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Kidney function and long-term medication adherence after myocardial infarction in the elderly
Tara I Chang1, Manisha Desai, Daniel H Solomon
1Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA.
Clinical Journal of the American Society of Nephrology : CJASN
|January 15, 2011
Summary
Elderly patients with myocardial infarction show poor medication adherence, particularly those with kidney dysfunction. Kidney function significantly impacts adherence to ACE inhibitors/ARBs and beta-blockers, highlighting a vulnerable population for targeted interventions.
Area of Science:
- Cardiology
- Nephrology
- Geriatrics
- Pharmacology
Background:
- Long-term medication adherence in elderly patients post-myocardial infarction (MI) is crucial but understudied in relation to kidney function.
- Understanding factors influencing adherence is vital for optimizing cardiovascular outcomes in aging populations.
Purpose of the Study:
- To investigate the association between baseline kidney function and long-term outpatient medication adherence in elderly patients following MI.
- To examine adherence rates to key cardiovascular medications, including ACE inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs), beta-blockers, and statins.
Main Methods:
- A cohort of 2103 patients aged over 65, discharged after MI, was analyzed.
- Linear mixed-effects models assessed the link between baseline kidney function and medication adherence over 36 months.
- Adherence was measured as the percentage of days covered by pharmacy refills.
Main Results:
- Overall long-term adherence to ACEIs/ARBs, beta-blockers, and statins was low (50-60% days covered).
- Patients with baseline kidney dysfunction exhibited significantly lower adherence to ACEIs/ARBs and beta-blockers.
- Statin adherence did not show a significant variation based on baseline kidney function levels.
Conclusions:
- Long-term medication adherence post-MI in the elderly is suboptimal, with kidney dysfunction exacerbating the issue.
- Elderly patients with kidney dysfunction represent a high-risk group requiring focused strategies to improve medication adherence and mitigate adverse clinical consequences.
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