--- title: "Medication non-adherence cardiometabolic disease | Sutter Health" description: "Medication non-adherence and therapeutic inertia independently contribute to poor disease control for cardiometabolic diseases" url: "https://www.sutterhealth.org/research/publications/medication-non-adherence-cardiometabolic-disease-1055312898" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Medication non-adherence cardiometabolic disease # Medication non-adherence and therapeutic inertia independently contribute to poor disease control for cardiometabolic diseases _Scientific Reports_ 2022-11-07 ## Abstract Poorly controlled cardiometabolic biometric health gap measures \[e.g.,uncontrolled blood pressure (BP), HbA1c, and low-density lipoprotein cholesterol (LDL-C)\] are mediated by medication adherence and clinician-level therapeutic inertia (TI). The study of comparing relative contribution of these two factors to disease control is lacking. We conducted a retrospective cohort study using 7 years of longitudinal electronic health records (EHR) from primary care cardiometabolic patients who were 35 years or older. Cox-regression modeling was applied to estimate how baseline proportion of days covered (PDC) and TI were associated with cardiometabolic related health gap closure. 92,766 patients were included in the analysis, among which 89.9%, 85.8%, and 73.3% closed a BP, HbA1c, or LDL-C gap, respectively, with median days to gap closure ranging from 223 to 408 days. Patients who did not retrieve a medication were the least likely to achieve biometric control, particularly for LDL-C (HR = 0.58, 95% CI: 0.55-0.60). TI or uncertainty of TI was associated with a high risk of health gap persistence, particularly for LDL-C (HR ranges 0.46-0.48). Both poor medication adherence and TI are independently associated with persistent health gaps, and TI has a much higher impact on disease control compared to medication adherence, implying disease management strategies should prioritize reducing TI. [PubMed abstract](https://pubmed.ncbi.nlm.nih.gov/36344613/) ![Andrew G Hudnut, M.D.](https://dyn.mktgcdn.com/p/bVlfpMjhVE1psGLwriBvgE40Ia8e8P7LLJaVzS8EKKw/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Andrew G Hudnut, M.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/andrew-g-hudnut-md-1049681039) ![J.B. Jones, Ph.D., MBA](https://dyn.mktgcdn.com/p/rIQfkoa5XfKJYCHSVrDKsACQSNJ7jTljZTHKC4Lae2E/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) J.B. Jones, Ph.D., MBA Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/jb-jones-phd-mba-1049680984) ![Xiaowei (Sherry) Yan, Ph.D.](https://dyn.mktgcdn.com/p/NTWox_hkmxIRiqJEc5PXKeBkfR_WMtpSQbEI4J69Xls/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Xiaowei (Sherry) Yan, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/xiaowei-sherry-yan-phd-1049681042) ## Research topics - [Cardiovascular Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cardiovascular+Diseases%5C%22%22) - [EHR Data](https://www.sutterhealth.org/research-search-results?query=%22%5C%22EHR+Data%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Evaluating the Impact of a Point-of-Care Cardiometabolic Clinical Decision Support Tool on Clinical Efficiency Using Electronic Health Record Audit Log Data: Algorithm Development and Validation](https://www.sutterhealth.org/research/publications/evaluating-impact-of-poc-cardiometabolic-clinical-care-tool-1055312804) JMIR Medical Informatics 2022 Sep 06 - Publication ### [Self-gated fat-suppressed cardiac cine MRI.](https://www.sutterhealth.org/research/publications/self-gated-fat-suppressed-cardiac-cine-mri-1055312491) Ingle RR, Santos JM, Overall WR, McConnell MV, Hu BS, Nishimura DG. Magn Reson Med. 73(5):1764-74. doi: 10.1002/mrm.25291. Epub 2014 May 7. 2015 May 01 - Publication ### [Home blood pressure monitoring among adults—American Heart Association Cardiovascular Health Consumer Survey, 2012](https://www.sutterhealth.org/research/publications/home-blood-pressure-monitoring-among-adults-1055312805) The Journal of Clinical Hypertension 2017 Jun 19 - Publication ### [No beneficial effects of pine bark extract on cardiovascular disease risk factors](https://www.sutterhealth.org/research/publications/pine-bark-extract-on-cardiovascular-disease-1055312556) Drieling RL, Gardner CD, Ma J, Ahn DK, Stafford RS. Arch Intern Med. 170(17):1541-7. doi: 10.1001/archinternmed.2010.310. 2010 Sep 27 - Publication ### [High-resolution variable-density 3D cones coronary MRA.](https://www.sutterhealth.org/research/publications/high-resolution-vary-density-3d-cones-coronary-mra-1055312425) Addy NO, Ingle RR, Wu HH, Hu BS, Nishimura DG. Magn Reson Med. 74(3):614-21. doi: 10.1002/mrm.25803. Epub 2015 Jul 14. 2015 Sep 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/medication-non-adherence-cardiometabolic-disease-1055312898#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Medication non-adherence cardiometabolic disease"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/medication-non-adherence-cardiometabolic-disease-1055312898#medicalscholarlyarticle","name":"Medication non-adherence and therapeutic inertia independently contribute to poor disease control for cardiometabolic diseases","headline":"Medication non-adherence cardiometabolic disease","abstract":"Poorly controlled cardiometabolic biometric health gap measures [e.g.,uncontrolled blood pressure (BP), HbA1c, and low-density lipoprotein cholesterol (LDL-C)] are mediated by medication adherence and clinician-level therapeutic inertia (TI). The study of comparing relative contribution of these two factors to disease control is lacking. We conducted a retrospective cohort study using 7 years of longitudinal electronic health records (EHR) from primary care cardiometabolic patients who were 35 years or older. Cox-regression modeling was applied to estimate how baseline proportion of days covered (PDC) and TI were associated with cardiometabolic related health gap closure. 92,766 patients were included in the analysis, among which 89.9%, 85.8%, and 73.3% closed a BP, HbA1c, or LDL-C gap, respectively, with median days to gap closure ranging from 223 to 408 days. Patients who did not retrieve a medication were the least likely to achieve biometric control, particularly for LDL-C (HR = 0.58, 95% CI: 0.55-0.60). TI or uncertainty of TI was associated with a high risk of health gap persistence, particularly for LDL-C (HR ranges 0.46-0.48). 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