The effects of dual antiplatelet therapy (DAPT) adherence on survival in patients undergoing revascularization and the determinants of DAPT adherence
Abstract Background The prevalence and burden of coronary heart disease (CHD) has increased substantially in India, accompanied with increasing need for percutaneous coronary interventions (PCI). Although a large government-funded insurance scheme in Maharashtra, India covered the cost of PCI for lo...
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | BMC Cardiovascular Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12872-022-02677-8 |
| _version_ | 1818204752104652800 |
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| author | Shuqi Zhang Mithlesh Chourase Nupur Sharma Sujata Saunik Mona Duggal Goodarz Danaei Bhanu Duggal |
| author_facet | Shuqi Zhang Mithlesh Chourase Nupur Sharma Sujata Saunik Mona Duggal Goodarz Danaei Bhanu Duggal |
| author_sort | Shuqi Zhang |
| collection | DOAJ |
| description | Abstract Background The prevalence and burden of coronary heart disease (CHD) has increased substantially in India, accompanied with increasing need for percutaneous coronary interventions (PCI). Although a large government-funded insurance scheme in Maharashtra, India covered the cost of PCI for low-income patients, the high cost of post-PCI treatment, especially Dual Antiplatelet Therapy (DAPT), still caused many patients to prematurely discontinue the secondary prevention. Our study aimed to investigate the effectiveness of DAPT adherence on all-cause mortality among post-PCI patients and explore the potential determinants of DAPT adherence in India. Method We collected clinical data of 4,595 patients undergoing PCI in 110 participating medical centers in Maharashtra, India from 2012 to 2015 by electronic medical records. We surveyed 2527 adult patients who were under the insurance scheme by telephone interview, usually between 6 to 12 months after their revascularization. Patients reporting DAPT continuation in the telephone survey were categorized as DAPT adherence. The outcome of the interest was all-cause mortality within 1 year after the index procedure. Multivariate Cox proportional hazard (PH) model with adjustment of potential confounders and standardization were used to explore the effects of DAPT adherence on all-cause mortality. We further used a multivariate logistic model to investigate the potential determinants of DAPT adherence. Results Out of the 2527 patients interviewed, 2064 patients were included in the analysis, of whom 470 (22.8%) discontinued DAPT prematurely within a year. After adjustment for baseline confounders, DAPT adherence was associated with lower one-year all-cause mortality compared to premature discontinuation (less than 6-month), with an adjusted hazard ratio (HR) of 0.52 (95% Confidence Interval (CI) = (0.36, 0.67)). We also found younger patients (OR per year was 0.99 (0.97, 1.00)) and male (vs. female, OR of 1.30 (0.99, 1.70)) had higher adherence to DAPT at one year as did patients taking antihypertensive medications (vs. non medication, OR of 1.57 (1.25, 1.95)). Conclusion These findings suggest the protective effects of DAPT adherence on 1-year mortality among post-PCI patients in a low-income setting and indicate younger age, male sex and use of other preventive treatments were predictors of higher DAPT adherence. |
| first_indexed | 2024-12-12T03:46:14Z |
| format | Article |
| id | doaj.art-34d4f072ed054f0db580b824904a8b52 |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-12-12T03:46:14Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-34d4f072ed054f0db580b824904a8b522022-12-22T00:39:34ZengBMCBMC Cardiovascular Disorders1471-22612022-05-012211910.1186/s12872-022-02677-8The effects of dual antiplatelet therapy (DAPT) adherence on survival in patients undergoing revascularization and the determinants of DAPT adherenceShuqi Zhang0Mithlesh Chourase1Nupur Sharma2Sujata Saunik3Mona Duggal4Goodarz Danaei5Bhanu Duggal6Department of Epidemiology, Harvard TH Chan School of Public HealthHealth Technology Assessment Hub, AIIMS RishikeshHealth Technology Assessment Hub, AIIMS RishikeshGovernment of MaharashtraDepartment of Community Medicine, PGIMERDepartment of Epidemiology, Harvard TH