Exploration of Cardiology

Table 1. Patient demographics and clinical characteristics (n = 7,847).

Variables	Total patients (n = 7,847)	Rapid decline (n = 1,400)	Near-perfect adherent (n = 3,713)	Adherent (n = 2,734)	p-value
Sex					< 0.0001^*
Male	3,728 (47.5%)	616 (44.0%)	1,722 (46.4%)	1,390 (50.8%)
Female	4,119 (52.5%)	784 (56.0%)	1,991 (53.6%)	1,344 (49.2%)
Age, years					0.0397^*
≤ 65	1,021 (13.0%)	205 (14.6%)	481 (13.0%)	335 (12.3%)
66–69	2,747 (35.0%)	521 (37.2%)	1,273 (34.3%)	953 (34.9%)
70–74	2,127 (27.1%)	337 (24.1%)	1,021 (27.5%)	769 (28.1%)
≥ 75	1,952 (24.9%)	337 (24.1%)	938 (25.3%)	677 (24.8%)
Health plan					0.3548
No subsidy	4,153 (52.9%)	756 (54.0%)	1,934 (52.1%)	1,463 (53.5%)
Low-income subsidy	3,694 (47.1%)	644 (46.0%)	1,779 (47.9%)	1,271 (46.5%)
No. of prior hospitalizations					0.1112
0	7,560 (96.3%)	1,336 (95.4%)	3,589 (96.7%)	2,635 (96.4%)
≥ 1	287 (3.7%)	64 (4.6%)	124 (3.3%)	99 (3.6%)
Depression					0.1202
No	7,826 (99.7%)	1,396 (99.7%)	3,699 (99.6%)	2,731 (99.9%)
Yes	21 (0.3%)	4 (0.3%)	14 (0.4%)	3 (0.1%)
CV events					0.5985
No	7,589 (96.7%)	1,358 (97.0%)	3,594 (96.8%)	2,637 (96.5%)
Yes	258 (3.3%)	42 (3.0%)	119 (3.2%)	97 (3.5%)
CMS risk score, mean (SD)	1.29 (0.77)	1.24 (0.74)	1.31 (0.77)	1.31 (0.80)	0.0065^*
Total number of other medications, mean (SD)	6.53 (4.21)	6.29 (4.15)	6.59 (4.18)	6.60 (4.29)	0.0522
Regimen complexity, mean (SD)	21.12 (38.8)	20.78 (37.28)	21.04 (37.49)	21.40 (41.26)	0.8769

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^*indicates statistical significance at p < 0.05. CV: cardiovascular; CMS: Centers for Medicare & Medicaid Services.

Supplementary materials

The supplementary tables for this article are available at: https://www.explorationpub.com/uploads/Article/file/1012110_sup_1.pdf.

Declarations

Author contributions

SCO: Data curation, Formal analysis, Investigation, Visualization, Writing—original draft. SSC: Conceptualization, Formal analysis, Investigation, Writing—review & editing. IO: Investigation, Writing—review & editing. SA: Conceptualization, Methodology, Supervision, Writing—review & editing. All authors read and approved the submitted version.

Conflicts of interest

The authors declare no conflicts of interest.

Ethical approval

This study was approved by the Institutional Review Board (IRB) at the University of Houston (Protocol ID: STUDY00004473). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.

Consent to participate

Informed consent to participate is waived because this is a retrospective study involving the analysis of de-identified secondary data with no direct patient interaction, as approved by the ethical committee.

Consent to publication

Not applicable.

Availability of data and materials

The data analyzed in this study were obtained from a third-party Medicare Advantage database. Requests for access to these datasets and the SAS codes used for this study should be directed to the corresponding author.

Funding

No funding was received for conducting this study.

Copyright

Publisher’s note

Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

References

Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol. 2017;70:1–25. [DOI] [PubMed] [PMC]

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97. [DOI] [PubMed]

GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1223–49. [DOI] [PubMed] [PMC]

Wilt TJ, Bloomfield HE, MacDonald R, Nelson D, Rutks I, Ho M, et al. Effectiveness of statin therapy in adults with coronary heart disease. Arch Intern Med. 2004;164:1427–36. [DOI] [PubMed]

Collins R, Reith C, Emberson J, Armitage J, Baigent C, Blackwell L, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2016;388:2532–61. [DOI] [PubMed]

Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2889–934. [DOI] [PubMed]

Pokharel Y, Tang F, Jones PG, Nambi V, Bittner VA, Hira RS, et al. Adoption of the 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline in Cardiology Practices Nationwide. JAMA Cardiol. 2017;2:361–9. [DOI] [PubMed] [PMC]

Anderson JL, Knowlton KU, May HT, Bair TL, Armstrong SO, Lappé DL, et al. Temporal changes in statin prescription and intensity at discharge and impact on outcomes in patients with newly diagnosed atherosclerotic cardiovascular disease—Real-world experience within a large integrated health care system: The IMPRES study. J Clin Lipidol. 2018;12:1008–18.e1. [DOI] [PubMed]

Bellows BK, Olsen CJ, Voelker J, Wander C. Antihyperlipidemic Medication Treatment Patterns and Statin Adherence Among Patients with ASCVD in a Managed Care Plan After Release of the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol. J Manag Care Spec Pharm. 2016;22:892–900. [DOI] [PubMed] [PMC]

10.

