Among patients with heart failure, the occurrence of ≥1 HF hospitalization was associated with low adherence to sacubitril/valsartan (OR 1.165; 95% CI 1.151-1.179).
Cohort (n=4,455)
What are the long-term adherence trajectories to sacubitril/valsartan and their associated factors in patients with heart failure?
Less than half of heart failure patients maintain high adherence to sacubitril/valsartan over 12 months, with polypharmacy and hospitalizations predicting poorer adherence.
Odds Ratio: 1.165 (95% CI 1.151–1.179)
Medication adherence in chronic conditions is a long-term process. Modeling longitudinal trajectories using routinely collected prescription data is a promising method for describing adherence patterns and identifying at-risk groups. The study aimed to characterize distinct long-term sacubitril/valsartan adherence trajectories and factors associated with them in patients with heart failure (HF). Subjects with incident HF starting sac/val in 2017-2018 were identified from the Campania Regional Database for Medication Consumption. We estimated patients' continuous medication availability (CMA9; R package AdhereR) during a 12-month period. We selected groups with similar CMA9 trajectories (Calinski-Harabasz criterion; R package kml). We performed multinomial regression analysis, assessing the relationship between demographic and clinical factors and adherence trajectory groups. The cohort included 4455 subjects, 70% male. Group-based trajectory modeling identified four distinct adherence trajectories: high adherence (42.6% of subjects; CMA mean 0.91 ± 0.08), partial drop-off (19.6%; CMA 0.63 ± 0.13), moderate adherence (19.3%; CMA 0.54 ± 0.11), and low adherence (18.4%; CMA 0.17 ± 0.12). Polypharmacy was associated with partial drop-off adherence (OR 1.194, 95%CI 1.175-1.214), while the occurrence of ≥1 HF hospitalization (OR 1.165, 95%CI 1.151-1.179) or other hospitalizations (OR 1.481, 95%CI 1.459-1.503) were associated with low adherence. This study found that tailoring patient education, providing support, and ongoing monitoring can boost adherence within different groups, potentially improving health outcomes.
Mucherino et al. (Wed,) conducted a cohort in Heart failure (n=4,455). Clinical factors (polypharmacy, hospitalizations) was evaluated on Low adherence trajectory (OR 1.165, 95% CI 1.151-1.179). Among patients with heart failure, the occurrence of ≥1 HF hospitalization was associated with low adherence to sacubitril/valsartan (OR 1.165; 95% CI 1.151-1.179).