Good Adherence Group Research Articles

Discrepancy between Subjective and Objective Measurements for the Evaluation of Medication Adherence-A Cross-Sectional Study in Patients with Cardiovascular Diseases.

Medication adherence is important for the appropriate drug-based treatment in patients with chronic diseases, especially those with cardiovascular diseases (CVDs). The purpose of the present study was to evaluate medication adherence among patients with CVDs using subjective and objective measurements. We enrolled outpatients who visited Fukuoka University Chikushi Hospital from June to December 2022. As a subjective measurement, we used a self-reported questionnaire developed by Ueno et al., which consists of 12 questionnaire items grouped into the following four domains: medication compliance (subjective compliance), collaboration with health care providers (collaboration), willingness to access and use information about medication (willingness), and acceptance to take medication and how taking medication fits a patient's lifestyle (acceptance). The pill counting method was used as an objective measurement to calculate the medication adherence rate; Poor Adherence was defined as a medication adherence rate of <100%. Ninety-four patients were analyzed. No statistically significant differences were observed between the patients in the Good and Poor Adherence groups classified by pill counting, an objective indicator; in the subjective evaluation index Ueno scale scores of subjective compliance, collaboration, willingness, and acceptance domains; and in the total score. A multivariate analysis revealed that obesity (odds ratio, 3.527; 95% confidence interval, 1.387-9.423; p = 0.008) was an independent factor associated with Poor Adherence. In conclusion, we found a discrepancy between subjective and objective measurements for the evaluation of medication adherence. Furthermore, obesity was an independent factor associated with poor medication adherence assessed by the pill counting method; thus, patients with CVD and obesity require a careful follow-up.

Visceral fat mass dynamics in a 2-year randomized STrength versus ENdurance training trial in people with obesity.

To compare the effectiveness of strength versus endurance training on reducing visceral fat in individuals with obesity. For the STrength versus ENdurance (STEN) 24-month randomized clinical trial, we assigned 239 participants with abdominal obesity to either strength or endurance training (two to three times a week, 60 min/training session) in addition to standard nutritional counselling to promote a healthy diet. Changes in abdominal visceral adipose tissue (VAT) area quantified by magnetic resonance imaging after 12 months were defined as a primary endpoint. Participants (aged 44 years, 74% women, body mass index: 37 kg/m2, mean VAT volume: 4050 cm3) had an approximately 50% retention rate and a 30% good training programme adherence at 12 months. There was no difference between strength and endurance training in VAT volume dynamics after 12 and 24 months (p = .13). Only in the good adherence group did we find a trend for reduced VAT volume in both training regimens. Independently of the exercise programme, there was a continuous trend for moderate loss of abdominal subcutaneous AT volume, body fat mass, body mass index and improved parameters of insulin sensitivity. Although parameters of physical fitness improved upon both exercise interventions, the dynamics of resting energy expenditure, glucose and lipid metabolism parameters were not different between the intervention groups and did not significantly improve during the 2-year trial (p > .05). Despite heterogeneous individual training responses, strength and endurance training neither affected VAT volume nor key secondary endpoints differently.

The association between irregularity in sleep-wake rhythm and CPAP adherence

This study aims to evaluate the association between sleep-wake rhythm regularity and continuous positive airway pressure (CPAP) adherence. We retrospectively analyzed sleep-wake rhythms with activity monitoring and CPAP adherence among obstructive sleep apnea (OSA) patients newly diagnosed and introduced to CPAP therapy at the Sapporo Hanazono Hospital from January 2018 to June 2022. Among a total of 45 patients, 10 withdrew from CPAP therapy within a year. Nineteen were classified into the good-adherence and 16 into the poor-adherence group. No significant differences were detected among the groups in apnea-hypopnea index (AHI), sleep efficiency, or subjective sleep quality, but a difference was observed in sleep latency, with the CPAP withdrawal group showing higher variability in sleep onset and lower regularity and/or amplitude in circadian behavior activity rhythm than the good-adherence group. Our results suggest that irregularities, particularly in sleep onset, and damped sleep-wake rhythm can be risk factors for CPAP withdrawal.

