The Association Between Levels of Post-Discharge Care Continuity and Long-Term Treatment Adherence and...

Post-discharge care continuity represents a modifiable factor influencing outcomes in myocardial infarction survivors, yet its multidimensional relationship with treatment adherence and psychological morbidity remains underexplored.

This retrospective cohort study analysed 452 adults with first-time acute myocardial infarction discharged between 2019 to 2024 from Beijing Tongren Hospital. Care continuity was quantified via a validated 10-point score (0-10) assessing follow-up frequency (0-4 points), content coverage (0-3 points), and multidisciplinary coordination (0-3 points). Participants were stratified into low (≤ 3 points, n = 231), moderate (4-6 points, n = 157), and high continuity (≥ 7 points, n = 64) groups. Primary outcomes were 6-month treatment adherence (composite of medication possession ratio ≥ 80% for ≥ 2 core medications and ≥ 75% scheduled visit completion) and anxiety/depression symptoms (PHQ-9 ≥ 10, GAD-7 ≥ 8, or clinical diagnosis). Multivariable logistic regression adjusted for sociodemographic, clinical, and psychological confounders.

High continuity care demonstrated significantly increased treatment adherence versus low continuity (adjusted odds ratio [aOR] = 2.50, 95% confidence interval [CI]: 1.82-3.42) and reduced anxiety/depression symptoms (aOR = 0.48, 95% CI: 0.30-0.77). Each 1-point continuity increase improved adherence by 22% (aOR = 1.22, 95% CI: 1.15-1.30) and decreased psychological risk by 13% (aOR = 0.87, 95% CI: 0.82-0.93). Absolute adherence difference between high and low continuity groups was 35.1% (number needed to treat = 3). Cardiovascular events decreased progressively across continuity levels (low: 22.1%, moderate: 12.7%, high: 7.8%; p = 0.003), with high continuity independently reducing event risk by 58% (aOR = 0.42, 95% CI: 0.24-0.73). Urban residence and higher left ventricular ejection fraction predicted better continuity access.

Quantified care continuity exhibits a dose-dependent association with superior medication adherence, psychological wellbeing, and reduced cardiovascular risk in myocardial infarction survivors. Optimising continuity represents a high-yield strategy for secondary prevention.