Journal Article

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

Henry, Timothy D., Honeycutt, Emily, Wang, Tracy Y., Zettler, Marjorie, Peterson, Eric D., Mathews, Robin, Chang, Michael, Fonarow, Gregg C.

2015

Overview

Persistent use of secondary prevention therapies after acute myocardial infarction (MI) is critical to optimizing long-term outcomes. 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. 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. 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.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Acute coronary syndromes / Adenosine / Adrenergic beta-Antagonists - therapeutic use / African Americans - statistics & numerical data / Age Factors / Aged / Angiotensin Receptor Antagonists - therapeutic use / Angiotensin-Converting Enzyme Inhibitors - therapeutic use / Aspirin - therapeutic use / Cardiology / Cardiovascular / Costs / Data collection / Deaths / Depression - epidemiology / Depression - psychology / European Continental Ancestry Group - statistics & numerical data / Female / Heart attacks / Hispanic Americans - statistics & numerical data / Hospitalization / Humans / Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use / Insurance coverage / Interviews / Logistic Models / Longitudinal Studies / Male / Marital Status / Medically Uninsured - statistics & numerical data / Medication Adherence - ethnology / Medication Adherence - psychology / Medication Adherence - statistics & numerical data / Middle Aged / Multivariate Analysis / Myocardial Infarction - drug therapy / Myocardial Infarction - epidemiology / Platelet Aggregation Inhibitors - therapeutic use / Prospective Studies / Purinergic P2Y Receptor Antagonists - therapeutic use / Risk Factors / Secondary Prevention / Smoking - epidemiology / Socioeconomic Factors