Anti-diabetic medication adherence and cardiovascular outcomes in patients with cancer: a nationwide population-based cohort study

Abstract Background Diabetes is an important cause of morbidity, which predisposes patients to major cardiovascular (CV) events and mortality. However, clinical implications of anti-diabetic medication adherence for cancer patients have not been well studied in the real clinical practice. Purpose This study aimed to evaluate the association between anti-diabetic medication adherence and clinical outcomes in adult patients with cancer. Methods Using the prospective nationwide cohort (Korean NHIS-NSC), we extracted adult cancer patients treated with anti-diabetic medications. Based on the medication possession ratio (MPR) value, participants were divided into 3 groups: good (MPR ≥0.8), moderate (0.5 ≤ MPR &amp;lt; 0.8), and poor (MPR&amp;lt;0.5) adherence groups. The primary outcomes were overall and CV mortality. The secondary outcome was CV events requiring hospitalization due to major CV diseases. Results Among 8,052 cancer patients with concomitant diabetes, 59.4% were nonadherence group (21.5% were moderate and 37.9% were poor adherence group). Over a median of 8.4 years of follow-up, 1,475 deaths and 2,931 CV events occurred. Compared to the good adherence group, the moderate and poor adherence groups had a 1.61-fold and 2.00-fold increased risk for overall mortality; and 1.66-fold and 1.98-fold elevated risk for CV mortality, respectively, after adjustment for possible confounders. Furthermore, moderate and poor adherence groups had a 1.29-fold and 1.38-fold elevated risk for new-onset CV events. These trends were consistent across CV event subtypes. Conclusions Nonadherence to anti-diabetic medication is common in cancer patients and is associated with worse clinical outcomes in adult cancer patients with diabetes. More attention should be paid to improve adherence to anti-diabetic medication among patients with cancer.

Antihypertensive Medication Adherence and Cardiovascular Outcomes in Patients With Cancer: A Nationwide Population‐Based Cohort Study

Background Hypertension is an important cause of morbidity, which predisposes patients to major cardiovascular events and mortality. The aim of this study was to explore the association between adherence to antihypertensive medication and clinical outcomes in adult patients with cancer. Methods and Results Using the 2002 to 2013 Korean National Health Insurance Service–National Sample Cohort, we extracted adult patients with cancer treated with antihypertensive medications. Based on the medication possession ratio value, participants were divided into 3 groups: good (medication possession ratio ≥0.8), moderate (0.5≤ medication possession ratio &lt;0.8), and poor (medication possession ratio &lt;0.5) adherence groups. The primary outcomes were overall and cardiovascular mortality. The secondary outcome was cardiovascular events requiring hospitalization due to major cardiovascular diseases. Among 19 246 patients with cancer with concomitant hypertension, 66.4% were in the nonadherence group (26.3% were moderate and 40.0% were poor adherence group). Over a median of 8.4 years of follow‐up, 2752 deaths and 6057 cardiovascular events occurred. Compared with the good adherence group, the moderate and poor adherence groups had a 1.85‐fold and 2.19‐fold increased risk for overall mortality, and 1.72‐fold and 1.71‐fold elevated risk for cardiovascular mortality, respectively, after adjustment for possible confounders. Furthermore, the moderate and poor adherence groups had a 1.33‐fold and 1.34‐fold elevated risk of new‐onset cardiovascular events, respectively. These trends were consistent across cardiovascular event subtypes. Conclusions Nonadherence to antihypertensive medication was common in patients with cancer and was associated with worse clinical outcomes in adult patients with cancer with hypertension. More attention should be paid to improving adherence to antihypertensive medication among patients with cancer.

