Adherent Group Research Articles

0760 Excessive daytime sleepiness, positive airway pressure, and patient satisfaction with multiple aspects of care in a real-world population with obstructive sleep apnea

Abstract Introduction Excessive daytime sleepiness (EDS) is common in patients with obstructive sleep apnea (OSA) and can persist despite use of positive airway pressure (PAP) therapy. These analyses assessed relationships between EDS, PAP use, and patient satisfaction across several aspects of OSA care in a real-world population with OSA. Methods US residents (aged ≥18 years, self-reported physician OSA diagnosis [1/1/2015–3/31/2020]) completed a survey in Evidation Health’s Achievement app assessing Epworth Sleepiness Scale (ESS), PAP usage, and satisfaction with care. Self-reported PAP use was categorized as nonuse, nonadherent (<4 h/night; <5 d/wk), intermediate (4–6 h/night, ≥5 d/wk), or highly adherent (≥6 h/night, ≥5 d/wk) (PAP-adherent=intermediate and highly adherent groups). Logistic regression models assessed impacts of PAP adherence and EDS on satisfaction with care across 7 domains. P-values are uncontrolled for multiplicity (nominal). Results Among all participants (N=2289; 50.3% female, 82.5% White, 44.8±11.1 years old [mean±SD], 35.4±8.7 kg/m2 body mass index [mean±SD]), 42.5% had EDS (ESS>10). PAP use was: nonuse (n=700), nonadherent (n=153), or adherent (n=1436; intermediate n=225, high n=1211). Within these subgroups, the proportions (95% CI) with EDS were: nonuse (47% [43.7–51.1]), nonadherent (52% [44.4–60.2]), intermediate (53% [46.4–59.4]), and highly adherent (36% [33.7–39.1]). Logistic regression (using data from PAP users) showed a positive association of PAP adherence with satisfaction with PAP (OR [95% CI]: 5.43 [3.73–7.90]); OSA treatment effectiveness (3.56 [2.48–5.12]); OSA symptom management (3.15 [2.17–4.57]); coordination of OSA care (2.60 [1.82–3.72]); and education from their healthcare provider on the impact of OSA on cardiovascular health (1.62 [1.13–2.35]), importance of using PAP (1.7 [1.15–2.52]), or availability of prescription drugs to treat OSA symptoms (1.55 [1.06–2.26]). The presence of EDS was associated with lower patient satisfaction in nearly all domains examined (ORs ranged from 0.44–0.62 across 6 of 7 domains). Conclusion EDS was common in this real-world population with OSA, even among participants who were highly adherent PAP users. PAP adherence was associated with higher patient satisfaction across all care domains; the presence of EDS was associated with lower patient satisfaction across 6 of 7 domains. Support (If Any) Jazz Pharmaceuticals

The negative impact of COVID-19 pandemic on age-related macular degeneration patients treated with intravitreal bevacizumab injections.

PurposeCOVID-19 emerged in the end of 2019 and was declared a worldwide pandemic shortly after. Social distancing and lockdowns resulted in lower compliance in intravitreal injections and office visits. We aimed to assess clinical outcomes among patients who missed these visits compared to those who arrived as planned.MethodsPatients who missed or were late to office visits or intravitreal injections were defined as non-adherent and were compared to adherent patients. Our main outcomes were the need for subsequent injections, mean change in best-corrected visual acuity (BCVA), and central macular thickness (CMT).ResultsThis study included 77 patients (24 adherent and 53 non-adherent). The mean BCVA remained stable during the study period for the adherent group (p = 0.159) and worsened in the non-adherent group (p < 0.001). Changes in CMT and maximum thickness were not significant for either group. A higher proportion of patients in the non-adherent group needed subsequent intravitreal injections (49% vs 20%, p = 0.014).ConclusionThe findings demonstrate the negative implications of the COVID-19 pandemic and the effect of deferring bevacizumab injections among individuals with age-related macular degeneration. This emphasizes the importance of a scheduled follow-up, also during a pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10792-022-02337-y.

