Key Points
- To identify longitudinal adherence patterns and their predictors for guideline-recommended medications prescribed following hospitalization for coronary heart disease.
- Conducted a population-based retrospective cohort study of patients discharged after hospitalization for coronary heart disease from public hospitals in Valencia, Spain in 2008 (n = 7,462).
- Created 4 medication subcohorts (antiplatelets, beta-blockers, ACE inhibitors/ARBs, and statins), defining monthly adherence as having at least 24 days covered out of 30.
- Used group-based trajectory models to classify adherence patterns over time and multinomial logistic regression to identify predictor variables.
- Identified up to five adherence trajectories across cohorts: nearly-always adherent, early gap with recovery, brief gaps/occasional use, slow decline, and fast decline.
- Descending trajectories were more frequent in the beta-blocker (16%) and ACEI/ARB (17%) cohorts compared to the antiplatelet (10%) and statin (8%) cohorts.
- Predictors of poor or intermediate adherence included a primary diagnosis of unstable angina or other non-AMI coronary heart disease, foreign-born status, prescription copayment requirements, and older age.
Structured PICO
PPopulation7,462 patients discharged after hospitalization for coronary heart disease (CHD) from public hospitals in the Valencia region (Spain) during 2008.
IInterventionEvidence-based medications (antiplatelet, beta-blockers, ACEI/ARB, statins) prescribed within the first 3 months after discharge.
OOutcomeAdherence patterns over time (monthly adherence defined as ≥24 days covered out of 30) and their predictors.
Identified 5 distinct medication adherence trajectories after CHD hospitalization, highlighting that patients with non-AMI diagnoses, older age, or copayment requirements are at higher risk for poor adherence.