Intestinal parasitic infections among HIV/AIDS patients in relation to ART adherence in Nigeria

Intestinal parasitic infections (IPI) cause morbidity among HIV-infected individuals. Poor adherence to antiretroviral therapy (ART) affects treatment outcomes, especially in low-middle-income countries. The study evaluated the prevalence of IPI among HIV patients in relation to ART adherence between May and November 2017. Ethical approval and consent were obtained from the ethical review committee of the Benue State Ministry of Health and patients respectively. Patients’ clinical records were reviewed, and ART adherence status was obtained from the adherence assessment cards. Participants were given two labelled sterile containers for stool samples. Direct wet mount of samples was prepared in normal saline to identify helminths ova and larvae. Samples were further processed using parasite concentrators. Slides were stained with Lugol’s iodine, modified Ziehl-Neelsen acid-fast and Giemsa and subsequently examined under a light microscope using x10 and x40 objectives. Data were analysed using the chi-square test and SPSS version 22. Of the 757 patients, females constituted 57.7% (n=437). Good adherence rate (&gt;95%) was 61.9% (n=469). More females (n=301, 64.2%) than males (n=168, 35.8%) had good adherence status. IPI rate among ART patients was 16.4% (n=124). Entamoeba histolytica (n=5, 1.0%), Giardia lamblia (n=3, 0.6%) and Taenia sp. (n=8, 1.7%) were IPI seen among good adherence patients, and as single infections without diarrhoea. IPI was significant (p&lt;0.05) among poor adherence patients (37.5%, n=108) compared to good adherence patients (3.4%, n=16). IPI were significant among females; 1.9% (n=9) in the good adherence group and 19.8% (n=57) in the poor adherence group. Cryptosporidium parvum (n=20, 6.9%), E. histolytica (n=15, 5.2%), E. coli (n=11, 3.8%), G. lamblia (n=10, 3.5%) and Taenia sp. (n=10, 3.5%) accounts for significant rates of infections among patients with poor adherence, with multiple infections and associated diarrhoea seen in 10 (3.5%) of them. Routine monitoring of HIV/AIDS patients for IPI by healthcare providers is necessary. Coinfected patients with poor ART adherence should be routinely screened for IPI and promptly treated. Antiparasitic drugs should be provided as prophylaxis along with ART, to enhance their overall treatment outcome.

The relationship between adherence to continuous positive airway pressure and nasal resistance measured by rhinomanometry in patients with obstructive sleep apnea syndrome.

Nasal breathing disorders are associated with obstructive sleep apnea (OSA) syndrome and influence the availability of continuous positive airway pressure (CPAP) therapy. However, information is scarce about the impact of nasal resistance assessed by rhinomanometry on CPAP therapy. This study aimed to examine the relationship between CPAP adherence and nasal resistance evaluated by rhinomanometry, and to identify clinical findings that can affect adherence to CPAP therapy for patients with OSA. This study included 260 patients (199 men, 61 women; age 58 [interquartile ranges (IQR) 50-66] years) with a new diagnosis of OSA who underwent rhinomanometry (before, and 1 and 3 months after CPAP introduction) between January 2011 and December 2018. CPAP use was recorded, and the good and poor CPAP adherence groups at the time of patient registration were compared. Furthermore, those with improved and unimproved pre-CPAP high rhinomanometry values were also compared. Their apnea-hypopnea index (AHI) by polysomnography at diagnosis was 45.6 (IQR 33.7-61.6)/hour, but the residual respiratory event (estimated AHI) at enrollment was 2.5 (IQR 1.4-3.9)/hour and the usage time was 318 (IQR 226-397) minutes, indicating that CPAP was effective and adherence was good. CPAP adherence was negatively correlated with nasal resistance (r = -0.188, p = 0.002). The participants were divided into good (n = 153) and poor (n = 107) CPAP adherence groups. In the poor adherence group, rhinomanometry values before CPAP introduction were worse (inspiration, p = 0.003; expiration, p = 0.006). There was no significant difference in patient background when comparing those with improved (n = 16) and unimproved (n = 12) pre-CPAP high rhinomanometry values. However, CPAP usage time was significantly longer in the improved group 1 month (p = 0.002) and 3 months (p = 0.026) after CPAP introduction. The results suggest that nasal resistance evaluated by rhinomanometry is a useful predictor of CPAP adherence, and that improved rhinomanometry values may contribute to extending the duration of CPAP use.

