Medication Adherence and Long-Term CV Outcomes

Study Questions:

What is the association between medication adherence levels in patients post–myocardial infarction (MI) or with atherosclerotic disease and long-term risk for major adverse cardiovascular events (MACE)?

Methods:

This was a nonconcurrent cohort study carried out using 2010-2013 medical and pharmaceutical claims obtained from Aetna Commercial and Medicare Advantage population databases. The post-MI cohort included adults who initiated both statin and angiotensin-converting enzyme inhibitor (ACEI) medications following a hospitalization discharge for MI. The atherosclerosis cohort included adults who initiated both statin and ACEI medications and had coronary, cerebrovascular, or peripheral arterial disease. Patients were categorized into one of three adherence groups on the basis of their proportion of days covered for both statin and ACEI: ≥80% (fully adherent [FA]), 40-79% (partially adherent [PA]), and <40% (nonadherent [NA]).

Results:

Data were available for 4,015 post-MI patients and 12,976 patients with atherosclerotic disease. In the post-MI cohort, the FA group had significantly lower MACE than the NA (18.9% vs. 26.3%; hazard ratio [HR], 0.73; p = 0.0004) and PA groups (18.9% vs. 24.7%; HR, 0.81; p = 0.02) at 2 years. In the atherosclerotic disease cohort, the FA group had a significantly lower rate of MACE than the NA (8.42% vs. 17.17%; HR, 0.56; p < 0.0001) and the PA groups (8.42% vs. 12.18%; HR, 0.76; p < 0.0001).

Conclusions:

Improved medication adherence in post-MI and atherosclerosis patients enrolled in a large US insurer plan translates to a lower rate of MACE and cost savings. The threshold effect is seen at ≥80% adherence in the post-MI population.

Perspective:

This is an important study that corroborates the need for heightened attention to novel solutions for improving medication adherence in post-MI patients and those with atherosclerotic disease. Post-MI only 43% were fully adherent to guideline-indicated therapy, even though such therapy is clearly associated with improved outcomes and cost savings.

Clinical Topics: Acute Coronary Syndromes, Clinical Topic Collection: Dyslipidemia, Geriatric Cardiology, Prevention, Vascular Medicine, Nonstatins, Novel Agents, Statins

Keywords: Acute Coronary Syndrome, Angiotensin-Converting Enzyme Inhibitors, Atherosclerosis, Coronary Artery Disease, Cost Savings, Geriatrics, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Insurance Carriers, Medication Adherence, Myocardial Infarction, Peripheral Arterial Disease, Primary Prevention


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