Self‐Controlled Case‐Series Study to Verify the Effect of Adherence to Beta‐Blockers in Secondary Prevention of Myocardial Infarction

Kim

Health Qual Life Outcomes

et al. 2018

BackgroundThe healthy adherer effect is a phenomenon in which patients who adhere to medical therapies tend to pursue health-seeking behaviors. Although the healthy adherer effect is supposed to affect health outcomes in patients with coronary artery disease, evaluation of its presence and extent is not easy. This study aimed to assess the relationship between medication adherence and lifestyle modifications and health-related quality of life among post-acute myocardial infarction (AMI) patients.MethodsA cross-sectional study was conducted in 417 post-AMI patients who underwent percutaneous coronary intervention (PCI). Patients were recruited from 11 university hospitals from December 2015 to March 2016 in South Korea. Details regarding socio-demographic factors, six health behaviors (low-salt intake, low-fat diet and/or weight-loss diet, regular exercise, stress reduction in daily life, drinking in moderation, and smoking cessation), medication adherence using the Modified Morisky Scale (MMS), and HRQoL using the Coronary Revascularization Outcome Questionnaire (CROQ) were surveyed in a one-on-one interview.ResultsIn the univariate logistic analysis, sex (female), age (≥70 years), MMS score (≥5), and CROQ score were associated with adherence to lifestyle modification. In the multiple logistic analysis, a high MMS score (≥5) was associated with adherence to lifestyle modification after adjusting for sex, age, marital status, education, and family income (adjusted odds ratio [OR] = 11.7, 95% confidence interval [CI] = 1.5–91.3). After further adjusting for the CROQ score, the association between high MMS score and adherence to lifestyle modification was significant (adjusted OR = 11.5, 95% CI = 1.4–93.3).ConclusionsAdherence to medication was associated with adherence to lifestyle modification, suggesting the possible presence of the healthy adherer effect in post-AMI patients. After further adjusting for HRQoL, the association remained. To improve health outcome in post-AMI patients, early detection of patients with poor adherence to medication and lifestyle modification and motivational education programs to improve adherence are important. In addition, the healthy adherer effect should be considered in clinical research, in particular, in studies evaluating the effects of therapies on health outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12955-018-0921-z) contains supplementary material, which is available to authorized users.

Section: Introductionmentioning

confidence: 99%

Relationships among medication adherence, lifestyle modification, and health-related quality of life in patients with acute myocardial infarction: a cross-sectional study

Kim

Health Qual Life Outcomes

et al. 2018

“…Table 1 shows the observed proportion of cases with Y = y total number of AMI episodes, as reported in Di Bartolomeo et al 14 Given an observed P(Y = 1 | Y > 0) = 0.877 and Equation ( 4), we get Λ = 0.26 and recommend using W = Λ × 10 ≈ 3 partitions. Di Bartolomeo et al 14 reported around 1400 AMI episodes out of a cohort of roughly 30 000 individuals at risk in the population, producing a crude incidence rate of Λ ≅ 0.05. Following Whitaker et al's recommendation, Λ = 0.05 < 0.1 indicates a rare event and would have been expected to yield an acceptable level of bias in first event analysis.…”

Section: Example With Beta-blockers and Acute Myocardial Infarctionmentioning

confidence: 86%

“…3,4 However, this assumption is violated in the presence of event dependence, where the occurrence of an event influences the probability and timing of subsequent events and can lead to biased estimates of the exposure RI. Event dependence is suspected in many medical outcome events in SCCS studies, including stroke, 9,11,13 acute myocardial infarction, 10,11,14 and venous thromboembolism. 15,16 When event dependence is present or suspected in an SCCS study, investigators are typically advised to use first event analysis, which only includes the first outcome event for each case in the analysis.…”

Section: Introductionmentioning

confidence: 99%

Estimation and reduction of bias in self‐controlled case series with non‐rare event dependent outcomes and heterogeneous populations

Lee,

Cheung

2024

Statistics in Medicine

The self‐controlled case series (SCCS) is a commonly adopted study design in the assessment of vaccine and drug safety. Recurrent event data collected from SCCS studies are typically analyzed using the conditional Poisson model which assumes event times are independent within‐cases. This assumption is violated in the presence of event dependence, where the occurrence of an event influences the probability and timing of subsequent events. When event dependence is suspected in an SCCS study, the standard recommendation is to include only the first event from each case in the analysis. However, first event analysis can still yield biased estimates of the exposure relative incidence if the outcome event is not rare. We first demonstrate that the bias in first event analysis can be even higher than previously assumed when subpopulations with different baseline incidence rates are present and describe an improved method for estimating this bias. Subsequently, we propose a novel partitioned analysis method and demonstrate how it can reduce this bias. We provide a recommendation to guide the number of partitions to use with the partitioned analysis, illustrate this recommendation with an example SCCS study of the association between beta‐blockers and acute myocardial infarction, and compare the partitioned analysis against other SCCS analysis methods by simulation.

Pharmacoepidemiology and Drug

“…Also, the authors found that adherence to dual antiplatelet therapy, ACEI/ARB and beta‐blockers was not significantly associated to lower risk of MACE 20 . However, a meta‐analysis of nearly 200 000 patients concluded that there was no association between beta‐blockers and all‐cause mortality, 36 but in other study found that being adherent to beta‐blockers was associated with a 20% reduction of recurrent AMIs 37 …”

Section: Discussionmentioning

confidence: 99%

Impact of adherence to drugs for secondary prevention on mortality and cardiovascular morbidity: A population‐based cohort study. IMPACT study

Sotorra-Figuerola

Ouchi

Giner-Soriano

et al. 2021

Purpose Adherence to pharmacological therapy for secondary prevention after an acute coronary syndrome (ACS) reduces the risk of new cardiovascular events. However, several studies showed poor adherence. Our study aim was to assess the risk of a composite endpoint of major cardiovascular events (MACE) and all‐cause mortality according to the adherence to these drugs in patients after an ACS in a primary health care cohort. Methods Population‐based observational cohort study of patients with a first episode of ACS during 2009–2016. Data source: Information System for Research in Primary Care (SIDIAP) database. Drug adherence was evaluated through proportion of days covered (PDC). Results We included 7152 patients and 5692 (79.6%) were adherent (PDC ≥ 75%) to the study drugs during the first year after the event. Adherents to any combination showed a significant reduction of the composite endpoint risk (HR 0.80 [0.73–0.88]), and a significant lower probability of the composite endpoint than nonadherents for all drugs, except beta‐blockers. Adherents to 2 (HR 1.2; 95% CI 1.0–1.3) and 1 drug (HR 1.5; 95% CI 1.2–1.8) had higher composite endpoint risk compared to adherents to 4–3 drugs. Conclusion Adherence to any combination of recommended drugs reduced the composite endpoint risk, regardless the number of drugs prescribed. Adherence to a combination of 4–3 drugs was significantly associated with a reduced mortality risk compared with adherents to 2 or 1, but it was not significant for MACE.