Barrier Factors of Adherence to Dupilumab Self-Injection for Severe Allergic Disease: A Non-Interventional Open-Label Study.

The status of dupilumab self-injection at home is not well understood. We therefore aimed to identify the barriers to adherence to dupilumab self-injection. This non-interventional open-label study was conducted between March 2021 and July 2021. Patients with atopic dermatitis, bronchial asthma, and chronic rhinosinusitis with nasal polyps receiving dupilumab, from 15 sites, were requested to complete a self-administered questionnaire regarding the frequency and effectiveness of dosing as well as their use and satisfaction with dupilumab. Barriers to adherence were assessed using the Adherence Starts with Knowledge-12. We included 331 patients who used dupilumab for atopic dermatitis (n = 164), chronic rhinosinusitis with nasal polyps (n = 102), and bronchial asthma (n = 65). The median efficacy of dupilumab scored 9.3 on the visual analog scale. Overall, 85.5% of the patients self-injected dupilumab, and 70.7% perfectly complied with the established injection dates. The pre-filled pen was significantly superior to the conventional syringe in terms of usability, operability, ease of pushing the plunger, and patient satisfaction. However, the pre-filled pen caused more pain during self-injection than did the syringe. Multivariate logistic regression analysis showed that adherence decreased with longer dupilumab treatment duration (p = 0.017) and was not associated with age, sex, underlying disease, or device type. There was a difference in responses related to "inconvenience/forgetfulness" between the good and poor adherence groups. The pre-filled dupilumab pen was superior to the syringe in terms of usability, operability, ease of pushing the plunger, and satisfaction. Repetitive instructions are recommended for preventing poor adherence to dupilumab self-injection.

Low Adherence to Mediterranean Diet Is Associated with Probable Sarcopenia in Community-Dwelling Older Adults: Results from the Longevity Check-Up (Lookup) 7+ Project

Muscle strength is a relevant metric of aging. Greater adherence to Mediterranean diet is associated with better health outcomes across all life stages; however, evidence on the relationship between Mediterranean diet and muscle strength in older adults is inconclusive. In this study, we evaluated the relationship between adherence to Mediterranean diet and handgrip strength in a large sample of community-dwelling older adults from the Longevity Check-up 7+ project. A total of 2963 participants (mean age 72.8 ± 5.7 years; 54.4% women) were analyzed. Mediterranean diet adherence was evaluated using a modified Medi-Lite score and categorized as low (≤8), good (9 to 11), or high (≥12). Handgrip strength was categorized as normal or low according to cut-points by the European Working Group on Sarcopenia in Older People 2. Older adults with lower Mediterranean diet adherence had a significantly higher prevalence of probable sarcopenia (25.9%) than those with good (19.1%) or high (15.5%) adherence. The proportion of participants with probable sarcopenia increased with age, but it remained lower in the good and high adherence groups. Logistic regression showed that greater Mediterranean diet adherence was associated with a lower risk of probable sarcopenia. Older age, female sex, and physical inactivity were associated with a greater risk of probable sarcopenia. Our findings emphasize the positive association between healthy lifestyles, including adherence to Mediterranean diet, and physical function in old age.

Evaluation of the Impact of Remote Monitoring Using the Sharesource Connectivity Platform on Adherence to Automated Peritoneal Dialysis in 51 Patients.

