Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction

• Published in: Journal of the American College of Cardiology Vol. 70; no. 13; pp. 1543 - 1554
• Main Authors: Korhonen, Maarit J., Robinson, Jennifer G., Annis, Izabela E., Hickson, Ryan P., Bell, J. Simon, Hartikainen, Juha, Fang, Gang
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 26.09.2017; Elsevier Limited
• Subjects: Adhesion; Adrenergic beta-Antagonists - therapeutic use; Age Factors; Aged; Aged, 80 and over; Angina pectoris; Angiotensin II; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin-converting enzyme inhibitors; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Beta blockers; Cardiology; Chronic illnesses; Clinical trials; Confidence intervals; Coronary vessels; Diabetes; Disease prevention; Drug Therapy, Combination; Enzymes; Female; Government programs; Hazards; Health care; Health hazards; Health risk assessment; Heart attacks; Heart failure; Heart surgery; Hospitalization; Hospitals; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypertension; Inhibitors; Male; Medicare; Medication Adherence; Meta-analysis; Mortality; Myocardial infarction; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Myocardial Infarction - prevention & control; older adults; Older people; Patient compliance; Patients; Peptidyl-dipeptidase A; Proportional Hazards Models; secondary prevention; Statins; Statistical models; Tradeoffs; United States; CVD; ARB; secondary prevention; ACE; CI; myocardial infarction; older adults; HR; medication adherence; AMI; PDC
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2017.07.783

Angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB), beta-blockers and statins are recommended after acute myocardial infarction (AMI). Patients may adhere to some, but not all, therapies. The authors investigated the effect of tradeoffs in adherence to ACE inhibitors/ARBs, beta-blockers, and statins on survival among older people after AMI. The authors identified 90,869 Medicare beneficiaries ≥65 years of age who had prescriptions for ACE inhibitors/ARBs, beta-blockers, and statins, and survived ≥180 days after AMI hospitalization in 2008 to 2010. Adherence was measured by proportion of days covered (PDC) during 180 days following hospital discharge. Mortality follow-up extended up to 18 months after this period. The authors used Cox proportional hazards models to estimate hazard ratios of mortality for groups adherent to 2, 1, or none of the therapies versus group adherent to all 3 therapies. Only 49% of the patients adhered (PDC ≥80%) to all 3 therapies. Compared with being adherent to all 3 therapies, multivariable-adjusted hazard ratios (95% confidence intervals [CIs]) for mortality were 1.12 (95% CI: 1.04 to 1.21) for being adherent to ACE inhibitors/ARBs and beta-blockers only, 0.98 (95% CI: 0.91 to 1.07) for ACEI/ARBs and statins only, 1.17 (95% CI: 1.10 to 1.25) beta-blockers and statins only, 1.19 (95% CI: 1.07 to 1.32) for ACE inhibitors/ARBs only, 1.32 (95% CI: 1.21 to 1.44) for beta-blockers only, 1.26 (95% CI: 1.15 to 1.38) statins only, and 1.65 (95% CI: 1.54 to 1.76) for being nonadherent (PDC <80%) to all 3 therapies. Patients adherent to ACE inhibitors/ARBs and statins only had similar mortality rates as those adherent to all 3 therapies, suggesting limited additional benefit for beta-blockers in patients who were adherent to statins and ACE inhibitors/ARBs. Nonadherence to ACE inhibitors/ARBs and/or statins was associated with higher mortality. [Display omitted]