Effects of the Atrial fibrillation Better Care (ABC) pathway on outcomes among clinically complex chinese patients with atrial fibrillation with multimorbidity and polypharmacy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with atrial fibrillation (AF) commonly have complex clinical backgrounds. In this ancillary analysis we assessed the adherence to and the effectiveness of the Atrial fibrillation Better Care (ABC) pathway in reducing adverse outcomes in Chinese AF patients with a complex clinical background of multimorbidity and/or polypharmacy. Methods The ChiOTEAF registry[1] is a prospective, multicentre nationwide study conducted from October 2014 to December 2018. The primary outcomes of interest were the composite endpoint of all-cause death and thromboembolic (TE) events, as well as individual endpoints of all-cause death, TE events, and major bleeding. ’Multimorbidity’ was defined as the presence of ≥2 co-morbidities, ’polypharmacy’ was defined as the concomitant use of ≥5 medications. The participants were assessed against the ABC pathway criteria: patients qualified for the ‘A’ criterion (Avoid stroke) if they were treated with oral anticoagulants according to their TE risk; ‘B’ criterion (Better symptom control) if they demonstrated optimal symptom control defined as European Heart Rhythm Association score of I/II at baseline; ‘C’ criterion (Cardiovascular risk factor and Comorbidity optimisation) if they received disease-specific treatment(s) according to current guidelines at baseline. Patients were considered as ABC-adherent if they fulfilled all three criteria. Results The eligible cohort included 4644 patients with multimorbidity and 2262 patients with polypharmacy (Fig 1.), of whom 56.2% (mean age 74.4±10.2; 42.8% female) and 58.7% (mean age 74.6±10.1; 43.3% female) respectively had available data to assess the ABC pathway utilisation. Adherence to the ABC pathway was associated with lower odds ratio (OR) of the primary composite outcome in the multimorbidy (OR: 0.48; 95% CI: 0.29-0.79) and polypharmacy (OR: 0.39; 95% CI: 0.19-0.78) groups (Table 1.). Adherence to the ABC pathway was associated with a lower risk of all-cause death in multimorbid patients (OR: 0.51; 95% CI: 0.27-0.95) and TE events in patients with polypharmacy (OR: 0.31; 95% CI: 0.10-0.95). In a subgroup of patients with concomitant multimorbidity and polypharmacy the risk of composite outcome (OR: 0.38; 95% CI: 0.18-0.79) and TE events (OR: 0.31; 95% CI: 0.10-0.94) were lower in the ABC-adherent patients. There were no significant differences in the incidence of major bleeding among patients with multimorbidity, polypharmacy or both in the ABC-adherent compared to the non-ABC adherent groups. Health-related quality of life (QoF) was lower in the non-ABC adherent compared to the ABC-adherent patients. Conclusion This study shows that adherence to the ABC pathway is associated with improved clinical outcomes and QoF in Chinese AF patients with multimorbidity and/or polypharmacy. There is no evidence to suggest that adhering to the ABC pathway is associated with a higher risk of major bleeding events compared to standard practice.

Physician adherence and patient-reported outcomes in heart failure with reduced ejection fraction in the era of angiotensin receptor-neprilysin inhibitor therapy

This Korean nationwide, multicenter, noninterventional, prospective cohort study aimed to analyze physician adherence to guideline-recommended therapy for heart failure (HF) with reduced ejection fraction (HFrEF) and its effect on patient-reported outcomes (PROs). Patients diagnosed with or hospitalized for HFrEF within the previous year were enrolled. Treatment adherence was considered optimal when all 3 categories of guideline-recommended medications (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors; beta-blockers; and mineralocorticoid receptor antagonists) were prescribed and suboptimal when ≤ 2 categories were prescribed. The 36-Item Short Form Survey (SF-36) scores were compared at baseline and 6 months between the 2 groups. Overall, 854 patients from 30 hospitals were included. At baseline, the optimal adherence group comprised 527 patients (61.7%), whereas during follow-up, the optimal and suboptimal adherence groups comprised 462 (54.1%) and 281 (32.9%) patients, respectively. Patients in the suboptimal adherence group were older, with a lower body mass index, and increased comorbidities, including renal dysfunction. SF-36 scores were significantly higher in the optimal adherence group for most domains (P < 0.05). This study showed satisfactory physician adherence to contemporary treatment for HFrEF. Optimal adherence to HF medication significantly correlated with better PROs.

Impact of treatment adherence on the effectiveness and safety of oral anticoagulants in patients with atrial fibrillation: a retrospective cohort study.