Lamprecht DG Jr, Shaw PB, King JB, Hogan KN, Olson KL. Trends in high-intensity statin use and low-density lipoprotein cholesterol control among patients enrolled in a clinical pharmacy cardiac risk service. J Clin Lipidol. 2018;12:999–1007. [DOI] [PubMed]

11.

Cutler RL, Fernandez-Llimos F, Frommer M, Benrimoj C, Garcia-Cardenas V. Economic impact of medication non-adherence by disease groups: a systematic review. BMJ Open. 2018;8:e016982. [DOI] [PubMed] [PMC]

12.

Punnapurath S, Vijayakumar P, Platty PL, Krishna S, Thomas T. A study of medication compliance in geriatric patients with chronic illness. J Family Med Prim Care. 2021;10:1644–8. [DOI] [PubMed] [PMC]

13.

Booth JN 3rd, Colantonio LD, Chen L, Rosenson RS, Monda KL, Safford MM, et al. Statin Discontinuation, Reinitiation, and Persistence Patterns Among Medicare Beneficiaries After Myocardial Infarction: A Cohort Study. Circ Cardiovasc Qual Outcomes. 2017;10:e003626. [DOI] [PubMed]

14.

Desai NR, Farbaniec M, Karalis DG. Nonadherence to lipid-lowering therapy and strategies to improve adherence in patients with atherosclerotic cardiovascular disease. Clin Cardiol. 2023;46:13–21. [DOI] [PubMed] [PMC]

15.

Vadhariya A, Fleming ML, Johnson ML, Essien EJ, Serna O, Esse T, et al. Group-Based Trajectory Models to Identify Sociodemographic and Clinical Predictors of Adherence Patterns to Statin Therapy Among Older Adults. Am Health Drug Benefits. 2019;12:202–11. [PubMed] [PMC]

16.

Nagin DS, Odgers CL. Group-based trajectory modeling in clinical research. Annu Rev Clin Psychol. 2010;6:109–38. [DOI] [PubMed]

17.

Franklin JM, Shrank WH, Pakes J, Sanfélix-Gimeno G, Matlin OS, Brennan TA, et al. Group-based trajectory models: a new approach to classifying and predicting long-term medication adherence. Med Care. 2013;51:789–96. [DOI] [PubMed]

18.

Cheruvu SS, Fatima B, Abughosh S. Group-based trajectory modeling to identify longitudinal patterns and predictors of adherence among older adults on concomitant triple therapy (oral antidiabetic, renin-angiotensin-system antagonists, statins). J Manag Care Spec Pharm. 2025;31:396–405. [DOI] [PubMed] [PMC]

19.

Raebel MA, Dyer W, Nichols GA, Goodrich GK, Schmittdiel JA. Relationships between Medication Adherence and Cardiovascular Disease Risk Factor Control in Elderly Patients with Diabetes. Pharmacotherapy. 2017;37:1204–14. [DOI] [PubMed] [PMC]

20.

Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10. [DOI] [PubMed]

21.

George J, Phun YT, Bailey MJ, Kong DC, Stewart K. Development and validation of the medication regimen complexity index. Ann Pharmacother. 2004;38:1369–76. [DOI] [PubMed]

22.

Giacobbe F, Giannino G, Annone U, Morena A, Di Vita U, Carmagnola L, et al. Impact of statin adherence and interruption within 6 months after ST-segment elevation myocardial infarction (STEMI): Results from the real-world regional registry FAST-STEMI. Int J Cardiol. 2024;405:131933. [DOI] [PubMed]

23.

Khalaf K, Johnell K, Austin PC, Tyden P, Midlöv P, Perez-Vicente R, et al. Low adherence to statin treatment during the 1st year after an acute myocardial infarction is associated with increased 2nd-year mortality risk—an inverse probability of treatment weighted study on 54 872 patients. Eur Heart J Cardiovasc Pharmacother. 2021;7:141–7. [DOI] [PubMed] [PMC]

24.

