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Am Heart J. 2015 Jul;170(1):62-9. doi: 10.1016/j.ahj.2015.03.019. Epub 2015 Apr 2.

Persistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study.

Author information

1
Duke Clinical Research Institute, Durham, NC. Electronic address: robin.mathews@duke.edu.
2
Duke Clinical Research Institute, Durham, NC.
3
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
4
Lilly, USA, LLC, Indianapolis, IN.
5
Mercy Heart Vascular Institute, Sacramento, CA.
6
Ahmanson-UCLA Cardiomyopathy Center, University of California at Los Angeles, Los Angeles, CA.

Abstract

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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01088503.

PMID:
26093865
PMCID:
PMC4808054
DOI:
10.1016/j.ahj.2015.03.019
[Indexed for MEDLINE]
Free PMC Article

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