The impact of adherence to oral anticoagulation has not been reported in terms of absolute risk, which would enhance patients' understanding and treatment adherence. This retrospective cohort study analysed data from the National Health Insurance Database of Korea, from January 2010 to December 2018, on 84 227 patients with non-valvular atrial fibrillation (NVAF). The participants were analysed according to their overall adherence to oral anticoagulants (OACs) and further divided into four groups: non-vitamin K antagonist oral anticoagulant (NOAC) adherent, vitamin K antagonist (VKA) adherent, NOAC non-adherent, and VKA non-adherent. The incidence of ischaemic stroke, major bleeding, and death was compared between the four groups using risk difference, number needed to treat and number needed to harm. Among the participants, 50 178 were adherent to (OACs), while 34 049 were non-adherent. The incidence of major bleeding was higher in the adherent group (4.49%; 95% confidence interval, 4.11-4.85%) than in the non-adherent group (3.61%; 3.16-4.06%), and the incidence of ischaemic stroke was higher in the non-adherent group (7.68%; 7.08-8.33%) than in the adherent group (5.61%; 5.17-6.07%). In terms of risk difference, adherence to OACs increased the risk of major bleeding by 0.87% and decreased the risk of ischaemic stroke by 2.08%. This finding suggests that one additional major bleeding event occurred for every 115 adherent patients, and one additional ischaemic stroke event was prevented for every 48 adherent patients. The benefits of OAC adherence in NVAF patients for ischaemic stroke prevention exceeding the risk of bleeding are shown more clearly in terms of absolute risk.

Patient-reported adherence to physical exercises of patients with ankylosing spondylitis

IntroductionStudies on adherence to exercise therapy of patients with ankylosing spondylitis (AS) are rare, and the criteria for adherence to exercise are inconsistent. This study aimed to quantify patient-reported adherence to exercise therapy of Chinese outpatients with AS and investigate the factors related to poor adherence.MethodsThe subjects’ sociodemographic, disease-related, radiographic, and laboratory parameters were collected. Patients’ adherence to exercise therapy was assessed using the Exercise Attitude Questionnaire (EAQ) with a 4-point Likert scale. All cases were grouped as good adherence and poor adherence using a cutoff score of 60, according to a previous study. Univariate analysis was conducted to assess the intergroup differences. Then, we built a multivariate logistic regression model to identify possible significant factors related to poor adherence to exercise therapy.ResultsA total of 185 outpatients completed the questionnaire. The mean EAQ score was 49.4 (IQR, 40.7–59.3) and 146 patients (78.9%) were considered to have poor adherence, and 39 patients (21.1%) were considered to have good adherence. The rates of current nonsteroidal anti-inflammatory drugs (NSAIDs), conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and tumor necrosis factor-α inhibitor (TNF-i) use were significantly higher in the poor adherence group (p=0.001, p=0.027, p=0.018, respectively). Our multivariate logistic regression model revealed that the only significant associated factor was current use of NSAIDs (OR=3.517; p=0.016; 95% CI, 1.259–9.827).ConclusionsOutpatients with AS had an unacceptable level of adherence to exercise therapy, and current use of NSAIDs was a significantly associated factor.Key Points• Outpatients with AS had an unacceptable level of adherence to exercise therapy.• Current use of NSAIDs exerted a negative impact on patients’ adherence to exercise therapy.

Treatment Adherence and Incidence of Coronary Heart Disease in Type 2 Diabetes Mellitus Patients

Previous studies showed that uncontrolled blood sugar and long-term use of several types of antidiabetic could increase the risk of coronary heart disease (CHD). This study aimed to compare the incidence of CHD in type 2 diabetes mellitus (T2DM) patients showing treatment adherence and non-adherence behavior over four years. This was a retrospective cohort study with data sets obtained from the Bogor Cohort Study of Non-Communicable Disease Risk Factors. All study subjects were not diagnosed with CHD at the beginning of the study. The sample was divided into two groups; one had adhered to treatment from health centers and followed the treatment instructions (adherent group), while the other had not followed the treatment instructions (non-adherent group). Of 5,690 subjects, 276 were eligible for this study (84 in the adherent and 192 in the non-adherent group). The incidence of CHD in the non-adherent group was 2.3% higher than in the adherent group (p-value = 0.564) and had a 1.7 times greater risk of developing CHD, but not statistically significant (adjusted HR = 1.739; 95% CI = 0.673-4.490). The non-adherent T2DM patients had a greater risk of developing CHD than adherent T2DM patients.