Noyes K, Liu H, Lyness JM, Friedman B. Medicare beneficiaries with depression: comparing diagnoses in claims data with the results of screening. Psychiatr Serv. 2011;62:1159–66. [DOI] [PubMed]

25.

Manteuffel M, Williams S, Chen W, Verbrugge RR, Pittman DG, Steinkellner A. Influence of patient sex and gender on medication use, adherence, and prescribing alignment with guidelines. J Womens Health (Larchmt). 2014;23:112–9. [DOI] [PubMed]

26.

Mann DM, Woodward M, Muntner P, Falzon L, Kronish I. Predictors of nonadherence to statins: a systematic review and meta-analysis. Ann Pharmacother. 2010;44:1410–21. [DOI] [PubMed] [PMC]

27.

Chamberlain J, Watt S, Mohide P, Muggah H, Trim K, Bantebya Kyomuhendo G. Women’s perception of self-worth and access to health care. Int J Gynaecol Obstet. 2007;98:75–9. [DOI] [PubMed]

28.

Kautzky-Willer A, Harreiter J, Pacini G. Sex and Gender Differences in Risk, Pathophysiology and Complications of Type 2 Diabetes Mellitus. Endocr Rev. 2016;37:278–316. [DOI] [PubMed] [PMC]

29.

Goldstein KM, Zullig LL, Bastian LA, Bosworth HB. Statin Adherence: Does Gender Matter? Curr Atheroscler Rep. 2016;18:63. [DOI] [PubMed]

30.

Venditti V, Bleve E, Morano S, Filardi T. Gender-Related Factors in Medication Adherence for Metabolic and Cardiovascular Health. Metabolites. 2023;13:1087. [DOI] [PubMed] [PMC]

31.

Colivicchi F, Bassi A, Santini M, Caltagirone C. Discontinuation of statin therapy and clinical outcome after ischemic stroke. Stroke. 2007;38:2652–7. [DOI] [PubMed]

32.

Chen ST, Huang ST, Shau WY, Lai CL, Li JZ, Fung S, et al. Long-term statin adherence in patients after hospital discharge for new onset of atherosclerotic cardiovascular disease: a population-based study of real world prescriptions in Taiwan. BMC Cardiovasc Disord. 2019;19:62. [DOI] [PubMed] [PMC]

33.

Pevnick JM, Keller MS, Kennelty KA, Nuckols TK, Ko EM, Amer K, et al. The Pharmacist Discharge Care (PHARM-DC) study: A multicenter RCT of pharmacist-directed transitional care to reduce post-hospitalization utilization. Contemp Clin Trials. 2021;106:106419. [DOI] [PubMed] [PMC]

34.

Ofori-Asenso R, Jakhu A, Zomer E, Curtis AJ, Korhonen MJ, Nelson M, et al. Adherence and Persistence Among Statin Users Aged 65 Years and Over: A Systematic Review and Meta-analysis. J Gerontol A Biol Sci Med Sci. 2018;73:813–9. [DOI] [PubMed]

35.

Ofori-Asenso R, Ilomäki J, Tacey M, Si S, Curtis AJ, Zomer E, et al. Predictors of first-year nonadherence and discontinuation of statins among older adults: a retrospective cohort study. Br J Clin Pharmacol. 2019;85:227–35. [DOI] [PubMed] [PMC]

36.

Bandi P, Goldmann E, Parikh NS, Farsi P, Boden-Albala B. Age-Related Differences in Antihypertensive Medication Adherence in Hispanics: A Cross-Sectional Community-Based Survey in New York City, 2011–2012. Prev Chronic Dis. 2017;14:E57. [DOI] [PubMed] [PMC]

37.

Marcum ZA, Gellad WF. Medication adherence to multidrug regimens. Clin Geriatr Med. 2012;28:287–300. [DOI] [PubMed] [PMC]

38.

Yala SM, Duru OK, Ettner SL, Turk N, Mangione CM, Brown AF. Patterns of prescription drug expenditures and medication adherence among medicare part D beneficiaries with and without the low-income supplement. BMC Health Serv Res. 2014;14:665. [DOI] [PubMed] [PMC]

39.

Duru OK, Edgington S, Mangione C, Turk N, Tseng CH, Kimbro L, et al. Association of Medicare Part D low-income cost subsidy program enrollment with increased fill adherence to clopidogrel after coronary stent placement. Pharmacotherapy. 2014;34:1230–8. [DOI] [PubMed] [PMC]

40.

Abughosh S, Wang X, Serna O, Esse T, Mann A, Masilamani S, et al. A Motivational Interviewing Intervention by Pharmacy Students to Improve Medication Adherence. J Manag Care Spec Pharm. 2017;23:549–60. [DOI] [PubMed] [PMC]