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Adherence to Secondary Prevention Measures after Acute Myocardial Infarction and Its Impact on Patient Outcome-A

Andreas Hammer1, Hana Sinkovec2, Marko Todorovic2

  • 1Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.

Journal of Clinical Medicine
|August 29, 2024
PubMed

Insights

Adherence to cardiac rehabilitation (CR) and secondary medications after acute myocardial infarction (MI) is low in Austria, leading to increased mortality. Improving patient adherence to CR, statins, and dual antiplatelet therapy (DAPT) is vital for better cardiovascular outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Public Health
  • Health Services Research

Background:

  • Secondary prevention is critical for reducing morbidity and mortality post-acute myocardial infarction (MI).
  • Adherence to cardiac rehabilitation (CR) and pharmacotherapy remains suboptimal despite established guidelines.
  • Understanding adherence patterns and their impact on outcomes is essential for improving patient care.

Purpose of the Study:

  • To investigate adherence to CR, dual antiplatelet therapy (DAPT), and statins following acute MI in Austria.
  • To evaluate the impact of adherence to these secondary preventive measures on patient mortality.
  • To provide a nationwide perspective on adherence challenges and their consequences.

Main Methods:

  • National observational study including patients diagnosed with acute MI (STEMI or NSTEMI) in Austria (April 2011 - August 2015).
  • Patient data, including comorbidities, were sourced from the Austrian national health insurance system.
  • Adherence to CR, high-intensity statins, and DAPT was determined using health insurance and pharmacy prescription records.
  • Cox Regression hazard analysis was employed to assess the impact on mortality.

Main Results:

  • Only 13.4% of 16,518 acute MI patients adhered to CR, which was associated with significantly lower mortality (aHR 0.73).
  • Non-compliance with high-intensity statins (66.4% of 23,240 patients) correlated with increased mortality risk (aHR 1.16).
  • Adherence to DAPT (29.3% of 22,331 patients) was linked to a 21% reduction in mortality (aHR 0.79).

Conclusions:

  • Alarmingly low adherence to CR and secondary preventive medications post-MI was observed nationwide.
  • Suboptimal adherence is significantly associated with higher mortality rates in acute MI patients.
  • Enhanced strategies, including structured referrals and personalized follow-ups, are crucial to improve adherence and cardiovascular health.

Keywords:
acute coronary syndromeacute myocardial infractionadherencecardiac rehabilitationdual antiplatelet therapyhigh-intensity statins

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