Physical activity patterns, genetic susceptibility, and risk of hip/knee osteoarthritis: a prospective cohort study based on the UK Biobank

The effect of physical activity on hip/knee osteoarthritis (OA) and how it varies by genetic susceptibility to OA remains inconclusive. In a cohort study of UK Biobank, 436,166 OA-free participants were recruited in 2006-2010 and followed for knee/hip OA until the end of 2020. 28 physical activity-related items were collected at baseline. Cox regression was used to estimate associations between physical activity behaviors, as well as major activity patterns (i.e., significant principal components[PCs] identified by principal component analysis), and risk of OA, adjusting for multiple confounders. We further stratified the analyses by polygenic risk score (PRS) for OA to examine the impact of genetic susceptibility to OA on the studied association. During a mean follow-up of 11.15 years, 13,227 hip and 21,119 knee OA cases were identified. 19, out of 28, studied items showed associations with increased OA risk. Compared with low adherence group(<1st tertile of PC score for each pattern), individuals with high adherence to five identified patterns were associated with increased risk of OA. The moderate adherence to "strenuous sports"(HR=0.93, 95%CI: 0.89-0.97) and "walking for pleasure"(HR=0.93, 95%CI: 0.89-0.98) patterns was associated with reduced OA. Similar risk patterns were obtained in the stratified analysis by PRS levels for OA. High intensity of most activity patterns were associated with increased OA. However, a protective effect was suggested for moderate adherence to patterns of "strenuous sports" and "walking for pleasure" that consistent across different genetic susceptibilities, underscoring the potential benefits of moderate-intensity physical activity on OA.

Long-Term Effect of Obstructive Sleep Apnea and Continuous Positive Airway Pressure Treatment on Blood Pressure in Patients with Acute Coronary Syndrome: A Clinical Trial.

Rationale: Obstructive sleep apnea (OSA) is prevalent in patients with acute coronary syndrome (ACS) and is a cause of secondary hypertension. Objectives: To explore the long-term effects of OSA and continuous positive airway pressure (CPAP) treatment on blood pressure (BP) in patients with ACS. Methods: Post hoc analysis of the ISAACC study (Continuous Positive Airway Pressure in Patients with Acute Coronary Syndrome and Obstructive Sleep Apnea; NCT01335087) included 1,803 patients admitted for ACS. Patients with OSA (apnea-hypopnea index [AHI], ⩾15 events/h) were randomly assigned to receive either CPAP or usual care and were seen in follow-up for 1-5 years. Office BP was determined at each visit. Results: We included 596 patients without OSA, 978 patients in the usual care or poor CPAP adherence group, and 229 patients in the good CPAP adherence group. At baseline, 52% of the patients were diagnosed with hypertension. Median (25th to 75th percentile) age and body mass index were 59 (52.0 to 67.0) years and 28.2 (25.6 to 31.2) kg/m2, respectively. After a median (25th to 75th percentile) follow-up of 41.2 (18.3 to 59.6) months, BP changes were similar in the OSA and non-OSA groups. However, we observed an increase in BP in the third tertile of the AHI (AHI, >40 events/h), with a maximum difference in mean BP of +3.3 mm Hg at 30 months. Patients with OSA with good CPAP adherence (⩾4 h/night) reduced mean BP after 18 months compared with patients with usual care/poor CPAP adherence, with a maximum mean difference (95% confidence interval) of -4.7 (-6.7 to -2.7) mm Hg. In patients with severe OSA, we observed a maximum mean difference of -7.1 (-10.3 to -3.8) mm Hg. Conclusions: In patients with ACS, severe OSA is associated with a long-term increase in BP, which is reduced by good CPAP adherence. Clinical trial registered with www.clinicaltrials.gov (NCT01335087).

Inverse Association Between Persistence With Antidepressant Medication and Onset of Chronic Pain in Patients With Depression: A Retrospective Cohort Study.

