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J Am Coll Cardiol. 2016 Aug 23;68(8):789-801. doi: 10.1016/j.jacc.2016.06.005.

Assessing the Impact of Medication Adherence on Long-Term Cardiovascular Outcomes.

Author information

1
Icahn School of Medicine at Mount Sinai School, New York, New York.
2
Icahn School of Medicine at Mount Sinai School, New York, New York; National Centre for Cardiovascular Research, Madrid, Spain; Hospital Universitario Monteprincipe, Grupo HM, Madrid, Spain.
3
Icahn School of Medicine at Mount Sinai School, New York, New York; Ferrer, Barcelona, Spain.
4
Aetna Inc., Hartford, Connecticut.
5
Ferrer, Barcelona, Spain.
6
Icahn School of Medicine at Mount Sinai School, New York, New York; National Centre for Cardiovascular Research, Madrid, Spain. Electronic address: valentin.fuster@mountsinai.org.

Abstract

BACKGROUND:

Although guideline-recommended therapies reduce major adverse cardiovascular events (MACE) in patients after myocardial infarction (MI) or those with atherosclerotic disease (ATH), adherence is poor.

OBJECTIVES:

The goal of this study was to determine the association between medication adherence levels and long-term MACE in these patients.

METHODS:

We queried the claims database of a large health insurer for patients hospitalized for MI or with ATH. The primary outcome measure was a composite of all-cause death, MI, stroke, or coronary revascularization. Using proportion of days covered for statins and angiotensin-converting enzyme inhibitors, patients were stratified as fully adherent (≥80%), partially adherent (≥40% to ≤79%), or nonadherent (<40%). Per-patient annual direct medical (ADM) costs were estimated by using unit costs from 2 national files.

RESULTS:

Data were analyzed for 4,015 post-MI patients and 12,976 patients with ATH. In the post-MI cohort, the fully adherent group had a significantly lower rate of MACE than the nonadherent (18.9% vs. 26.3%; hazard ratio [HR]: 0.73; p = 0.0004) and partially adherent (18.9% vs. 24.7%; HR: 0.81; p = 0.02) groups at 2 years. The fully adherent group had reduced per-patient ADM costs for MI hospitalizations of $369 and $440 compared with the partially adherent and nonadherent groups, respectively. In the ATH cohort, the fully adherent group had a significantly lower rate of MACE than the nonadherent (8.42% vs. 17.17%; HR: 0.56; p < 0.0001) and the partially adherent (8.42% vs. 12.18%; HR: 0.76; p < 0.0001) groups at 2 years. The fully adherent group had reduced per-patient ADM costs for MI hospitalizations of $371 and $907 compared with the partially adherent and nonadherent groups.

CONCLUSIONS:

Full adherence to guideline-recommended therapies was associated with a lower rate of MACE and cost savings, with a threshold effect at >80% adherence in the post-MI population; at least a 40% level of long-term adherence needs to be maintained to continue to accrue benefit. Novel approaches to improve adherence may significantly reduce cardiovascular events.

KEYWORDS:

atherosclerosis; myocardial infarction; secondary prevention

PMID:
27539170
DOI:
10.1016/j.jacc.2016.06.005
[Indexed for MEDLINE]
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