BACKGROUND This study from a single center in Taiwan aimed to evaluate the impact of remote patient monitoring (RPM) using the Sharesource connectivity platform on adherence to automated peritoneal dialysis (APD) in 51 patients. MATERIAL AND METHODS We analyzed data on 51 patients with end-stage renal disease (ESRD) under APD. They were treated with a traditional APD machine HomeChoice (phase 1), changed to new APD machine HomeChoice Claria for 12 weeks (phase 2), then connected to the Sharesource platform for another 12 weeks (phase 3), and were followed up for 1 year. The non-adherence rate was compared between the 3 phases. The secondary outcomes included peritonitis rate, hospitalization rate, and hospitalization days, 1 year before and after receiving a new APD machine. Patients were subdivided into good and poor adherence (>1 episode of non-adherence in phase 1) groups for further analysis. RESULTS The average non-adherence rates were 10.5%, 5.1%, and 4.9% in phases 1, 2, and 3, respectively, although differences were not significant. Serum potassium (P<0.0001) and C-reactive protein (CRP) (P=0.026) levels significantly decreased in phase 3. The 1-year peritonitis rate, hospitalization rate, and number of days of hospitalization showed no significant changes. Subgroup analysis revealed that the non-adherence rate in the poor adherence group decreased from 48.4% in phase 1 to 14.2% and 12.4% in phases 2 and 3, respectively (P=0.007). CONCLUSIONS Remoting monitoring using the Sharesource connectivity platform increased dialysis adherence in APD treatment, especially in patients with poor adherence. Serum potassium level and inflammation status were also improved by this system.

Risk factors for poor adherence to inhaled corticosteroid therapy in patients with moderate to severe asthma.

Poor adherence to inhaled corticosteroid (ICS) therapy is a common reason for worsened asthma control. We investigated the characteristics of patients with moderate to severe asthma who showed poor adherence to therapy, to identify the barriers for optimal ICS therapy in a real-world observational cohort. We enrolled patients aged ≥20 years presenting with moderate to severe asthma who were enrolled at 18 hospitals in Japan. According to the Global Initiative for Asthma 2018 steps 3-5, the patients were considered as moderate to severe asthmatic. At inclusion, clinical information was obtained using a self-completed questionnaire. Poor adherence was defined as skipping the ICS therapy for more than once a week or inability to recognize the necessity of daily ICS therapy. Adherence Starts with Knowledge 20 (ASK-20) questionnaire was used to evaluate the cause of therapy incompliance. Of the total 85 participants, 19 (22%) showed poor adherence. The median age at diagnosis in the poor adherence group was 10.0 years (interquartile range [IQR], 3.0-50.0), and that in the good adherence group was 41.0 years (18.5-51.5; P = 0.050). The scores for the ASK-20 items related to the "resistance to taking too much medicine" and "compliance with the number of dosing" demonstrated statistically significant differences between patients diagnosed with asthma during their childhood and others. Age at diagnosis is an independent risk factor to predict poor ICS adherence among adults with moderate to severe asthma.

Characteristics of Patients With More Than 90% Adherence to Automatic Positive Airway Pressure

