 1.63) had a greater risk of adverse clinical outcomes, which was also different to the risk ascertained through concurrent PDC < 80 (HR: 1.13, 95% CI 1.01; 1.27).
Conclusion:
Overall, seven adherence trajectories to ≥3 drugs were identified, with three distinct adherence patterns being at higher risk of adverse outcomes. The identification of patterns of concurrent adherence, a more comprehensive approach than traditional measurements, may be useful to target interventions to improve adherence to multiple medications.
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