Effect of adherence to evidence-based therapy after acute myocardial infarction on all-cause mortality
Hatem Hamood1,2, Rola Hamood3, Manfred S Green3
1Department of Cardiology, Bnai Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
Insights
Medication nonadherence after acute myocardial infarction (AMI) is common. Not taking aspirin, statins, or combined therapies significantly increases mortality risk in AMI survivors.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Cardioprotective medications are crucial for acute myocardial infarction (AMI) survivors.
- Medication nonadherence is a significant challenge in managing chronic cardiovascular conditions.
Purpose of the Study:
- To quantify the impact of nonadherence to evidence-based cardioprotective medications on all-cause mortality in AMI survivors.
- To identify specific medication classes associated with increased mortality risk due to nonadherence.
Main Methods:
- Retrospective cohort study of 1-year AMI survivors (2005-2010).
- Adherence measured by proportion-of-days-covered (≥80%).
- Cox proportional hazards models adjusted for demographic and clinical factors.
Main Results:
- Nonadherence to aspirin, statins, and ACE inhibitors/ARBs (in heart failure patients) was linked to increased all-cause mortality.
- Combined therapy adherence showed a dose-response survival benefit.
- Patients nonadherent to all medications faced the highest mortality risk (HR 1.38).
Conclusions:
- Nonadherence to key cardioprotective drugs like aspirin and statins is prevalent and elevates mortality risk post-AMI.
- Combined therapy adherence is associated with better survival outcomes.
- Further investigation is needed for ACE inhibitors/ARBs in specific patient subgroups.
Purpose:
Our aim is to estimate the effect of nonadherence to evidence-based cardioprotective medications on all-cause mortality in survivors of acute myocardial infarction (AMI).
Methods:
A patient-based retrospective cohort study of 1-year survivors of AMI, members of a health organization in Israel, between 2005 and 2010 was used. Adherence was measured using the proportion-of-days-covered metric and defined as a proportion of days covered ≥80%. In order to determine the independent impact of medication nonadherence on all-cause mortality, Cox proportional hazards models were constructed, adjusting for patient demographic and clinical characteristics.
Results:
Of 4655 patients prescribed at least one medication, 864 died during an 8-year follow-up (median 4.5 years). Except for beta-blockers, medication nonadherence was significantly associated with increased adjusted all-cause mortality risk for aspirin [hazard ratio (HR), 1.28; 95% confidence interval (CI), 1.11-1.47], statins (HR, 1.36; 95%CI, 1.18-1.57), and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers only among ischemic heart disease patients with documented heart failure (HR, 1.57; 95%CI, 1.16-2.14). Multidrug-combined therapy exerted incremental survival benefit in a dose-response gradient, exceeding that of single-component treatment. The highest risk of mortality was observed in patients adherent to none of the medications compared with adherents to all medications, with a 38% increase in risk of mortality (HR, 1.38; 95%CI, 1.06-1.80).
Conclusions:
Outpatient nonadherence to evidence-based cardioprotective medications in patients with AMI is common, and in the case of aspirin, statin or combined therapy is associated with a marked risk increase in all-cause mortality. Further research is needed to elucidate the role of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker in patient subgroups.
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