Background and Objective Among patients suffering from obstructive sleep apnea, there is a group with surprisingly high adherence (≥ 90%) to automatic positive airway pressure (APAP) treatment. This study aims to evaluate the characteristics of these patients.Methods Medical records of 4757 patients, who received APAP prescriptions between July 2018 and December 2019, were reviewed retrospectively. After the exclusion of patients not meeting the study criteria, a total of 103 patients were included in the study, and patients were divided into a very good adherence (VGA; adherence ≥ 90%) group and a poor adherence (PA; adherence &lt; 70%) group, based on nine months of APAP adherence. Patient demographics, medical history, body mass index, and pretreatment polysomnography (PSG) results, as well as APAP therapy adherence-related variables (percentage of total days of APAP usage, and the mean time of APAP usage), the 90th percentile pressure (P90), residual apnea-hypopnea index (AHI), and the type of devices or company managers were compared between the two groups.Results Median age was significantly higher in the VGA group than in the PA group (p = 0.032). The Beck Depression Inventory (BDI) also differed significantly (p = 0.017) between the two groups. There were significant differences in the total sleep time (p = 0.003): 309.04 ± 64.96 min in the VGA group and 345.47 ± 53.06 min in the PA group. Patient sleep efficiency was observed and differed significantly (p = 0.003) 74.46 ± 13.73% in the VGA group and 82.09 ± 10.82% in the PA group. Other parameters, such as a pretreatment PSG and sleep-related questionnaires, did not show significant differences between the two groups. The device-related data at 1, 3, and 9 months were similar, and there were significant differences in the mean usage time (p &lt; 0.001) and the number of days on which the device was used for more than 4 hours a day (p &lt; 0.001) between the two groups. However, the two groups had no significant differences in mean pressure, residual AHI, and the P90.Conclusions The total sleep time, sleep efficiency, and BDI were the main determinants of adherence in patients in the VGA group. To find additional factors which affect adherence, further studies will be needed.

Loss to follow-up in "test and treat era" and its predictors among HIV-positive adults receiving ART in Northwest Ethiopia: Institution-based cohort study.

BackgroundPeople living with HIV/AIDS are enrolled in lifelong Anti-Retroviral Treatment (ART) irrespective of their clinical staging as well as CD4 cell count. Although this “Universal Test and Treat” strategy of ART was found to have numerous benefits, loss from follow-up and poor retention remained a long-term challenge for the achievement of ART program targets. Hence, this study is aimed at addressing the much-needed effect of the test and treat strategy on the incidence of loss to follow-up (LTFU) in Ethiopia.Method and materialsAn institution-based follow-up study was conducted on 513 adults (age ≥15) who enrolled in ART at a public health institution in Bahir Dar City, Northwest Ethiopia. Data were extracted from the charts of selected patients and exported to Stata 14.2 software for analysis. Basic socio-demographic, epidemiological, and clinical characteristics were described. The Kaplan–Meier curve was used to estimate the loss to follow-up free (survival) probability of HIV-positive adults at 6, 12, 24, and 48 months of ART therapy. We fitted a multivariable Cox model to determine the statistically significant predictors of LTFU.ResultThe incidence density of LTFU was 9.7 per 100 person-years of observation (95% CI: 7.9–11.9 per 100 PYO). Overall, LTFU is higher in the rapid ART initiation (24% in rapid initiated vs. 11.3% in lately initiated, AHR 2.08, P = 0.004), in males (23% males vs. 14.7% females, AHR1.96, P = 0.004), in singles (34% single vs. 11% married, with AHR1.83, P = 0.044), in non-disclosed HIV-status (33% non-disclosed 11% disclosed, AHR 2.00 p = 0.001). Patients with poor/fair ART adherence were also identified as another risk group of LTFU (37% in poor vs. 10.5% in good adherence group, AHR 4.35, P = 0.001).ConclusionThe incidence of LTFU in this universal test and treat era was high, and the highest figure was observed in the first 6 months. Immediate initiation of ART in a universal test and treat strategy shall be implemented cautiously to improve patient retention and due attention shall be given to those high-risk patients.

Impact of Adherence with Disease-Modifying Therapies on All-Cause Mortality Rates Among Veterans with Multiple Sclerosis.

