# Effect of continuity of care on medication adherence and psychological outcomes in patients with coronary heart disease: a retrospective cohort study

## TL;DR

This study shows that structured continuity of care improves medication adherence and mental health in patients recovering from coronary heart disease.

## Contribution

The study provides large-sample evidence for the benefits of continuity of care in post-discharge CHD patients.

## Key findings

- Continuity of care significantly improved 6-month medication adherence compared to conventional care.
- Patients with continuity of care had lower anxiety and depression scores.
- The intervention group had a significantly reduced cardiovascular readmission rate.

## Abstract

Coronary heart disease (CHD) is a prevalent cardiovascular disorder worldwide. Post-discharge medication non-adherence and high anxiety/depression rates often lead to disease recurrence and reduced quality of life in CHD patients. While continuity of care is hypothesized to improve these outcomes, existing evidence is limited by high heterogeneity and lack of large-sample standardized validation in CHD populations.

This study aimed to assess the effects of continuity of care on medication adherence, psychological status, and cardiovascular readmission rates in post-discharge CHD patients.

A total of 320 CHD patients discharged between January 2021 and June 2023 were divided into an intervention group (structured continuity of care) and a conventional care group. We adopted 1:1 propensity score matching to control baseline confounders, with 128 patients per group included in the final analysis. The primary outcome was 6-month medication adherence measured by Medication Possession Ratio (MPR). Secondary outcomes included Hospital Anxiety and Depression Scale (HADS) scores and cardiovascular readmission rates.

Post-matching, the two groups were well-balanced in baseline characteristics. The intervention group showed significantly higher 6-month MPR (86.3 ± 9.7% vs. 67.5 ± 11.3%; MD = 18.8%, 95% CI: 16.1%–21.5%) and a greater proportion of good adherence (82.0% vs. 53.9%; RR = 1.52, 95% CI: 1.31–1.77). HADS anxiety and depression scores were notably lower in the intervention group (anxiety: 6.1 ± 2.2 vs. 9.0 ± 2.6; depression: 5.7 ± 2.4 vs. 8.6 ± 2.8). The 6-month cardiovascular readmission rate was significantly reduced in the intervention group (5.5% vs. 16.4%; RR = 0.33, 95% CI: 0.15–0.72).

Continuity of care is associated with improved long-term medication adherence, alleviated anxiety and depression, and reduced cardiovascular readmission risk in post-discharge CHD patients. It is recommended to gradually incorporate it into the routine management of cardiovascular disease rehabilitation after its efficacy has been validated in multicenter studies.