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This work was supported by the 2018 Health Outcomes Research Grant from Merck Health Foundation (partially) and by the Instituto de Salud Carlos III, Spanish Ministry of Health, through the REDISSEC network [grant number RD16/0001/0011 to CR-B, formerly and FS-S, currently]; and through a competitive grant [Sara Borrell CD19/00137 to CR-B, currently]. The funding sources have no access to study data, did not participate in any way in the design or conduct of the study, data analysis, or decisions regarding the dissemination of findings, the development of the manuscript, or its publication.

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Sanchez-Saez, FranciscoAuthor
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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

Publicated to:Front Cardiovasc Med. 9 863876- - 2022-05-25 9(), DOI: 10.3389/fcvm.2022.863876

Authors: Rodriguez-Bernal, Clara L; Sanchez-Saez, Francisco; Bejarano-Quisoboni, Daniel; Hurtado, Isabel; Garcia-Sempere, Anibal; Peiro, Salvador; Sanfelix-Gimeno, Gabriel

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Fdn Promot Hlth & Biomed Res Valencia Reg FISABIO, Hlth Serv Res Unit, Valencia, Spain - Author
Red Invest Serv Salud Enfermedades Cron REDISSEC, Valencia, Spain - Author

Abstract

AimAdherence 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). MethodsPopulation-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. ResultsAmong 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). ConclusionOverall, 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.

Keywords
Acute coronary syndromeAssociationClinical outcomesCohorComplexityConcomitant medicationsConcurrent adherenceGroup-based trajectory modelsMultiple preventive therapiesOlder-adultsPopulation-based cohorPopulation-based cohortReal-world dataSecondary preventionValencia

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Front Cardiovasc Med due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Cardiology and Cardiovascular Medicine.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 2.22, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-25, the following number of citations:

  • WoS: 5
  • Scopus: 5
  • Europe PMC: 2
  • OpenCitations: 6
Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-25:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 23.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 23 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 1.25.
  • The number of mentions on the social network X (formerly Twitter): 2 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.