BackgroundAdherence to disease-modifying therapies (DMTs) is essential for reducing multiple sclerosis (MS)-related relapses and disability. However, no known data exist regarding rates of adherence to DMTs and their impact on mortality. The present study aimed to determine the effect of adherence to DMTs on all-cause mortality in patients with MS in a real-world setting.Material/MethodsWe reviewed electronic records of 279 patients with MS and followed them longitudinally in our MS clinic between Januray1, 2000 and December 31, 2019. The inclusion criteria were complete electronic records along with documentation of initial and final functional outcome measures, including mortality. The exclusion criteria were incomplete electronic records and lack of documentation of initial and final functional outcome measures.ResultsOf 279 patients with MS, 148 (53.0%) were non-adherent to any DMT medication(s). Of the 131 (47.0%) MS patients who were adherent, 13 (4.7%) had poor adherence and 118 (42.3%) had good adherence. More patients in the good-adherence group survived (94.9%) compared to the non-adherence group (66.9%, P<0.001). The odds of being alive were 12 times higher among those who adhered to their DMT compared to those who did not.ConclusionsThis study indicates that veterans who adhere to their DMTs are 12 times more likely to be alive than those who are non-adherent, even after adjusting for variables known to affect S-related mortality such as age at entry, MS type, MS duration, body mass index, and diabetes.

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.

Impact of Medication Adherence and Glycemic Control on the Risk of Micro- and Macrovascular Diseases in Patients with Diabetes

PurposeOur purpose in the research was to clarify the impact of medication adherence to oral hypoglycemic agents during a 1-year period and subsequent glycemic control on the risk of micro- and macrovascular diseases. MethodsExamined was a nationwide claims database on 13,256 individuals with diabetic eye disease without requiring prior treatment, 7,862 without prior initiation of dialysis, 15,556 without prior coronary artery disease, 16,243 without prior cerebrovascular disease, and 19,386 without prior heart failure from 2008 to 2016 in Japan. Medication adherence was evaluated by the proportion of days covered. Patients were considered to have poor adherence if the proportion of days covered was <80%. Multivariate Cox regression model identified risks of micro- and macrovascular diseases. ResultsIn each group, mean age was 53 to 54 years, HbA1c was 7.1% to 7.2%, and median follow-up period was 4.6 to 5.1 years, and the percentage of poor adherence was approximately 30%. During the study period, 532 treatment-requiring diabetic eye disease, 75 dialysis, 389 coronary artery disease, 316 cerebrovascular disease, and 144 heart failure events occurred. Multivariate Cox regression model revealed that the hazard ratio (95% confidence interval) of dialysis in the poor adherence group was 2.04 (1.27-3.30) compared with the good adherence group. The hazard ratios in the poor adherence/poor glycemic control group were 3.34 (2.63-4.24) for treatment-requiring diabetic eye disease, 4.23 (2.17-8.26) for dialysis, 1.69 (1.23-2.31) for coronary artery disease, and 2.08 (1.25-3.48) for heart failure compared with the good adherence/good glycemic control group. ConclusionsPoor medication adherence was an independent risk factor for the initiation of dialysis, suggesting that clinicians must pay close attention to these patients.

Impact of direct oral anticoagulants on evolution of post-thrombotic syndrome

BackgroundThe effect of direct oral anticoagulants (DOACs) on evolution of a post-thrombotic syndrome (PTS) is unknown. Methods and resultsThis retrospective study included patients (n = 98) with a PTS occurring after a proximal deep-vein thrombosis (DVT). The PTS progression was assessed by the Villalta scale change over time from when patients were started on DOACs for the prevention of DVT recurrence according to current guidelines. The PTS evolution was compared between patients with good (n = 63) vs. poor (n = 35) DOACs adherence, defined by using a medication possession ratio cut point of 0.80. The mean follow-up was 41.7 ± 17.7 and 27.5 ± 10.5 months in patients with good or poor adherence, respectively. The primary endpoint of PTS improvement (defined when the Villalta score became <5 and/or decreased by ≥30% from baseline) was higher in patients with good vs. poor adherence (66.7% vs. 20%, p < 0.001). None of the patients in the good adherence group experienced at any time of follow-up the co-primary endpoint of PTS worsening (defined as the Villalta score increase ≥30%), which instead occurred in 12 (34.3%) of those with poor adherence (p < 0.001). All study-defined primary endpoints occurred within 2 years. The mean values of the Villalta partial scores related to the subjective symptoms (patient-rated) and to the potentially reversible physician-rated signs were significantly improved in the good adherence group, while they were unchanged among patients with poor adherence. ConclusionsIn this study a good vs. poor DOACs adherence was associated with a more favorable progression of PTS over a long-term follow-up. Larger studies are needed to explore the clinical efficacy of DOACs on PTS manifestations.

