Ajrouche Aya, Estellat Candice, De Rycke Yann, Tubach Florence
Sorbonne Université, Faculté de médecine Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), INSERM, UMR 1123, ECEVE, CIC-P 1421, Paris, France.
J Cardiovasc Pharmacol Ther. 2020 Jan;25(1):37-46. doi: 10.1177/1074248419865287. Epub 2019 Jul 24.
Previous studies have shown that adherence to low-dose aspirin (LDA) is suboptimal. However, these studies were based on an average measure of adherence during follow-up, ignoring its dynamic process over time. We described the trajectories of adherence to LDA treatment among the French population over 3 years of follow-up.
We identified a cohort of 11 793 new LDA users, aged ≥50 years in 2010, by using the French national health-care database. Patients included had at least 3 years of history in the database before study entry to exclude prevalent aspirin users and to assess baseline comorbidities. They were followed from the first date of LDA supply (the index date) until the first date among death, exit from the database, or 3 years after the index date. Adherence to LDA was assessed every 3 months by using the proportion of days covered (PDC) and dichotomized with a cutoff of PDC of 0.8. We used group-based trajectory modeling to identify trajectories of LDA adherence. Predictors of LDA adherence trajectory membership were identified by multinomial logistics regression.
We identified 4 trajectories of adherence among new LDA users: the not-adherents (4737 [40.2%]), the delayed not-adherents (gradual decrease in adherence probability, 1601 [13.6%]), the delayed adherents (gradual increase in adherence probability, 1137 [9.6%]), and the persistent adherents (4318 [36.6%]). The probability of belonging to the not-adherent group was increased with female sex, low socioeconomic status, and polymedication and was reduced with a secondary indication for LDA use, such as diabetes, hypertension, and dementia, at least 4 consultations in the previous year, or 1 hospitalization or a cardiologist consultation in the 3 months before the index date.
This study provides a dynamic picture of adherence behaviors among new LDA users and underlines the presence of critical trajectories that intervention could target to improve adherence.
既往研究表明，低剂量阿司匹林（LDA）的依从性欠佳。然而，这些研究基于随访期间依从性的平均测量值，忽略了其随时间的动态变化过程。我们描述了法国人群在3年随访期间LDA治疗的依从性轨迹。
我们利用法国国家医疗数据库，确定了一个队列，其中包括2010年年龄≥50岁的11793名新LDA使用者。纳入的患者在研究入组前在数据库中至少有3年病史，以排除现有的阿司匹林使用者并评估基线合并症。从LDA供应的第一天（索引日期）开始对他们进行随访，直至死亡、退出数据库或索引日期后3年中的第一个日期。每3个月使用覆盖天数比例（PDC）评估LDA的依从性，并以PDC为0.8作为分界点进行二分法分类。我们使用基于组的轨迹模型来识别LDA依从性轨迹。通过多项逻辑回归确定LDA依从性轨迹成员的预测因素。
我们在新LDA使用者中确定了4种依从性轨迹：不依从者（4737例[40.2%]）、延迟不依从者（依从概率逐渐降低，160例[13.6%]）、延迟依从者（依从概率逐渐增加，1137例[9.6%]）和持续依从者（4318例[36.6%]）。女性、社会经济地位低和联合用药会增加属于不依从组的概率，而LDA使用的二级指征（如糖尿病、高血压和痴呆）、前一年至少4次会诊、或索引日期前3个月内1次住院或心脏病专家会诊则会降低该概率。
本研究提供了新LDA使用者依从行为的动态情况，并强调了存在可作为干预目标以提高依从性的关键轨迹。
