Adherence and Persistence to Long-Acting Injectable Dopamine Receptor Blocking Agent Therapy in the United States: A Systematic Review and Meta-Analysis of Cohort Studies

Background The majority of people born with congenital heart disease require lifelong cardiac follow‐up. However, discontinuity of care is a recognized problem and appears to increase around the transition to adulthood. We performed a systematic review and meta‐analysis to estimate the proportion of adolescents and emerging adults with congenital heart disease discontinuing cardiac follow‐up. In pooled data, we investigated regional differences, disparities by disease complexity, and the impact of transition programs on the discontinuity of care. Methods and Results Searches were performed in PubMed, Embase, Cinahl, and Web of Science. We identified 17 studies, which enrolled 6847 patients. A random effects meta‐analysis of single proportions was performed according to the DerSimonian‐Laird method. Moderator effects were computed to explore sources for heterogeneity. Discontinuity proportions ranged from 3.6% to 62.7%, with a pooled estimated proportion of 26.1% (95% CI, 19.2%–34.6%). A trend toward more discontinuity was observed in simple heart defects (33.7%; 95% CI, 15.6%–58.3%), compared with moderate (25.7%; 95% CI, 15.2%–40.1%) or complex congenital heart disease (22.3%; 95% CI, 16.5%–29.4%) ( P =0.2372). Studies from the United States (34.0%; 95% CI, 24.3%–45.4%), Canada (25.7%; 95% CI, 17.0%–36.7%), and Europe (6.5%; 95% CI, 5.3%–7.9%) differed significantly ( P =0.0004). Transition programs were shown to have the potential to reduce discontinuity of care (12.7%; 95% CI, 2.8%–42.3%) compared with usual care (36.2%; 95% CI, 22.8%–52.2%) ( P =0.1119). Conclusions This meta‐analysis showed that there is a high proportion of discontinuity of care in young people with congenital heart disease. The highest discontinuity proportions were observed in studies from the United States and in patients with simple heart defects. It is suggested that transition programs have a protective effect. Registration URL: www.crd.york.ac.uk/prospero . Unique identifier: CRD42020182413.

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Abstract MP017: Television Viewing and Life Expectancy in the United States

Circulation ◽

10.1161/circ.125.suppl_10.amp017 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Peter T Katzmarzyk ◽

I-Min Lee

Keyword(s):

United States ◽

Life Expectancy ◽

Cohort Studies ◽

Prospective Cohort ◽

Television Viewing ◽

Meta Analysis ◽

The United States ◽

Sedentary Behaviors ◽

Prospective Cohort Studies ◽

All Cause Mortality

Introduction: Sedentary behaviors such as television viewing are ubiquitous in modern society. Several prospective studies have demonstrated an association between television viewing and incident obesity and type 2 diabetes as well as cardiovascular disease and all-cause mortality. Hypothesis: We tested the null hypothesis that television viewing has no impact on life expectancy in the United States. Methods: A prevalence-based cause-deleted methodology was used to estimate the gains in life expectancy in the population that would be expected under current mortality patterns if television viewing was eliminated as a potential risk factor in the United States. The population attributable fraction (PAF, calculated using adjusted relative risk (RR) = ∑P(RR-1/RR)) was computed from the RR of all-cause mortality associated with television viewing (2–3.9 h and ≥4 h versus < 2 h) obtained from a meta-analysis of available prospective cohort studies, and the estimated case prevalence (P) of television viewing obtained from the U.S. National Health and Nutrition Examination Survey (2005–06) and the prospective cohort studies. The resulting PAF was applied to mortality rates among 18+ year olds living in the United States and an abridged life table analysis was used to estimate the potential gains in life expectancy. Results: Three prospective cohort studies contributed data to the meta-analysis, yielding summary RR estimates for all-cause mortality of 1.17 (95% CI: 1.04 – 1.32) and 1.49 (95% CI: 1.22–1.82) for 2–3.9 h and ≥4 h of television viewing versus <2 h, respectively. The estimated case prevalences of television viewing in the U.S. population were 23.8%, 45.7% and 37.2% for <2 h, 2–3.9 h and ≥4 h of television viewing, respectively. The estimated gain in life expectancy in the US population associated with television viewing was 1.38 years. The lower and upper limits from a sensitivity analysis which involved simultaneously varying the estimates of RR (using the upper and lower bounds of the 95% CI) and the prevalence of television viewing (± 20%) were 0.48 years and 2.50 years. Conclusions: Reducing sedentary behaviors such as television viewing has the potential to increase life expectancy in the United States.

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