Medications adherence post-primary percutaneous coronary intervention in acute myocardial infarction: A
Alaa Rahhal1, Ahmed Mahfouz1, Fadi Khir2
1Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Insights
Medication adherence after percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is low. Regular follow-up and attending the first clinic appointment significantly improve adherence to crucial secondary prevention medications.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Secondary prevention medications are vital for managing coronary artery disease (CAD) post-percutaneous coronary intervention (PCI).
- Suboptimal medication adherence worldwide poses a significant challenge in achieving optimal patient outcomes.
- Understanding predictors of non-adherence is crucial for developing targeted interventions.
Purpose of the Study:
- To assess medication adherence rates in ST-elevation myocardial infarction (STEMI) patients following PCI.
- To identify factors predicting non-adherence to post-PCI secondary prevention medications.
- To evaluate the impact of follow-up care on medication adherence.
Main Methods:
- Retrospective observational cohort study including 1334 STEMI patients who underwent primary PCI.
- Medication adherence assessed by prescription refill rates for 12 months post-discharge (80% availability criterion).
- Analysis of demographic, clinical, and healthcare utilization factors as predictors of non-adherence.
Main Results:
- Overall medication adherence rate was low at 28.4% across all prescribed secondary prevention drugs.
- Individual adherence rates varied: Aspirin (50.5%), P2Y12 inhibitors (49.9%), statins (48.1%), beta-blockers (39.6%), ACE inhibitors/ARBs (42.9%).
- Prolonged hospital stay and receiving medications at no charge predicted non-adherence, while regular follow-up and first clinic visit attendance reduced it.
Conclusions:
- Adherence to essential post-PCI medications in STEMI patients remains a significant clinical concern.
- Attending the initial outpatient clinic appointment and consistent follow-up care are key factors in improving medication adherence.
- Interventions focusing on patient engagement with follow-up care are warranted to enhance secondary prevention in CAD patients.
What Is Known And Objective:
The use of medications for secondary prevention is the cornerstone in the treatment of coronary artery disease (CAD). However, adherence to these medications is still suboptimal worldwide. This retrospective observational study aimed to assess the adherence to post-percutaneous coronary intervention (PCI) medications, along with predictors of non-adherence.
Methods:
We conducted a retrospective observational cohort study to assess the adherence to post-PCI medications by determining the rate of prescription refills for 12 months after discharge among STEMI patients, as well as predictors of non-adherence. Adherence was assessed by medication availability 80% of the time monitored by the prescription refills rate for 1 year post-discharge.
Results And Discussion:
A total of 1334 patients who presented with STEMI and underwent primary PCI were included in our retrospective analysis. The majority of patients included were male (96%) with a mean age of 51 ± 10.2 years. The overall adherence rate for all medications was only 28.4%, with an individual adherence rate of 50.5% for aspirin, 49.9% for P2 Y12 inhibitors, 48.1% for statins, 39.6% for beta-blockers and 42.9% for angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB). Factors that increased the likelihood of non-adherence were prolonged hospital length of stay and getting the medications with charge (aOR = 1.94, 95% CI 1.1-3.3; p-value = 0.017, aOR = 1.87, 95% CI 1.1-3.3; p-value = 0.029, respectively), while having a regular follow-up after discharge and attending the first clinic appointment were significantly associated with decreased likelihood of non-adherence (aOR = 0.01, 95% CI 0.004-0.04; p-value < 0.001, aOR = 0.06, 95% CI 0.03-0.1; p-value < 0.001, respectively).
What Is New And Conclusion:
The adherence rate to post-PCI medications among patients with STEMI was relatively low; however, attending the first outpatient clinic appointment and having a regular follow-up reduced the likelihood of non-adherence.
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