Predicting Lipid-Lowering Medication Persistence after the First Cardiovascular Disease Hospitalization.

Abstract

This study analyzed patient factors in medication persistence after discharge from the first hospitalization for cardiovascular disease (CVD) with the aim of predicting persistence to lipid-lowering therapy for 1 to 2 years. A subcohort having a first CVD hospitalization was selected from 313,207 patients for proportional hazard model analysis. Logistic regression, support vector machine, artificial neural networks, and boosted regression tree (BRT) models were used to predict 1- and 2-year medication persistence. Proportional hazard modeling found significant association of persistence with age, diabetes history, complication and comorbidity level, days stayed in hospital, CVD diagnosis type, in-patient procedures, and being new to therapy. BRT had the best predictive performance with c-statistic of 0.811 (0.799-0.824) for 1-year and 0.793 (0.772-0.814) for 2-year prediction using variables potentially available shortly after discharge. The results suggest that development of a machine learning-based clinical decision support tool to focus improvements in secondary prevention of CVD is feasible.