Determinants of adherence to evidence-based therapy after acute myocardial infarction
Hatem Hamood1, Rola Hamood2, Manfred S Green2
1Department of Cardiology, Bnai-Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel Leumit Health Services, Karmiel, Israel hhamood@leumit.co.il.
Insights
Patient adherence to heart medications after heart attack is low, with nearly 50% not taking them. Adherence is linked to healthcare use, with Jewish patients and those seeing cardiologists more likely to adhere. Comorbidities reduce adherence.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Patient adherence to evidence-based cardioprotective medications after acute myocardial infarction (AMI) is crucial but not fully understood.
- Factors influencing adherence to these vital medications in AMI survivors require investigation.
Purpose of the Study:
- To identify patient characteristics and healthcare utilization factors associated with adherence to cardioprotective medications in AMI survivors.
- To explore determinants of medication adherence in a large cohort of elderly AMI patients.
Main Methods:
- Retrospective cohort study of 4655 elderly AMI survivors (2005-2010).
- Medication adherence measured by proportion-of-days-covered (PDC) ≥80%.
- Multivariable analyses examined associations between patient characteristics, healthcare utilization, and adherence.
Main Results:
- Nonadherence approximated 50% for individual medications and 80% for combined therapy.
- Adherence was higher among Jewish patients, residents of central/northern districts, and those with regular cardiologist follow-up.
- Increased outpatient visits correlated with better adherence; comorbid conditions and readmissions were linked to reduced adherence.
Conclusions:
- Outpatient adherence to recommended therapies post-AMI is suboptimal and associated with healthcare service utilization.
- Further research is needed to understand patient-specific behavioral factors influencing medication discontinuation after AMI.
Background:
The extent to which drug adherence may be affected by patient characteristics remains unclear. This study investigated potential determinants of adherence to evidence-based cardioprotective medications in patients with acute myocardial infarction.
Design:
Patient-based retrospective cohort study of 4655 elderly one-year survivors of acute myocardial infarction, members of a health organization in Israel, between 2005 and 2010.
Methods:
All patients filled at least one prescription for any key medication. Adherence was measured using the proportion-of-days-covered (PDC) metric and defined as PDC ≥ 80%.
Results:
Nonadherence to aspirin, β-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers or statins approximated 50%, and 80% for combined therapy of all medications. In multivariable analyses, compared with nonadherents to all medications, adherers to at least one medication were more likely to be of Jewish origin (adjusted odds ratio (AOR), 2.11; 95% confidence interval (CI), 1.60-2.78), inhabitants of the central or northern districts, and attending a cardiologist at least once during the first year of follow-up (AOR, 1.26; 95% CI, 1.05-1.51). Increasing number of outpatient visits was associated with improved adherence and followed a significant dose-response gradient. Factors significantly associated with reduced adherence were presence of comorbid conditions, particularly chronic ischemic heart disease (AOR 0.69; 95% CI, 0.57-0.83) and readmissions (AOR, 0.65; 95% CI, 0.55-0.78). Results were consistent when evaluating adherence to each medication separately.
Conclusions:
Outpatient adherence to recommended therapy in patients with acute myocardial infarction is suboptimal and is related to health services utilization. Further research is needed to investigate patient subjective behavioral-related drivers for medication therapy discontinuation after myocardial infarction in the absence of a clinical reason.
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