title: Factors affecting medication adherence trajectories for patients with heart failure.
abstract: OBJECTIVE
  To examine the relationship between patient characteristics and medication adherence trajectories for patients with congestive heart failure (CHF).
  
  
  METHODS
  Historical prospective study.
  
  
  METHODS
  We conducted a secondary analysis of data assembled for the Practice Variation and Care Outcomes (PRAVCO) study, which examined patterns of cardiovascular care. We used group based trajectory modeling to define medication adherence trajectories, and then modeled factors associated with belonging to a trajectory group during the 6year period from 2005 to 2010 (n = 10,986). We focused on the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) for secondary prevention of CHF.
  
  
  RESULTS
  Four trajectory groups were optimal in characterizing adherence level patterns: 1) low adherence group, with an initial average adherence rate of 62% that dropped to between 40% and 50%; 2) increasing adherence group, with an initial average adherence rate of 55% that increased to 90%; 3) decreasing adherence group, with an initial average adherence rate above 90% that decreased to 60%; 4) high adherence group, with an average adherence rate consistently above 90%. Age, region, education, smoking, and race were all significantly associated with the likelihood of belonging to a particular trajectory. Nonwhites were less likely to be in the high adherence group, and smoking was more common in the low adherence group (22%) than in the high group (10%); increasing body mass index and Charlson Comorbidity Index (CCI) scores were also associated with being in the low adherence group.
  
  
  CONCLUSIONS
  Population characteristics associated with sustained low adherence might be used to target interventions and improve vulnerable patients' prospects of heart health.
authors.affiliation: University of Hawaii at Hilo, Daniel K. Inouye College of Pharmacy, 677 Ala Moana Blvd, Ste 1025, Honolulu, HI 96813. Email: dtjuarez@hawaii.edu.
authors.forename: Deborah Taira
authors.initials: DT
authors.lastname: Juarez
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Williams
authors.forename: Chuhe
authors.initials: C
authors.lastname: Chen
authors.forename: Yihe Goh
authors.initials: YG
authors.lastname: Daida
authors.forename: Sara K
authors.initials: SK
authors.lastname: Tanaka
authors.forename: Connie Mah
authors.initials: CM
authors.lastname: Trinacty
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Vogt
mesh_terms: D000367:Age Factors; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004522:Educational Status; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D019601:Pacific States / Q000453:epidemiology; D011446:Prospective Studies; D044469:Racial Groups / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors