Abstract 15622: Impact of Cardiac Rehabilitation on Six-Month Adherence to Cardiovascular Pharmacotherapy: Insights From the Ami-Optima 2 Study

Introduction: It remains unclear whether cardiac rehabilitation (CR) can enhance adherence to cardiovascular (CV) medications. We aim to determine the impact of CR on 6-month adherence to CV pharmacotherapy. Methods: We conducted a prospective observational cohort study of patients hospitalized for acute coronary syndromes (ACS) in Quebec, Canada, during 2016-2018. The primary endpoint was 6-month adherence to all of these drugs (dual anti-platelets, beta-blockers, hypocholesterolemiants, angiotensin pathway inhibitors). The secondary endpoints were adherence to each individual class of CV medication. Adherence was determined by measuring the proportion of days covered (PDC) (evaluated by pharmacies refills). PDC was measured both as continuous and categorical variables. Suboptimal adherence was defined as PDC< 80%. We used inverse probability weighting to adjust for various factors which may have influenced the referral for CR and confounded the impact of CR on 6-month adherence (age, sex, coronary angioplasty, marital status, education, and occupation). All patients signed informed consent. Results: We enrolled 318 patients. Their mean age was 66±12 years; 30% were females. Of these patients, 152 undertook CR and 166 received standard follow-up. The mean age was 68 and 64 years, respectively. The proportions of females were similar in both groups. Overall PDC were 96%±13% vs 93%±17%; 7.2% and 11.2% patients had 6-month suboptimal adherence, respectively in patients who had CR vs patients without CR. After inverse weighting adjustment, CR was independently associated with improved adherence only with hypocholesterolemiants (Table 1). Conclusion: CR was not associated with improved 6-month overall adherence. However, patients who undertook CR were more adherent to hypocholesterolemiants than patients who did not undergo CR. CR programs should reinforce further to patients the importance of adherence to all ACS medications.

Spatial Logistic Regression Modeling With Inverse Weighting Distance For Open Unemployment In Districts/Cities On The Island Of Sulawesi

Unemployment is a condition where a person does not have a job, but is looking for a job. To see the unemployment situation in an area, logistic regression analysis can be used. Logistic regression is an analysis used to see the relationship between the response variable (Y) which is binary and the explanatory variable (X) which is categorical or continuous. The application of logistic regression often has a spatial influence on the model. In this study to model the open unemployment rate the spatial logistic regression method is used. Spatial logistic regression is logistic regression analysis by incorporating spatial influences into the model. Spatial dependency testing is used by Moran’s I Test. The weighting matrix used is the distance inverse weighting matrix. The results obtained, the value of Moran's I Test with a p-value of 2.14 x 10-12 <α (0.05), meaning that there is a spatial influence on the level of open unemployment on the island of Sulawesi. So the spatial logistic regression model is obtained as follows : g(x) = 4,848 0,000002885(X1) 0,0473(X2) 0,006669(X3) 0,04263(X4) 0,269(X5) 0,1642(X6) 1,531(X7) 0,1581(X8) 0,2208(X9) 0,009732(X10) 0,01871(Z) Spatial factors affect the level of open unemployment based on the significance value <α (0.05)

Assessing the Effects of Maternal HIV Infection on Child Birth Weight and Knowledge of HIV status on Breastfeeding using Observational Data in Malawi

Background : Evidence has shown that maternal HIV infection has adverse effect on pregnancy outcomes including childbirth weight and that knowledge of mothers HIV status affects practice of exclusive breastfeeding for the first six month. Using methods for matching possible confounders, the purpose of this study were twofold: a) to assess whether or not the association of maternal HIV on childbirth weight was moderated by use of ART drugs and b) to determine if indeed knowledge of HIV status among mothers was associated with exclusive breastfeeding. Methods: Data on over 18,000 and 16,000 children still alive and born within five years of the 2010 and 2015-16 Malawi Demographic and Health Surveys (MDHS) were analysed. A set of methods for confounder balance namely, the 1:1 nearest neighbour (NN) matching, matching on the propensity score (PS) and inverse weighting the propensity score (PS) were used. Results: Using the 2010 data, maternal HIV infection had a negative effect on infant birth weight -149.0 (-324.2, -26.2) and -154.3 (-295.4, -13.3), under PS matching and PS inverse weighting respectively. Infant birth weights from HIV-infected mothers on ART and uninfected mothers were the same (mean: 3121.3, 95% CI: 3021.9, 3220.7) and (3273.7, 95% CI: 3259.1, 3288.3), respectively) and differed significantly from those HIV-infected mothers (3193.9, 95% CI: 3122.2, 3265.6). For the 2015-16 data, mothers who were HIV-infected gave birth to infants who significantly weighted more than infants from HIV-uninfected mothers 144.7 (40.4, 249.1) and 115.4 (11.6, 219.2), under PS matching and PS inverse weighting respectively. Knowledge of HIV status among mothers was not associated with their behaviour concerning exclusive breastfeeding for the 2010 and 2015-16 data. Conclusion: The association between maternal HIV infection and birth weight depended on the data used, with the 2010 data showing adverse effect. The higher birth weight among infants born to HIV infected mothers in 2015-16 maybe indicative of successes of policies and interventions within the PMTCT program in Malawi. The observed mitigating effect of ART usage by HIV infected mothers on child birth weight further confirms that PMTCT interventions should continue to be supported among antenatal clinics in Malawi.