Despite the known involvement of depression in chronic pain, the association between persistence with and adherence to antidepressant medication and onset of chronic pain in patients with depression remains unclear. This retrospective cohort study used a Japanese claims database to extract data for adult patients with depression who were prescribed antidepressants between April 2014 and March 2020. Patients were divided into groups according to duration of continuous prescription of antidepressants (≥6 months [persistent group] and <6 months [nonpersistent group]) and medication possession ratio (≥80% [good adherence group] and <80% [poor adherence group]). The outcome was onset of chronic pain, which was defined as continuous prescription >3 months of analgesics and diagnosis of pain-related condition after discontinuation of the first continuous antidepressant prescription. The risk of onset of chronic pain was compared between the paired groups. A total of 1859 patients were selected as the study population and categorized as the persistent (n = 406) and nonpersistent (n = 1453) groups, and good adherence (n = 1551) and poor adherence (n = 308) groups. Risk of onset of chronic pain was significantly lower in the persistent group than in the nonpersistent group after controlling for confounding via standardized mortality ratio weighting (hazard ratio, 0.38; 95% confidence interval, 0.18-0.80; P = 0.011). There was no significant difference between the good and poor adherence groups. Antidepressant persistence for ≥6 months is recommended and may reduce the onset of chronic pain in patients with depression.

Application of Inverse-Probability-of-Treatment Weighting to Estimate the Effect of Daytime Sleepiness in Patients with Obstructive Sleep Apnea.

Rationale: Continuous positive airway pressure (CPAP), the first line therapy for obstructive sleep apnea (OSA), is considered effective in reducing daytime sleepiness. Its efficacy relies on adequate adherence, often defined as >4 hours per night. However, this binary threshold may limit our understanding of the causal effect of CPAP adherence and daytime sleepiness, and a multilevel approach for CPAP adherence can be more appropriate. Objectives: In this study, we show how two causal inference methods can be applied on observational data for the estimation of the effect of different ranges of CPAP adherence on daytime sleepiness as measured by the Epworth Sleepiness Scale (ESS). Methods: Data were collected from a large prospective observational French cohort for patients with OSA. Four groups of CPAP adherence were considered (0-4, 4-6, 6-7, and 7-10 h per night). Multivariable regression, inverse-probability-of-treatment weighting (IPTW), and inverse propensity weighting with regression adjustment (IPW-RA) were used to assess the impact of CPAP adherence level on daytime sleepiness. Results: In this study, 9,244 patients with OSA treated by CPAP were included. The mean initial ESS score was 11 (±5.2), with a mean reduction of 4 points (±5.1). Overall, there was evidence of the causal effect of CPAP adherence on daytime sleepiness which was mainly observed between the lower CPAP adherence group (0-4 h) compared with the higher CPAP adherence group (7-10 h). There are no differences by considering higher level of CPAP adherence (>4 h). Conclusions: We showed that IPTW and IPW-RA can be easily implemented to answer questions regarding causal effects using observational data when randomized trials cannot be conducted. Both methods give a direct causal interpretation at the population level and allow the assessment of the appropriate consideration of measured confounders.

Impact of NCCN Guideline Adherence in Adult Cancer Pain on Length of Stay

To improve the management of cancer related pain, the National Comprehensive Cancer Network (NCCN) publishes the Adult Cancer Pain guideline on an annual basis. However, a large majority of oncology patients still report inadequate pain control. Single-center, retrospective cohort study of adult patients admitted for uncontrolled pain or pain crisis between 3/1/19 and 06/30/20 were assigned to cohorts of either adherent or non-adherent to NCCN guideline recommendations for management of pain crises based on their initial opioid orders. Patients must have reported a pain score >/= 4 and received at least one dose of opioids within 24 hours upon admission. The length of stay (LOS), pain scores, and naloxone administration were compared between both groups. Patients in the adherent group had a shorter median LOS (3.7 days [range: 1 to 18.93] vs 5.4 days [range: 1.45 to 19.64 days], p = 0.04). Patients that received lower doses than recommended had longer LOS compared to adherent group (6.1 vs. 3.7 days; p = 0.009). When adjusted for confounders, this significance did not remain. The lowest reported pain score within 24 hours of admission was lower in the adherent group (median 3 vs 4, p = 0.04). Predictors of LOS included opioid tolerance and a pain or palliative care consult. Adherence to NCCN guidelines for acute pain crisis management in adult patients with cancer remains poor. Patients who received guideline adherent initial opioid regimens demonstrated a trend toward a shorter LOS. Opioid-tolerant patient outcomes remain inadequate; appropriate pain management for these patients need to improve.

