Association between trajectories of statin adherence and subsequent cardiovascular events
Association between trajectories of statin adherence and subsequent cardiovascular events
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DOI：
10.1002/pds.3787
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发表时间：
2015-10-01
影响因子：
2.6
通讯作者：
Choudhry, Niteesh K.
中科院分区：
文献类型：
--
作者：
Franklin, Jessica M.;Krumme, Alexis A.;Choudhry, Niteesh K.
目的试验模型已被证明可以(1)确定具有相似药物灌装行为模式的患者组，以及(2)总结轨迹，即每组患者随时间的平均依从性。然而，依从性轨迹和临床结果之间的关联仍不清楚。这项研究调查了12个月的他汀类药物轨迹和随后的心血管事件之间的关系。方法我们确定了2007年1月1日至2010年12月31日期间从一家大型国家保险公司开始他汀类药物治疗的患者。我们评估了在开始治疗后的360天内的药物依从性，并根据覆盖天数比例(PDC)和轨迹模型对患者进行分组。然后，我们在依从性评估后的一年内测量心血管事件。用COX比例风险模型评估依从性措施与心血管结局之间的关联；关联强度通过风险比、模型C统计量的增加和净重新分类指数(NRI)来量化。结果在519842名他汀类药物启动者中，8777名(1.7%)在随访期间发生了心血管事件。无论是通过轨迹组还是通过PDC来衡量依从性，使用更一致的药物与临床事件的可能性较低相关。当通过在模型中包括依从性的测量来评估对未来心血管事件的预测时，当使用三个或四个轨迹组(NRI=0.189；95%可信区间：[0.171，0.210])来测量依从性时，观察到最佳的模型重分类。结论他汀类依从性轨迹对未来心血管事件的预测比对PDC分类的测量更好。因此，依从性轨迹对于定向依从性干预可能是有用的。版权所有(C)2015 John Wiley&Sons，Ltd.
PurposeTrajectory models have been shown to (1) identify groups of patients with similar patterns of medication filling behavior and (2) summarize the trajectory, the average adherence in each group over time. However, the association between adherence trajectories and clinical outcomes remains unclear. This study investigated the association between 12-month statin trajectories and subsequent cardiovascular events.MethodsWe identified patients with insurance coverage from a large national insurer who initiated a statin during January 1, 2007 to December 31, 2010. We assessed medication adherence during the 360days following initiation and grouped patients based on the proportion of days covered (PDC) and trajectory models. We then measured cardiovascular events during the year after adherence assessment. Cox proportional hazards models were used to evaluate the association between adherence measures and cardiovascular outcomes; strength of association was quantified by the hazard ratio, the increase in model C-statistic, and the net reclassification index (NRI).ResultsAmong 519842 statin initiators, 8777 (1.7%) had a cardiovascular event during follow-up. More consistent medication use was associated with a lower likelihood of clinical events, whether adherence was measured through trajectory groups or PDC. When evaluating the prediction of future cardiovascular events by including a measure of adherence in the model, the best model reclassification was observed when adherence was measured using three or four trajectory groups (NRI=0.189; 95% confidence interval: [0.171, 0.210]).ConclusionsStatin adherence trajectory predicted future cardiovascular events better than measures categorizing PDC. Thus, adherence trajectories may be useful for targeting adherence interventions. Copyright (c) 2015 John Wiley & Sons, Ltd.