[Methodology and rules for measuring adherence: beyond the doctor-patient combination.]

Area of Science:

• Cardiology
• Public Health
• Health Services Research

Background:

• International guidelines recommend chronic polytherapy for secondary prevention after acute myocardial infarction.
• Previous observational studies indicate low adherence to these recommended therapies.
• Current evidence lacks quantification of adherence determinants (patient, local care, hospital).

Purpose of the Study:

• To measure adherence to chronic polytherapy in real-world clinical practice following acute myocardial infarction.
• To assess the variability in adherence across different care settings.
• To identify the primary care setting responsible for adherence variability.

Main Methods:

• A cohort of approximately 17,600 patients with incident myocardial infarction was selected from the Lazio region.
• Pharmaceutical prescriptions were collected and analyzed for two years post-discharge.
• Adherence to guideline-indicated chronic polytherapy was evaluated.

Main Results:

• Low adherence to chronic polytherapy was observed in the studied cohort.
• Significant intra-regional variability in adherence levels was found.
• The hospital of discharge was identified as the main contributor to adherence variability, persisting up to two years post-acute episode.

Conclusions:

• Real-world adherence to secondary prevention polytherapy post-myocardial infarction is suboptimal.
• Hospital of discharge is a critical factor influencing adherence variability.
• Interventions targeting hospital-level practices may improve guideline adherence and patient outcomes.