Persistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study - 18/06/15
, Tracy Y. Wang, MD, MHS, MSc a, Emily Honeycutt, MBI a, Timothy D. Henry, MD b, Marjorie Zettler, PhD c, Michael Chang, MD d, Gregg C. Fonarow, MD e, Eric D. Peterson, MD, MPH aon behalf of the
TRANSLATE-ACS Study Investigators
Résumé |
Background |
Persistent use of secondary prevention therapies after acute myocardial infarction (MI) is critical to optimizing long-term outcomes.
Methods |
Medication persistence was assessed among 7,955 MI patients in 216 hospitals participating in the Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome study from 2010 to 2012. Persistence was defined as continuation of aspirin, adenosine diphosphate receptor inhibitors, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins from discharge to 6 months post-MI. Multivariable logistic regression modeling was used to determine factors associated with nonpersistence, defined as <80% persistence with all medication classes.
Results |
Overall, 31% of MI patients stopped taking a least 1 medication by 6 months. The most common reasons cited for medications discontinuation were side effects and physician instruction (57%), whereas financial concerns were cited in 8% overall. After multivariable modeling, black race (odds ratio 1.36, 95% CI 1.15-1.62), older age (odds ratio 1.07, 95% CI 1.02-1.12), atrial fibrillation (odds ratio 1.67, 95% CI 1.33-2.09), dialysis (odds ratio 1.79, 95% CI 1.15-2.78), and depression (odds ratio 1.22, 95% CI 1.02-1.45) were associated with lower likelihood of persistence. Private insurance (odds ratio 0.85, 95% 0.76-0.95), prescription cost assistance (odds ratio 0.63, 95% CI 0.54-0.75), and outpatient follow-up arranged before discharge (odds ratio 0.89, 95% CI 0.80-0.99) were associated with higher persistence.
Conclusions |
Nearly one-third of MI patients are no longer persistent with their prescribed medications by 6 months. Patients at high risk for nonpersistence may be identified by clinical and sociodemographic features. These observations underscore key opportunities to optimize longitudinal use of secondary prevention therapies.
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| Sources of funding: TRANSLATE-ACS was funded by Daiichi Sankyo Ltd and Eli Lilly USA (clinicaltrials.gov no. NCT01088503). The Duke Clinical Research Institute is the coordinating center for this study, which represents a collaborative effort with the American College of Cardiology. Robin Mathews is supported by grant number KM1CA156687 from the National Institute of Health/National Cancer Institute. |
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| William S. Weintraub, MD served as guest editor for this article. |
Vol 170 - N° 1
P. 62-69 - juillet 2015 Retour au numéro
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