Abstract: FR-PO357
Trajectories of Adherence to Thienopyridines After Coronary Stenting in Patients on Dialysis
Session Information
- Hypertension and CVD: Clinical, Outcomes, Trials
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Lidgard, Benjamin, Harbor UCLA Medical Center, Carson, California, United States
- Chang, Tara I., Stanford University School of Medicine , Palo Alto, California, United States
- Montez-Rath, Maria E., Stanford University School of Medicine , Palo Alto, California, United States
- Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
- Shen, Jenny I., LaBiomed at Harbor-UCLA, Torrance, California, United States
Background
Adherence to medications often fluctuates over time. We identified distinct trajectories of adherence to thienopyridines after percutaneous intervention (PCI) with stenting in patients on dialysis and hypothesized that better adherence would be associated with lower risk of cardiovascular events.
Methods
Using the U.S. Renal Data System, we identified all adult patients on dialysis who underwent PCI with stenting from July 2007 to December 2012, filled a discharge prescription for a thieneopyridine, and survived the following 6 months. We applied group-based trajectory modeling to categorize patients into patterns of thienopyridine adherence in the 6 months after discharge. We used Cox regression to estimate the hazard ratios for the composite outcome of myocardial infarction, revascularization, and death associated with each trajectory.
Results
Among 8,296 patients, we identified 4 distinct trajectories of adherence: 1) consistently high adherence, 2) high adherence with gradual decline, 3) moderate adherence with gradual improvement, and 4) moderate adherence with rapid decline (Figure). The unadjusted risk of the composite outcome was significantly lower for those with consistently high adherence (Table).
Conclusion
Consistently high adherence to thienopyridines was associated with a lower unadjusted risk of cardiovascular events than other trajectories of adherence. Further work to identify correlates of these trajectories may help inform interventions to improve adherence and potentially reduce adverse outcomes.
Hazard Ratios for CV Outcomes
| Trajectory (vs. Group 1) | HR (95% Confidence Interval) |
| Group 1 (consistently high adherence) | reference group |
| 2 (high adherence with gradual decline) | 1.15 (1.05-1.25) |
| 3 (moderate adherence with gradual improvement) | 1.12 (1.04-1.21) |
| 4 (moderate adherence with rapid decline) | 1.19 (1.11-1.28) |
Funding
- NIDDK Support