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J Am Heart Assoc. 2019 May 7;8(9):e011793. doi: 10.1161/JAHA.118.011793.

Association Between Medication Adherence and 1-Year Major Cardiovascular Adverse Events After Acute Myocardial Infarction in China.

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1 School of International Pharmaceutical Business China Pharmaceutical University Nanjing China.
2 NHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College National Center for Cardiovascular Diseases Beijing China.
3 National School of Development Peking University Beijing China.
4 Cardiology Section Rocky Mountain Regional VA Medical Center Aurora CO.
5 Division of Cardiology University of Colorado School of Medicine Aurora CO.
11 Health Care and International Medical Services Peking Union Medical College Hospital Beijing China.
6 Department of Biostatistics Harvard T.H. Chan School of Public Health Boston MA.
7 Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT.
8 Department of Health Care Policy Harvard Medical School Boston MA.
9 Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.
10 Department of Health Policy and Management Yale School of Public Health New Haven CT.


Background Secondary prevention after acute myocardial infarction ( AMI ) requires long-term guideline-directed medical therapy. However, the level of medication adherence, factors associated with poor adherence, and extent to which good adherence can reduce adverse events after AMI in China remain uncertain. Methods and Results In 2013 to 2014, 4001 AMI patients aged ≥18 years were discharged alive from 53 hospitals across China (mean age 60.5±11.7 years; 22.7% female). Good adherence was defined as taking medications (aspirin, β-blockers, statins, clopidogrel, or angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers) ≥90% of the time as prescribed. Cox models assessed the association between good adherence (a time-varying covariate) and 1-year cardiovascular events after AMI . The most common medications were aspirin (82.2%) and statins (80.5%). There were 243 patients who were not prescribed any medications during follow-up; 1-year event rates were higher for these patients (25.1%, 95% CI 19.7-30.6%) versus those taking ≥1 medications (6.6%, 95% CI 5.76-7.34%). The overall rate of good adherence was 52.9%. Good adherence was associated with lower risk of 1-year events (adjusted hazard ratio 0.61, 95% CI 0.49-0.77). The most common reason for poor adherence was belief that one's condition had improved/no longer required medication. More comorbidities and lower education level were associated with poor adherence. Conclusions Good adherence reduced 1-year cardiovascular event risk after AMI . About half of our cohort did not have good adherence. National efforts to improve AMI outcomes in China should focus on medication adherence and educating patients on the importance of cardiovascular medications for reducing risk of recurrent events. Clinical Trial Registration URL : . Unique identifier: NCT01624909.


acute myocardial infarction; cardiovascular adverse events; medication adherence; patient‐reported outcomes

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