Heart Failure Clinic No-show Rates And Effect On Heart Failure Hospitalizations: A Real-World Experience From The Middle East

<h3>Introduction</h3> Adherence to scheduled appointments in heart failure (HF) patients remains an important factor for optimum HF management. Recognizing patterns of adherence to appointments will provide insight and help to improve compliance in attending future HF clinics. <h3>Aim</h3> We aim to describe the frequency and characteristics of no-show appointments in relation to patient demographics and distance traveled, and evaluate the effect on HF hospitalizations in our newly established advanced HF program in the Middle East-Gulf Region. <h3>Methods</h3> A total of 230 patients who have been followed up in our HF clinic were included. Retrospective chart review was used to collect data on patients' demographics and adherence to appointments. Based on the average no-show rate, a head-to-head comparison was conducted using appropriate testing methods between those who were adherent (no-show rate ≤10%) vs. non-adherent (no-show rate >10%) patients. The comparison included the 12 months HF-admissions as well. <h3>Results</h3> A total of 1667 appointments were scheduled and confirmed. Patients did not show in 199 (11.9%) of the appointments, but attended an average of 6.5± 2 appointments during 12 months follow-up. Wednesday and Monday clinic appointments were more likely to be missed (32.6% and 24.1%, respectively). Afternoon appointments represented 57.8% of all missed appointments. Non-convenient appointment was the most documented reason for not showing (29.4%, Table.1). When comparing the adherent vs. the non-adherent group, (Table.2). Travel distance was similar in both groups. Males and smokers were more predominant in the non-adherent group (p=0.02 and p=0.02, respectively). The adherent group had a total of 35 HF hospitalizations compared to the non-adherent group who had a total of 42 HF hospitalizations (p=0.15). <h3>Conclusion</h3> This study explores important real-world data and adds to the available evidence on HF patient adherence. Highlighting key patient characteristics, including distance traveled to specialized HF programs increases our understanding and helps formulate future strategic planning to predict and reduce the impact of patient no-show rates and future HF hospitalizations.

Exploration of the patient’s voice

Diabetes self-management is a complex process in which individuals are asked to modify established health behaviors. Healthcare providers are instrumental in enhancing individual self-management and are encouraged to consider the patient perspective, often expressed indirectly. Using multidimensional analysis, this study analyzed talk to compare linguistic features used by adherent and non-adherent individuals with diabetes. In-depth telephone interviews were conducted with 108 individuals. Recruitment was stratified by sex, race and glycated hemoglobin (A1C) score. Interviewer contributions were removed from the transcripts, leaving only the participants’ contributions. Using A1C score (?7%, &gt;7%) the texts were divided into adherent and non-adherent datasets. Based on computer-assisted, quantitative analysis, ten linguistic features had a significant difference in frequency of use between the two groups. The participants in the adherent group used a greater frequency of linguistic features related to personal stance than the non-adherent group, and these expressions of personal stance were considered in relation to the participant’s sense of agency. A better understanding of the way in which different subsets of individuals talk about diabetes self-management would facilitate greater healthcare provider understanding of the patient’s perspective during clinical encounters to improve adherence.

Factors associated with glycemic control among patients with type 2 diabetes: a cross-sectional study.

Achieving glycemic control significantly improves the progression of the disease among diabetes mellitus patients although this is not achieved by many diabetics. The aim of the study is to explore the factors associated with glycemic control among patients with type 2 diabetes. In addition to sociodemographic variables, beliefs about medications and medication adherence were evaluated using the validated Beliefs about Medications Questionnaire and the 4-item medication adherence scale. A cut-off point of HbA1c% <7 was used as an indicator of glycemic control. Stepwise binary logistic regression was conducted to explore the variables associated with poor glycemic control. A total of 287 patients participated in the study. More than half (58%) were found to have poor glycemic control‎. Females had significantly higher odds of having controlled diabetes (OR=2.28, p-value <0.01). Increasing necessity for diabetes medications was significantly associated with improved glycemic control (OR=2.75, p-value <0.01). Participants in low or moderate adherence groups had significantly higher odds of having uncontrolled diabetes. Future diabetes management programs should focus on emphasizing medication necessity and improving medication adherence, particularly for male patients, with the aim of improving glycemic control and health outcomes among patients with type 2 diabetes.

