Karim Merchant , Parth V. Desai , Stephen Morris , Sovik De Sirkar , Dalila Masic , Parth Shah , Nicolas Krepostman , Matthew Collins , Kevin Walsh , Nathalie Antonios , Lucas Chan , Sorcha Allen , Ahmad Manshad , Shannon Kuhrau , Alexandru Marginean , Ahmed Elkaryoni , Jawed Fareed , Yevgeniy Brailovsky , Amir Darki
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Adherence data, including AC refill dates, were collected from pharmacies, and adherence measures including Continuous Measure of Medication Acquisition (CMA), Proportion of Days Covered (PDC), and Optimal Medication Adherence (OMA) were calculated per standardized formulas. Univariable and multivariable linear and logistic regression was used to analyze different variables affecting AC adherence.</p></div><div><h3>Results</h3><p>A total of 118 out of 144 patients had sufficient follow-up data to measure adherence and were included in the final analysis. Mean age was 60 ± 15 years, with 64 (54.2%) women; 70 (59.3%) White, 26 (22%) African American, 13 (11%) Hispanic; 58 (49.2%) patients had private insurance, 48 (40.7%) Medicare, 11 (9.3%) Medicaid. Type of AC comprised of 57 (48.3%) apixaban, 17 (14.4%) rivaroxaban, 8 (6.8%) warfarin, 6 (5.1%) enoxaparin, and 30 (25.4%) patients with changing AC. In univariable regression, African American and Medicaid-insured patients had significantly lower adherence, while advancing age, apixaban usage, and 30-day follow-up clinic visit showed a higher adherence. However, in multivariable regression, African American race (PDC -0.135, p = 0.006, CI (−0.231, −0.040) | OMA Adjusted OR 0.166, p = 0.030, CI (0.033, 0.837)) and other non-White, non-Hispanic races (PDC -0.314, p = 0.009, CI (−0.548, −0.080)) were associated with lower AC adherence.</p></div><div><h3>Conclusion</h3><p>In our study, African American and other minority race patients showed lower AC adherence after hospital admission for acute PE. 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Adherence data, including AC refill dates, were collected from pharmacies, and adherence measures including Continuous Measure of Medication Acquisition (CMA), Proportion of Days Covered (PDC), and Optimal Medication Adherence (OMA) were calculated per standardized formulas. Univariable and multivariable linear and logistic regression was used to analyze different variables affecting AC adherence.</p></div><div><h3>Results</h3><p>A total of 118 out of 144 patients had sufficient follow-up data to measure adherence and were included in the final analysis. Mean age was 60 ± 15 years, with 64 (54.2%) women; 70 (59.3%) White, 26 (22%) African American, 13 (11%) Hispanic; 58 (49.2%) patients had private insurance, 48 (40.7%) Medicare, 11 (9.3%) Medicaid. Type of AC comprised of 57 (48.3%) apixaban, 17 (14.4%) rivaroxaban, 8 (6.8%) warfarin, 6 (5.1%) enoxaparin, and 30 (25.4%) patients with changing AC. 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引用次数: 0
摘要
背景:急性肺栓塞(PE)后抗凝(AC)依从性对于预防死亡率和静脉血栓栓塞(VTE)的未来复发至关重要。我们的目的是分析急性PE后影响AC依从性的因素。方法选取2016年4月至2020年5月连续接受CT血管造影或V/Q扫描确诊急性PE的成人患者进行单中心回顾性研究。从药房收集依从性数据，包括AC补充日期，并计算每个标准化处方的依从性措施，包括药物获取的持续测量(CMA)，覆盖天数比例(PDC)和最佳药物依从性(OMA)。采用单变量和多变量线性和逻辑回归分析影响AC依从性的不同变量。结果144例患者中有118例有足够的随访数据来衡量依从性，并被纳入最终分析。平均年龄60±15岁，女性64例(54.2%);白人70人(59.3%)，非洲裔26人(22%)，西班牙裔13人(11%);58例(49.2%)患者有私人保险，48例(40.7%)有医疗保险，11例(9.3%)有医疗补助。AC类型包括57例(48.3%)阿哌沙班，17例(14.4%)利伐沙班，8例(6.8%)华法林，6例(5.1%)依诺肝素和30例(25.4%)AC变化患者。在单变量回归中，非裔美国人和医疗保险患者的依从性明显较低，而年龄增长，阿哌沙班使用和30天随访临床访问显示更高的依从性。然而，在多变量回归中，非裔美国人种族(PDC -0.135, p = 0.006, CI (- 0.231， - 0.040) | OMA校正OR 0.166, p = 0.030, CI(0.033, 0.837))和其他非白人、非西班牙裔种族(PDC -0.314, p = 0.009, CI(- 0.548， - 0.080))与较低的AC依从性相关。结论在我们的研究中，非裔美国人和其他少数民族患者在急性PE住院后表现出较低的AC依从性。需要进一步的研究来解决潜在的影响因素并改善这一人群的依从性。
Predictors of anticoagulation adherence in patients with acute pulmonary embolism
Background
Anticoagulation (AC) adherence after acute pulmonary embolism (PE) is vital to prevent mortality and future recurrence of venous thromboembolism (VTE). We aimed to analyze factors affecting AC adherence after acute PE.
Methods
Consecutive adult patients with CT angiography or V/Q scan confirmed acute PE were included in a single-center retrospective study from April 2016 to May 2020. Adherence data, including AC refill dates, were collected from pharmacies, and adherence measures including Continuous Measure of Medication Acquisition (CMA), Proportion of Days Covered (PDC), and Optimal Medication Adherence (OMA) were calculated per standardized formulas. Univariable and multivariable linear and logistic regression was used to analyze different variables affecting AC adherence.
Results
A total of 118 out of 144 patients had sufficient follow-up data to measure adherence and were included in the final analysis. Mean age was 60 ± 15 years, with 64 (54.2%) women; 70 (59.3%) White, 26 (22%) African American, 13 (11%) Hispanic; 58 (49.2%) patients had private insurance, 48 (40.7%) Medicare, 11 (9.3%) Medicaid. Type of AC comprised of 57 (48.3%) apixaban, 17 (14.4%) rivaroxaban, 8 (6.8%) warfarin, 6 (5.1%) enoxaparin, and 30 (25.4%) patients with changing AC. In univariable regression, African American and Medicaid-insured patients had significantly lower adherence, while advancing age, apixaban usage, and 30-day follow-up clinic visit showed a higher adherence. However, in multivariable regression, African American race (PDC -0.135, p = 0.006, CI (−0.231, −0.040) | OMA Adjusted OR 0.166, p = 0.030, CI (0.033, 0.837)) and other non-White, non-Hispanic races (PDC -0.314, p = 0.009, CI (−0.548, −0.080)) were associated with lower AC adherence.
Conclusion
In our study, African American and other minority race patients showed lower AC adherence after hospital admission for acute PE. Further studies are needed to address underlying contributors and improve adherence in this population.
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