Determinants of adherence to evidence-based therapy after acute myocardial infarction

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Abstract

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.

Original languageEnglish
Pages (from-to)975-985
Number of pages11
JournalEuropean Journal of Preventive Cardiology
Volume23
Issue number9
DOIs
StatePublished - Jun 2015

Bibliographical note

Publisher Copyright:
© 2015 European Society of Cardiology.

Keywords

  • Acute myocardial infarction
  • adherence
  • evidence-based medicine
  • secondary prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Epidemiology

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