The Relationship between Drug Adherence to Antiretroviral Therapy and Viral Load in Children Living with HIV

Introduction: HIV infection is one of the major public health issues in India and globally. Adherence to ARV drugs is important for optimal virological suppression and should be assessed routinely and strictly reinforced. There is limited information on adherence patterns and its determinants in children in resource-constrained countries because these countries have limited options if viral resistance develops. The objective of our study was to determine the relationship between viral load and drug adherence in children living with HIV and to determine socio-demographic factors affecting adherence and reasons for non-adherence.&#x0D; Materials and Methods: In this cross-sectional observational study, 70 children on ART were enrolled after applying the inclusion and exclusion criteria. All clinical, demographic details and investigations available were noted. Adherence was assessed by the pill counting method. Caregivers who reported missing doses were given the pediatric nonadherence questionnaire. Blood sample was analyzed for viral load estimation. Appropriate statistical tests were used and analysis was done.&#x0D; Results: The mean age of diagnosis in study subjects was 8.13 ± 3.89 years and mean duration of treatment was 4.24 ± 3.05 years. Majority, 61(87.1%) patients had adherence more than 95%. Among 9 non-adherent children, the main reason was that they forgot to take medicine in 8(88.9%) cases. The adherent group had significant virological suppression and higher CD4 count. Mean viral load in the adherent group was 2379 ± 5996.74 copies per ml against 46529.22 ± 86633.12 copies per ml in the non-adherent group.&#x0D; Conclusion: We found that adherent group had a higher CD4 count and a suppressed viral load and adherence to ART was unrelated to age, sex, duration of HIV infection and treatment, socioeconomic status, and route of transmission.

Explorative study regarding influenza vaccine hesitancy among HIV-infected patients

ABSTRACT There are scarce data regarding influenza vaccination among people with HIV infection (PWHIV). The goal of this explorative study is to assess hesitancy toward influenza vaccination in a group of PWHIV during the COVID-19 pandemic. A questionnaire was administered to 219 patients vaccinated at our clinic during the 2020–2021 campaign. It evaluated subjects’ adherence to influenza vaccine over the last three seasonal vaccination campaigns, vaccine confidence, complacency and convenience, and the effect of the pandemic on the choice to become vaccinated. The population was divided into two groups: fully adherent to influenza vaccine (all three campaigns, 117 patients) and non-fully adherent (one or two campaigns, 102 patients). Adherence increased in the non-fully adherent group in 2020–2021, but the pandemic did not affect the choice. Misbeliefs emerged: the influenza vaccine was considered protective against SARS-CoV-2 (22.8% of the total population); almost half of all patients thought the influenza vaccine could improve their CD4 T cell level (57.3% in fully adherent, 40.2% in non-fully adherent, p < .05). In 2020–2021 campaign, three quarters of the non-fully adherent group would not have been vaccinated in a location other than our clinic (75.5% vs. 88.9% in the fully adherent group, p < .05). Conclusively, offering a secure and private space for vaccination against influenza seems to encourage vaccination; healthcare professionals should improve counseling to increase adherence and correct misbeliefs.

PAP therapy and readmission rates after in-hospital laboratory titration polysomnography in patients with hypoventilation.

Hypoventilation associated with sleep-disordered breathing in inpatients is associated with higher risk of morbidity, hospitalizations, and death. In-hospital titration polysomnography qualifies patients for positive airway pressure (PAP) therapy and optimizes settings, but impact is unknown. This study describes a process for in-hospital sleep testing and evaluates subsequent PAP adherence and readmission. A retrospective cohort of patients with hypoventilation and in-hospital titration polysomnography with available PAP data were analyzed to determine whether PAP adherence was associated with 90-day readmission. Absolute differences were obtained using logistic regression models. Models were adjusted for body mass index, age, and Elixhauser index. PAP adherence and nonadherence were defined as ≥ 4 and < 4 hours of daily average use prior to readmission or first 90 days postdischarge. Eighty-one patients, 50.6% male, with age (mean ± SD) 61.1 ± 13.5 years were included. Comorbid sleep disorders included 91.4% with obstructive sleep apnea and 23.5% with central sleep apnea. Twenty-eight of 52 (53.8%) nonadherent and 6 of 29 (20.7%) adherent patients had 90-day readmissions. Eleven (13.6%) patients (all nonadherent) were readmitted within 2 weeks of discharge. The adjusted model showed a 35.6% (95% confidence interval 15.9-55.2%) reduction in 90-day readmission in the adherent group compared with the nonadherent group (P = .004). Similar reductions in readmission were found with adherence of ≥ 50% and ≥ 70% of days ≥ 4 hours. Male sex, treatment with iVAPS (intelligent volume-assured pressure support), and highest CO2 ≥ 60 mmHg on polysomnography were associated with the largest differences in readmission rates between adherent and nonadherent patients. Adherence to optimized PAP therapy after in-hospital titration polysomnography in patients with hypoventilation may decrease readmissions. Johnson KG, Rastegar V, Scuderi N, Johnson DC, Visintainer P. PAP therapy and readmission rates after in-hospital laboratory titration polysomnography in patients with hypoventilation. J Clin Sleep Med. 2022;18(7):1739-1748.

