MOX, Department of Mathematics, Politecnico di Milano, Milan, Italy.
CHRP-National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
Am J Cardiovasc Drugs. 2020 Apr;20(2):179-190. doi: 10.1007/s40256-019-00367-z.
Much data about prescription adherence in patients with heart failure (HF) are available, but few exist about the evaluation of true patient adherence. Further, methods for analyzing this issue are poorly known.
Our objective was to evaluate the impact of patient adherence to disease-modifying drugs after HF hospitalization in a community-based cohort.
Patients hospitalized with first diagnostic HF code and at least one post-discharge purchase of evidence-based drugs for HF between 2009 and 2015 were included (12,938 patients). A new method for measuring adherence to polypharmacy (patient adherence indicator [PAI]) was introduced, based on proportion of days covered (PDC) and medication possession ratio (MPR). The investigated drugs were β-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), and anti-aldosterone agents (AAs). Regional administrative databases were analyzed.
The mean age of the cohort was 80 years; 53% was female; the median Charlson Comorbidity Index score was 2, and the overall death rate was 60%. PAI based on PDC estimated a nonadherence rate of 47%. Median daily dosages were well below target dosages for all drugs considered. A good PAI significantly lowered the mortality risk, irrespective of the computational method used: PDC (PAI adjusted hazard ratio [HR] 0.93; 95% confidence interval [CI] 0.88-0.97; p = 0.001) or MPR (PAI adjusted HR 0.93; 95% CI 0.89-0.98; p = 0.004).
In a real-world setting, medication adherence of patients with HF remains unsatisfactory, especially when in a polypharmacy setting. Irrespective of PDC and MPR, good patient adherence to polypharmacy was associated with a lower death rate.
有大量关于心力衰竭（HF）患者用药依从性的资料，但关于真实患者依从性评估的资料却很少。此外，分析这个问题的方法也知之甚少。
我们的目的是评估社区基础队列中 HF 住院后患者对疾病修正药物的依从性的影响。
纳入了 2009 年至 2015 年间首次诊断为 HF 并出院后至少购买过一种 HF 循证药物的患者（12938 例）。引入了一种新的衡量多药治疗依从性的方法（患者依从性指标[PAI]），该方法基于覆盖天数（PDC）和用药比例（MPR）。研究药物包括β受体阻滞剂（BBs）、血管紧张素转换酶抑制剂（ACEIs）、血管紧张素受体阻滞剂（ARBs）和抗醛固酮药物（AAs）。分析了区域行政数据库。
队列的平均年龄为 80 岁；53%为女性；Charlson 合并症指数中位数为 2，总死亡率为 60%。基于 PDC 的 PAI 估计不依从率为 47%。考虑到所有药物，中位数的日剂量均远低于目标剂量。良好的 PAI 显著降低了死亡率，无论使用哪种计算方法：PDC（PAI 调整后的危险比[HR]为 0.93；95%置信区间[CI]为 0.88-0.97；p=0.001）或 MPR（PAI 调整后的 HR 为 0.93；95%CI 为 0.89-0.98；p=0.004）。
在现实环境中，HF 患者的药物依从性仍然不尽如人意，尤其是在多药治疗的情况下。无论 PDC 和 MPR 如何，良好的患者多药治疗依从性与较低的死亡率相关。
