arXiv subjects

Laura Savaré

Publications and source records attributed to Laura Savaré.

3 recordsLinked to original sources

arXiv2026

A latent class approach to assess the effects of dynamic adherence to polytherapy in heart failure patients

Heart failure (HF) treatment relies heavily on pharmacotherapy, particularly combining multiple therapies as recommended by clinical guidelines. However, non-adherence to prescribed regimens remains a significant challenge, contributing to increased hospitalizations and poorer patient outcomes. This study introduces a novel methodological pipeline that integrates Latent Markov Models (LMM) with dynamic adherence modeling to evaluate adherence behaviors and their impact on HF rehospitalization. Using administrative healthcare data from Lombardy, Italy, we analyzed 6,818 patients hospitalized for HF between July and December 2020. Adherence was assessed monthly over a six-month observation period, and adherence profiles were linked to clinical outcomes using Cox regression. Seven latent behavioral profiles were identified, reflecting varying levels and trajectories of adherence. The findings revealed that higher adherence levels significantly reduced the risk of rehospitalization. Patients with consistently high adherence exhibited a 56% lower risk of HF rehospitalization compared to those with low adherence. Importantly, improving adherence during the observation period was associated with better survival probabilities, highlighting the potential benefits of timely interventions. Additionally, adherence behaviors were influenced by factors such as age, comorbidity burden, and hospitalization during the observation period. This study underscores the importance of dynamic and personalized strategies to monitor and enhance adherence to polytherapy. By linking adherence patterns to clinical outcomes, the proposed approach offers actionable insights for improving patient management and reducing the burden of HF on healthcare systems.

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arXiv2023

Integrating state-sequence analysis to uncover dynamic drug-utilization patterns to profile heart failure patients

Globally, the incidence of heart failure is increasing, and its principal treatment involves drug therapy. However, widespread non-adherence to therapies is prevalent among heart failure patients and often results in worsening health conditions and an increase in hospital admissions. This study aims to develop an innovative approach, the State-Sequence analysis, to profile heart failure patients based on different drug-utilization patterns. These patterns aim to capture both the multidimensional and dynamic effects of therapies. Subsequently, the study explores how combining clustering algorithms with this technique influences overall patient survival. Findings highlight the importance of continued drug therapy after the first hospitalization in improving heart failure prognosis, irrespective of its severity. The proposed approach can assist healthcare specialists in evaluating the pathways provided to patients, allowing for a change in analysis from a transversal and syntactical approach to a holistic one that leverages statistical tools that are slightly more complex than traditional methods. Moreover, because of the many options available for defining states, temporal granularity, and spacing metrics, SSA is a flexible method applicable to various epidemiological scenarios.

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arXiv2022

Mining and evaluation of patients' diagnostic therapeutic paths through state sequences analysis

The concept of care pathways is increasingly being used to enhance the quality of care and to optimize the use of resources for health care. Nevertheless, recommendations regarding the sequence of care are mostly based on consensus-based decisions as there is a lack of evidence on effective treatment sequences. In a real-world setting, classical statistical tools resulted to be insufficient to adequately consider a phenomenon with such high variability and has to be integrated with novel data mining techniques suitable of identifying patterns in complex data structures. Data-driven techniques can potentially support the empirical identification of effective care sequences by extracting them from data collected routinely. The purpose of this study is to perform sequence analysis to identify different patterns of treatment and to assess the most efficient in preventing adverse events. The clinical application that motivated the study of this method concerns the several problems frequently encountered in the quality of care provided in the mental health field. In particular, we analyzed administrative data provided by Regione Lombardia related to all the beneficiaries of the National Health Service with a diagnosis of schizophrenia from 2015 to 2018 resident in Lombardy, a region of northern Italy. This methodology considers the patient's therapeutic path as a conceptual unit, i.e., a sequence, composed of a succession of different states that can describe longitudinal patient's status. This kind of information, such as common patterns of care that allowed us to risk profile patients, can provide health policymakers an opportunity to plan optimum and individualized patient care by allocating appropriate resources, analyzing trends in the health status of a population, and finding the risk factors that can be leveraged to prevent the decline of mental health status at the population level.

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