Assessing Concurrent Adherence to Combined Essential Medication and Clinical Outcomes in Patients With Acute Coronary Syndrome. A Population-Based, Real-World Study Using Group-Based Trajectory Models

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Abstract

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.

Graphical Abstract

Our paper at a glance: assessing concurrent adherence to combined essential medication and clinical outcomes in acute coronary syndrome patients. A population-based, real-world study using group-based trajectory models.

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Most cited references 29

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Group-based trajectory modeling in clinical research.

Daniel S. Nagin, Candice L. Odgers (2010)

Group-based trajectory models are increasingly being applied in clinical research to map the developmental course of symptoms and assess heterogeneity in response to clinical interventions. In this review, we provide a nontechnical overview of group-based trajectory and growth mixture modeling alongside a sampling of how these models have been applied in clinical research. We discuss the challenges associated with the application of both types of group-based models and propose a set of preliminary guidelines for applied researchers to follow when reporting model results. Future directions in group-based modeling applications are discussed, including the use of trajectory models to facilitate causal inference when random assignment to treatment condition is not possible.

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Author and article information

Contributors

Clara L. Rodríguez-Bernal: URI : http://loop.frontiersin.org/people/398832/overview

Francisco Sánchez-Saez: URI : http://loop.frontiersin.org/people/1377723/overview

Daniel Bejarano-Quisoboni: URI : http://loop.frontiersin.org/people/468067/overview

Isabel Hurtado: URI : http://loop.frontiersin.org/people/624115/overview

Anibal García-Sempere: URI : http://loop.frontiersin.org/people/453420/overview

Salvador Peiró: URI : http://loop.frontiersin.org/people/597166/overview

Gabriel Sanfélix-Gimeno: URI : http://loop.frontiersin.org/people/404499/overview

Journal

Journal ID (nlm-ta): Front Cardiovasc Med

Journal ID (iso-abbrev): Front Cardiovasc Med

Journal ID (publisher-id): Front. Cardiovasc. Med.

Title: Frontiers in Cardiovascular Medicine

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2297-055X

Publication date (Electronic): 25 May 2022

Publication date Collection: 2022

Volume: 9

Electronic Location Identifier: 863876

Affiliations

[1] ¹Health Services Research Unit, The Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO) , Valencia, Spain

[2] ²Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) , Valencia, Spain

Author notes

Edited by: Liesl Joanna Zühlke, South African Medical Research Council, South Africa

Reviewed by: Chien-Yi Hsu, Taipei Medical University Hospital, Taiwan; Susan Abughosh, University of Houston, United States; Eelko Hak, University of Groningen, Netherlands

*Correspondence: Clara L. Rodríguez-Bernal rodriguez_claber@ 123456gva.es

This article was submitted to Cardiovascular Epidemiology and Prevention, a section of the journal Frontiers in Cardiovascular Medicine

Article

DOI: 10.3389/fcvm.2022.863876

PMC ID: 9174582

PubMed ID: 35694663

SO-VID: 2fe10cfe-f062-4ef5-90ec-ea6a7355ce1a

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 27 January 2022

Date accepted : 21 March 2022

Page count

Figures: 5, Tables: 2, Equations: 0, References: 29, Pages: 12, Words: 6457

Funding

Funded by: Instituto de Salud Carlos III, doi 10.13039/501100004587;

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Assessing Concurrent Adherence to Combined Essential Medication and Clinical Outcomes in Patients With Acute Coronary Syndrome. A Population-Based, Real-World Study Using Group-Based Trajectory Models

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Abstract

Aim

Methods

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Graphical Abstract

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Most cited references 29

2020 International Society of Hypertension Global Hypertension Practice Guidelines

2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC).

Group-based trajectory modeling in clinical research.

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