Chronic obstructive pulmonary disease patients' experience using Trelegy as compared with other inhalers.

IntroductionTrelegy is a combination inhaler that is often reported to offer benefits over multiple inhalers. We compared Trelegy use with multiple inhalers for adherence, symptoms, medication beliefs, and medication attitudes.MethodsThis cross-sectional survey of 58 patients compared the patient’s experience with Trelegy (n = 18) versus any other inhaler (n = 40). Outcome variables consisted of Test of the Adherence to Inhalers scale, the Chronic obstructive pulmonary disease Assessment Test (CAT) scale, attitude items from the St. George’s Respiratory Questionnaire, the Beliefs about Medicines Questionnaire (BMQ)-necessity subscale, and the BMQ-concerns subscale.ResultsWe found that patients using Trelegy had greater CAT symptoms (M = 19.8, SD = 7.75) in comparison with the any other inhaler group (M = 15.7, SD = 11.10; P = 0.04). We did not find any difference between the groups for adherence or any of the medication attitudes or beliefs. CAT score was positively correlated with the number of months patients were on their current inhaler (rs = 0.29, P < 0.05) and their use of a rescue inhaler (rs = 0.42, P < 0.01). Patients with more concern about their medications were negatively correlated with the use of a rescue inhaler (rs = −0.31, P < 0.05).DiscussionWe found that patients using Trelegy had greater symptoms in comparison with the any other inhaler group, but did not differ for adherence, medication attitudes, or medication beliefs.ConclusionWe recommend that clinicians should regularly re-evaluate their Trelegy recommendations, as Trelegy use may not be the best therapy for certain patients. Also, a study with a larger sample size can be beneficial to confirm these findings.

Maternal and child-health outcomes in different endometrial preparation methods for frozen-thawed embryo transfer: a retrospective study

The purpose of this study was to analyse the obstetric outcome after frozen embryo transfer depending on the protocol used. The endometrial preparation during frozen embryo transfer (FET) was performed in the natural cycle (NC) with timing based on monitoring of the naturally occurring luteinizing hormone (LH) peak or in human chorionic gonadotropin (hCG)-triggered modified natural cycles (MNC), artificial cycle (AC) with hormone replacement therapy cycle and cycle with ovulation induction (OI). A retrospective cohort study was conducted between 2018 and 2020. Pregnancy, perinatal complications and neonatal outcomes were compared among patients treated during AC or MNC or OI protocols. After adjusting for the effect of gravidity, parity, pre-pregnancy body mass index (BMI) and number of miscarriages, the AC group had higher but not significantly different rates of gestational hypertension, preeclampsia and intrahepatic cholestasis of pregnancy (ICP) than women in OI and MNC groups. Significant differences were observed in the rates of placental adherence (15.30% in AC vs. 9.24% in MNC, p = 0.004) and postpartum haemorrhage (PPH) (24.33% in AC vs. 13.07% in OI, p = 0.003, 24.33% in AC vs. 16.24% in MNC, p = 0.002) among the three groups. In singletons, significant differences were observed in the rates of placental adherence (14.09% in AC vs. 8.57% in MNC, p = 0.002), AC and MNC groups had higher risk of PPH compared with OI group (18.36% in AC vs. 12.38% in MNC, p = 0.042 and 7.69% in OI vs. 18.36% in AC, p = 0.013). Neonatal outcomes were similar among the three groups except risk of small for date infants (0.35% in AC vs. 1.44% in MNC, p = 0.008). These findings are important in view of increasing use of frozen cycles and new policy of freeze-all cycles in in vitro fertilization (IVF). The results suggest a link between the absence of corpus luteum and adverse obstetric outcomes.