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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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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

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

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

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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.

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