Chan School of Public HealthDepartment of Cardiology, AIIMS RishikeshAbstract Background The prevalence and burden of coronary heart disease (CHD) has increased substantially in India, accompanied with increasing need for percutaneous coronary interventions (PCI). Although a large government-funded insurance scheme in Maharashtra, India covered the cost of PCI for low-income patients, the high cost of post-PCI treatment, especially Dual Antiplatelet Therapy (DAPT), still caused many patients to prematurely discontinue the secondary prevention. Our study aimed to investigate the effectiveness of DAPT adherence on all-cause mortality among post-PCI patients and explore the potential determinants of DAPT adherence in India. Method We collected clinical data of 4,595 patients undergoing PCI in 110 participating medical centers in Maharashtra, India from 2012 to 2015 by electronic medical records. We surveyed 2527 adult patients who were under the insurance scheme by telephone interview, usually between 6 to 12 months after their revascularization. Patients reporting DAPT continuation in the telephone survey were categorized as DAPT adherence. The outcome of the interest was all-cause mortality within 1 year after the index procedure. Multivariate Cox proportional hazard (PH) model with adjustment of potential confounders and standardization were used to explore the effects of DAPT adherence on all-cause mortality. We further used a multivariate logistic model to investigate the potential determinants of DAPT adherence. Results Out of the 2527 patients interviewed, 2064 patients were included in the analysis, of whom 470 (22.8%) discontinued DAPT prematurely within a year. After adjustment for baseline confounders, DAPT adherence was associated with lower one-year all-cause mortality compared to premature discontinuation (less than 6-month), with an adjusted hazard ratio (HR) of 0.52 (95% Confidence Interval (CI) = (0.36, 0.67)). We also found younger patients (OR per year was 0.99 (0.97, 1.00)) and male (vs. female, OR of 1.30 (0.99, 1.70)) had higher adherence to DAPT at one year as did patients taking antihypertensive medications (vs. non medication, OR of 1.57 (1.25, 1.95)). Conclusion These findings suggest the protective effects of DAPT adherence on 1-year mortality among post-PCI patients in a low-income setting and indicate younger age, male sex and use of other preventive treatments were predictors of higher DAPT adherence.https://doi.org/10.1186/s12872-022-02677-8Dual antiplatelet therapy (DAPT)Percutaneous coronary intervention (PCI)Coronary artery diseaseAdherenceIndia |
| spellingShingle | Shuqi Zhang Mithlesh Chourase Nupur Sharma Sujata Saunik Mona Duggal Goodarz Danaei Bhanu Duggal The effects of dual antiplatelet therapy (DAPT) adherence on survival in patients undergoing revascularization and the determinants of DAPT adherence BMC Cardiovascular Disorders Dual antiplatelet therapy (DAPT) Percutaneous coronary intervention (PCI) Coronary artery disease Adherence India |
| title | The effects of dual antiplatelet therapy (DAPT) adherence on survival in patients undergoing revascularization and the determinants of DAPT adherence |
| title_full | The effects of dual antiplatelet therapy (DAPT) adherence on survival in patients undergoing revascularization and the determinants of DAPT adherence |
| title_fullStr | The effects of dual antiplatelet therapy (DAPT) adherence on survival in patients undergoing revascularization and the determinants of DAPT adherence |
| title_full_unstemmed | The effects of dual antiplatelet therapy (DAPT) adherence on survival in patients undergoing revascularization and the determinants of DAPT adherence |
| title_short | The effects of dual antiplatelet therapy (DAPT) adherence on survival in patients undergoing revascularization and the determinants of DAPT adherence |
| title_sort | effects of dual antiplatelet therapy dapt adherence on survival in patients undergoing revascularization and the determinants of dapt adherence |
| topic | Dual antiplatelet therapy (DAPT) Percutaneous coronary intervention (PCI) Coronary artery disease Adherence India |
| url | https://doi.org/10.1186/s12872-022-02677-8 |
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