Differences in cardiovascular disease risk when antihypertensive medication adherence is assessed by pharmacy fill versus self-report: the Cohort Study of Medication Adherence among Older Adults (CoSMO).
Differences in cardiovascular disease risk when antihypertensive medication adherence is assessed by pharmacy fill versus self-report: the Cohort Study of Medication Adherence among Older Adults (CoSMO).
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DOI：
10.1097/hjh.0000000000000382
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发表时间：
2015-02
影响因子：
4.9
通讯作者：
Muntner P
中科院分区：
文献类型：
--
作者：
Krousel-Wood M;Holt E;Joyce C;Ruiz R;Dornelles A;Webber LS;Morisky DE;Frohlich ED;Re RN;He J;Whelton PK;Muntner P
药房续药依从性评估药物填充行为，而自我报告依从性评估药物服用行为。我们对比了药房续药和自我报告的降压药物依从性与心血管疾病（CVD）发生率的相关性。纳入了2006年8月至2007年9月招募的老年人药物依从性前瞻性队列研究（CoSMO）的成人（n=2075）。使用药房再填充测量，药物持有率-MPR（低，中，高MPR：分别为<0.5，0.5至<0.8，≥0.8）和自我报告的测量，8项Morisky药物依从性量表-MMAS-8（低，中，高MMAS-8：分别为<6，6至<8和8）确定抗高血压药物依从性。识别并裁定了截至2011年2月的新发心血管疾病事件（中风、心肌梗死、充血性心力衰竭或心血管疾病死亡）。MPR的低、中和高依从性的发生率分别为4.5%、23.7%和71.8%，MMAS-8为14.0%、34.3%和51.8%。在平均3.8年的随访中，240人（11.5%）发生了CVD事件。经多变量校正后，与高MPR组相比，中、低MPR组CVD的风险比（HR）分别为1.17（95%置信区间[CI] 0.87，1.56）和1.87（95% CI：1.06，3.30）。与高MMAS-8的受试者相比，中等和低MMAS-8的MMAS-8的HR（95%CI）分别为1.04（0.79-1.38）和0.89（0.58-1.35）。药房续药而非自我报告的抗高血压药物依从性与CVD事件相关。这些关联的差异可能是由于每个依从性测量评估的区别。
Pharmacy refill adherence assesses medication-filling behaviors whereas self-report adherence assesses medication-taking behaviors. We contrasted the association of pharmacy refill and self-reported antihypertensive medication adherence with cardiovascular disease (CVD) incidence. Adults (n=2075) from the prospective Cohort Study of Medication Adherence among Older Adults (CoSMO) recruited between August 2006 and September 2007 were included. Antihypertensive medication adherence was determined using a pharmacy refill measure, Medication Possession Ratio-MPR (low, medium, high MPR: <0.5, 0.5 to <0.8, ≥0.8, respectively) and a self-reported measure, 8-item Morisky Medication Adherence Scale-MMAS-8 (low, medium, high MMAS-8: <6, 6 to <8, and 8, respectively). Incident CVD events (stroke, myocardial infarction, congestive heart failure, or CVD death) through February 2011 were identified and adjudicated. The prevalence of low, medium and high adherence was 4.5 %, 23.7%, and 71.8% for MPR and 14.0%, 34.3%, and 51.8% for MMAS-8. During a median 3.8 years follow-up, 240 (11.5%) people had a CVD event. After multivariable adjustment and compared to those with high MPR, the hazard ratios (HR) for CVD associated with medium and low MPR were 1.17 (95% confidence interval [CI] 0.87, 1.56) and 1.87 (95% CI: 1.06, 3.30), respectively. Compared to those with high MMAS-8, the HRs (95% CI) for MMAS-8 for medium and low MMAS-8 were 1.04 (0.79–1.38) and 0.89 (0.58–1.35), respectively. Pharmacy refill but not self-report antihypertensive medication adherence was associated with incident CVD. The differences in these associations may be due to distinctions in what each adherence measure assesses.