Effect of number of medications and complexity of regimens on medication adherence and blood pressure management in hospitalized patients with hypertension.

IntroductionGood adherence of antihypertensives is recommended for the accomplishment of hypertension therapy. The number of medications and characteristics contributing to medication regimen complexity, such as dosage forms and dosing frequency, are known to influence medication adherence. However, the effect of medication regimen complexity on the therapeutic efficacy of medicines remains to be clarified. In the present study, we retrospectively investigated the effect of number of medications and medication regimen complexity on medication adherence and therapeutic efficacy in patients with hypertension.MethodsAccording to the inclusion and exclusion criteria, 1,057 patients, who were on medications including antihypertensives on admission at the Mie University Hospital between July 2018 and December 2018, were enrolled in this study. Poor blood pressure management was defined if the systolic or diastolic blood pressure were ≥140 mmHg or ≥ 90 mmHg. Medication regimen complexity was quantified using the medication regimen complexity index (MRCI) score.ResultsAmong 1,057 patients, 164 and 893 patients were categorized into poor and good adherence groups, respectively. The multivariate analyses revealed that age ≥ 71 years and oral MRCI score ≥ 19.5 but not number of oral medications were extracted as risk factors for poor medication adherence. Medication adherence and blood pressure management were poor in the group with oral MRCI score ≥ 19.5, regardless of the age. The rate of readmission was similar.ConclusionOur study is the first to demonstrate that medication regimen complexity rather than number of medications is closely related to medication adherence and blood pressure management. Hence, physicians and/or pharmacists should consider the complexity of medication regimens while modifying them.

Impact of adherence to disease-modifying therapies on employment among veterans with multiple sclerosis

Purpose Patients who adhere to their disease-modifying therapies (DMTs) have a lower rate of MS-related relapses and disability. We sought to determine the adherence rate to DMTs and the association between adherence to DMTs and employment in patients with multiple sclerosis (MS). Method One hundred and forty-two patients with MS who were periodically followed in our clinic between January 2000 and January 2020. We compared three groups of patients, defined according to their adherence to DMTs (non-adherent; poorly adherent; adherent), on their obtaining paid employment. Results Forty-seven MS patients (33.1%) were non-adherent to any DMT medication, while 88 MS patients (62.0%) demonstrated good and 7 (4.9%) poor adherences. More patients in the good-adherence group were in paid employment 42.0% compared to 23.4% in the non-adherent group (p = 0.587) after controlling for potential co-founders. Conclusion In this study veterans who adhered to their DMTs were 2.4 times more likely to be in paid-employment compared to non- or poorly-adherent patients. The clinical significance of this study is to encourage MS patients to adhere to their DMTs as a motivating factor of being in paid-employment. Implications for rehabilitation What is known about this subject? In the setting of a randomized controlled trial adherence rates reported for different injectable DMTs vary from 79–85% for once a week interferon beta-1a (IM IFNb-1a) to 49–78% for other injectable DMTs. •What are the new findings and/or impact on clinical practice? •Paid employment was more common among veterans whose adherence to DMTs was good (42.0% employed) or poor (42.9%) than among those who were non-adherent (23.4%). Veterans who adhered to DMTs were also younger, had less severe MS, and displayed less cognitive and physically impairment than those who did not adhere. •Being employed can act as a motivating factor to encourage adherence to treatment aimed at preventing accumulation of mental and physical disabilities.