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Poor adherence to beta-blockers is associated with increased long-term mortality even beyond the first year after an

Jaakko Allonen1, Markku S Nieminen1, Juha Sinisalo1

  • 1Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.

Annals of Medicine
|March 10, 2020
PubMed

Insights

Poor adherence to beta-blockers significantly increases long-term mortality risk in acute coronary syndrome (ACS) patients. This finding holds true even for low-risk individuals, underscoring the importance of consistent medication use.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Pharmacotherapy

Background:

  • Acute coronary syndrome (ACS) patients commonly receive long-term beta-blocker therapy post-cardiac event.
  • Optimal duration and survival benefits of beta-blockers, particularly for low-risk ACS patients, require further investigation.

Purpose of the Study:

  • To examine the impact of adherence to beta-blocker therapy on the long-term survival rates of patients following an acute coronary syndrome.
  • To determine if beta-blocker therapy offers survival benefits to low-risk ACS patients.

Main Methods:

  • A cohort of 1855 ACS patients surviving 30 days post-angiography was followed for a median of 8.6 years.
  • Medication adherence was dynamically assessed based on yearly periods covered by prescription purchases.
  • Cox proportional hazards models were employed to analyze the association between adherence and all-cause mortality.

Main Results:

  • Non-adherence to beta-blockers was significantly associated with increased all-cause mortality (HR 1.84, p < .001) in multivariable analyses.
  • This increased mortality risk was observed consistently among low-risk ACS patients (HR 1.60, p = .004).
  • The detrimental effect of non-adherence on survival persisted beyond the first year post-ACS.

Conclusions:

  • Suboptimal adherence to beta-blocker therapy is a significant predictor of increased long-term mortality in ACS patients.
  • Long-term beta-blocker therapy appears beneficial for survival, even in patients initially classified as low-risk.
  • Maintaining medication adherence is crucial for secondary prevention in ACS survivors.

Keywords:
Acute coronary syndromeadherencebeta-blockerslong-term survivalmortalitysecondary prevention medications

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