Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia.
Pharmacoepidemiol Drug Saf. 2024 Aug;33(8):e5881. doi: 10.1002/pds.5881.
Cardiovascular diseases are the leading cause of death globally. Ensuring ongoing use of medicines-medication persistence-is crucial, yet no prior studies have examined this in residential aged care facilities (RACFs). We aimed to identify long-term trajectories of persistence with cardiovascular medicines and determine predictors of persistence trajectories.
A longitudinal cohort study of 2837 newly admitted permanent residents from 30 RACFs in New South Wales, Australia. We monitored weekly exposure to six cardiovascular medicine classes-lipid modifiers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs), beta-blockers, diuretics, calcium channel blockers (CCB), and cardiac therapy-over 3 years. Group-based trajectory modeling was employed to determine persistence trajectories for each class.
At baseline, 76.6% (n = 2172) received at least one cardiovascular medicine with 41.2% receiving lipid modifiers, 31.4% ACEI/ARBs, 30.2% beta-blockers, 24.4% diuretics, 18.7% CCBs, and 14.8% cardiac therapy. The model identified two persistence trajectories for CCBs and three trajectories for all other classes. Sustained high persistence rates ranged from 68.4% (ACEI/ARBs) to 79.8% (beta-blockers) while early decline in persistence and subsequent discontinuation rates ranged from 7.6% (cardiac therapy) to 25.3% (CCBs). Logistic regressions identified 11 predictors of a declining persistence across the six medicine classes.
Our study revealed varied patterns of cardiovascular medicine use in RACFs, with 2-3 distinctive medicine use trajectories across different classes, each exhibiting a unique clinical profile, and up to a quarter of residents discontinuing a medicine class. Future studies should explore the underlying reasons and appropriateness of nonpersistence to aid in identifying areas for improvement.
心血管疾病是全球范围内的主要死亡原因。确保持续使用药物——药物维持——至关重要，但以前的研究尚未在养老院中对此进行研究。我们旨在确定心血管药物维持的长期轨迹，并确定维持轨迹的预测因素。
这是一项在澳大利亚新南威尔士州 30 家养老院中，对 2837 名新入住的常住居民进行的纵向队列研究。我们监测了 3 年内每周暴露于 6 种心血管药物类别的情况——降脂药、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）、β-受体阻滞剂、利尿剂、钙通道阻滞剂（CCB）和心脏治疗。采用基于群组的轨迹建模来确定每种类别的维持轨迹。
基线时，76.6%（n=2172）至少使用了一种心血管药物，其中 41.2%使用降脂药，31.4%使用 ACEI/ARB，30.2%使用β-受体阻滞剂，24.4%使用利尿剂，18.7%使用 CCB，14.8%使用心脏治疗。该模型确定了 CCB 的两种维持轨迹和其他所有类别的三种轨迹。持续高维持率范围从 68.4%（ACEI/ARB）到 79.8%（β-受体阻滞剂），而维持率早期下降和随后停药率范围从 7.6%（心脏治疗）到 25.3%（CCB）。逻辑回归确定了六个药物类别中药物维持下降的 11 个预测因素。
我们的研究揭示了养老院中心血管药物使用的不同模式，不同类别中有 2-3 种独特的药物使用轨迹，每种轨迹都有独特的临床特征，高达四分之一的居民停止使用一种药物类别。未来的研究应探讨非维持的潜在原因和适当性，以帮助确定需要改进的领域。
