Evidence-based medication adherence among seniors in the first year after heart failure hospitalisation and subsequent long-term outcomes: a restricted cubic spline analysis of adherence-outcome relationships

被引:6
作者
Qin, Xiwen [1 ]
Hung, Joseph [2 ]
Knuiman, Matthew W. [1 ]
Briffa, Tom G. [1 ]
Teng, Tiew-Hwa Katherine [1 ,3 ]
Sanfilippo, Frank M. [1 ]
机构
[1] Univ Western Australia, Sch Populat & Global Hlth, Perth, WA, Australia
[2] Univ Western Australia, Med Sch, Perth, WA, Australia
[3] Natl Heart Ctr Singapore, Singapore, Singapore
基金
英国医学研究理事会;
关键词
Heart failure; Medication adherence; Renin-angiotensin system inhibitors; beta-blockers; Outcomes; Restricted cubic splines; NONADHERENCE; AUSTRALIA; DISCHARGE; SOCIETY; IMPACT; SCORE; RISK;
D O I
10.1007/s00228-023-03467-7
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Purpose Non-adherence to heart failure (HF) medications is associated with poor outcomes. We used restricted cubic splines (RCS) to assess the continuous relationship between adherence to renin-angiotensin system inhibitors (RASI) and beta-blockers and long-term outcomes in senior HF patients.Methods We identified a population-based cohort of 4234 patients, aged 65-84 years, 56% male, who were hospitalised for HF in Western Australia between 2003 and 2008 and survived to 1-year post-discharge (landmark date). Adherence was calculated using the proportion of days covered (PDC) in the first year post-discharge. RCS Cox proportional-hazards models were applied to determine the relationship between adherence and all-cause death and death/HF readmission at 1 and 3 years after the landmark date.Results RCS analysis showed a curvilinear adherence-outcome relationship for both RASI and beta-blockers which was linear above PDC 60%. For each 10% increase in RASI and beta-blocker adherence above this level, the adjusted hazard ratio for 1-year all-cause death fell by an average of 6.6% and 4.8% respectively (trend p < 0.05) and risk of all-cause death/HF readmission fell by 5.4% and 5.8% respectively (trend p < 0.005). Linear reductions in adjusted risk for these outcomes at PDC >= 60% were also seen at 3 years after landmark date (all trend p < 0.05).Conclusion RCS analysis showed that for RASI and beta-blockers, there was no upper adherence level (threshold) above 60% where risk reduction did not continue to occur. Therefore, interventions should maximise adherence to these disease-modifying HF pharmacotherapies to improve long-term outcomes after hospitalised HF.
引用
收藏
页码:553 / 567
页数:15
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