Impact of Medication Adherence on Long-Term Outcomes Post-MI

New research has found that high levels of adherence to guideline-recommended therapies for myocardial infarction (MI) medication adherence is associated with a lower rate of major cardiovascular events compared to partial or non-adherence, according to results from a study presented Aug. 31 as part of ESC Congress 2014.

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Data currently shows that that evidence-based medications for secondary prevention of cardiovascular disease have led to a 50 percent reduction in mortality, but nearly half of patients are non-adherent within the first year post event. With limited long-term studies linking adherence with outcomes, Sameer Bansilal, MD, and his co-investigators evaluated the association of levels of medication adherence with lasting major cardiovascular events: death, hospitalization for MI, stroke and coronary revascularization. They utilized information from Aetna Commercial and Medicare Advantage population databases, including enrollment records, medical and pharmacy health insurance claims, and records linked for comprehensive tracking of individuals’ use of health care resources and clinical outcomes over time and across providers.

Analyzing the proportion of days covered for both statin and ace-inhibitor (ACEI) medications following a hospitalization discharge for MI and a six-month follow-up, results showed out of a study population of 4,015 patients, 1,721 (43 percent) were fully-adherent, or ≥80 percent; 1,031 (31 percent) were partially-adherent, or 40–79 percent; and 1,263 (26 percent) were non-adherent, or <40 percent. The fully-adherent group showed statistically significant lower events across the board when compared with partially adherent and non-adherent groups. The outcomes were not statistically different for the partially adherent and non-adherent groups.

While high level of adherence was associated with a lower rate of major cardiovascular events, the investigators conclude that there appeared to be a threshold effect for this benefit at >80 percent adherence. Moving forward, the investigators note that novel approaches to improve adherence such as a polypill may enable >80 percent adherence with secondary preventive therapies and may lead to a significant reduction in cardiovascular events post MI.

Clinical Topics: Dyslipidemia, Prevention, Nonstatins, Novel Agents, Statins

Keywords: Medication Adherence, Myocardial Infarction, Stroke, Medicare Part C, Follow-Up Studies, Secondary Prevention, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Patient Discharge

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