Analysis of Longitudinal Patterns and Predictors of Medicine Use in Residential Aged Care Using Group‐Based Trajectory Modeling: The “MEDTRAC‐Cardiovascular” Longitudinal Cohort Study

Abstract

ABSTRACTAimCardiovascular diseases are the leading cause of death globally. Ensuring ongoing use of medicines—medication persistence—is crucial, yet no prior studies have examined this in residential aged care facilities (RACFs). We aimed to identify long‐term trajectories of persistence with cardiovascular medicines and determine predictors of persistence trajectories.MethodA longitudinal cohort study of 2837 newly admitted permanent residents from 30 RACFs in New South Wales, Australia. We monitored weekly exposure to six cardiovascular medicine classes—lipid modifiers, angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs), beta‐blockers, diuretics, calcium channel blockers (CCB), and cardiac therapy—over 3 years. Group‐based trajectory modeling was employed to determine persistence trajectories for each class.ResultsAt baseline, 76.6% (n = 2172) received at least one cardiovascular medicine with 41.2% receiving lipid modifiers, 31.4% ACEI/ARBs, 30.2% beta‐blockers, 24.4% diuretics, 18.7% CCBs, and 14.8% cardiac therapy. The model identified two persistence trajectories for CCBs and three trajectories for all other classes. Sustained high persistence rates ranged from 68.4% (ACEI/ARBs) to 79.8% (beta‐blockers) while early decline in persistence and subsequent discontinuation rates ranged from 7.6% (cardiac therapy) to 25.3% (CCBs). Logistic regressions identified 11 predictors of a declining persistence across the six medicine classes.ConclusionOur study revealed varied patterns of cardiovascular medicine use in RACFs, with 2–3 distinctive medicine use trajectories across different classes, each exhibiting a unique clinical profile, and up to a quarter of residents discontinuing a medicine class. Future studies should explore the underlying reasons and appropriateness of nonpersistence to aid in identifying areas for improvement.