National Adherence to Medical Management of Aortic Aneurysms |
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| Institution: | 1. Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia;2. Leonard Davis Institute, University of Pennsylvania, Philadelphia;3. Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Philadelphia, Penn;1. Department of Medicine, Section of Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC;2. Department of Internal Medicine, College of Medicine, Ohio State University, Columbus;3. Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco;4. Department of Medicine, Division of Hospital Medicine, Washington University, St Louis, Mo;5. Department of Medicine, University of Massachusetts Chan Medical School, Worcester;6. Department of Medicine, University of Washington, Seattle;7. Department of Medicine, University of South Florida, Morsani College of Medicine, Tampa;8. Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, College of Medicine, University of Arizona, Phoenix;9. Department of Medicine, Division of General Internal Medicine, Baylor College of Medicine, Houston, Tex;10. Department of Medicine, Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University, Indianapolis;11. Department of Medicine, Division of Pulmonary Critical Care Sleep Medicine, Beaumont Health and William Beaumont School of Medicine, Oakland University, Rochester, Minn;12. Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill;13. Department of Medicine, Division of Geriatrics, School of Medicine and Public Health, University of Wisconsin, Madison;14. Department of Medicine, Division of Hospital Medicine, Rush University, Chicago, Ill;1. Department of Internal Medicine, University of Michigan, Ann Arbor;2. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor;3. VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Mich;4. Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor;5. Department of Medicine, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago, Chicago, Ill;6. Perelman School of Medicine, University of Pennsylvania, Philadelphia;7. Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville;8. Yale School of Medicine, New Haven, Conn;9. VA Connecticut Healthcare System, West Haven, Conn;1. National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK;2. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK;3. Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK;4. Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea;5. Department of Sport Science, University of Seoul, Seoul, South Korea;6. Department of Urban Big Data Convergence, University of Seoul, Seoul, Republic of Korea;7. Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland;8. Central Finland Health Care District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland;9. Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland |
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| Abstract: | ObjectivesThe purpose of this study was to describe levels of adherence to guideline-based medical management in patients with aortic aneurysms, using an analogous population with coronary artery disease as a comparator. Adherence among those with aortic aneurysms has never been studied.MethodsAdult patients with an aortic aneurysm or coronary artery disease diagnosed between 2004 and 2018 in the Optum Clinformatics deidentified Datamart were queried. Aneurysms were subclassified as thoracic, abdominal, or both. Receipt of an antihypertensive or antihyperlipidemic was determined through pharmacy claims. Adherence was determined as receipt of the indicated pharmacologic(s) after a diagnosis of aneurysm or coronary artery disease. Adherence was compared between those with aneurysms and coronary disease using univariable logistic regression.ResultsAfter exclusions, 194,144 patients with an aortic aneurysm and 3,946,782 with coronary artery disease were identified. Overall adherence was low (45.0%) and differed significantly by aneurysm subtype: highest in isolated thoracic (45.9%) and lowest in isolated abdominal aneurysms (42.6%). Adherence levels declined significantly after 1 year by about 15% in each aneurysm subtype. All subtypes of aneurysm had a significantly lower odds of adherence compared to those with coronary disease with odds ranging from 0.61 in those with isolated abdominal aneurysms to 0.80 with isolated thoracic aneurysms.ConclusionsAdherence among those with aortic aneurysms is very low, differs by subtype, and declines with time. Levels of adherence in those with aortic aneurysms is significantly lower compared to those with coronary artery disease. This should prove a reasonable target for implementation initiatives. |
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