TY - JOUR
T1 - Long-term Medication Adherence after Myocardial Infarction
T2 - Experience of a Community
AU - Shah, Nilay D.
AU - Dunlay, Shannon M.
AU - Ting, Henry H.
AU - Montori, Victor M.
AU - Thomas, Randal J.
AU - Wagie, Amy E.
AU - Roger, Véronique L.
PY - 2009/10
Y1 - 2009/10
N2 - Background: Adherence to evidence-based medications after myocardial infarction is associated with improved outcomes. However, long-term data on factors affecting medication adherence after myocardial infarction are lacking. Methods: Olmsted County residents hospitalized with myocardial infarction from 1997-2006 were identified. Adherence to HMG-CoA reductase inhibitors (statins), beta blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers, were examined. Cox proportional hazard regression was used to determine the factors associated with medication adherence over time. Results: Among 292 subjects with incident myocardial infarction (63% men, mean age 65 years), patients were followed for an average of 52 ± 31 months. Adherence to guideline-recommended medications decreased over time, with 3-year medication continuation rates of 44%, 48%, and 43% for statins, beta-blockers, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, respectively. Enrollment in a cardiac rehabilitation program was associated with an improved likelihood of continuing medications, with adjusted hazard ratio (95% confidence interval) for discontinuation of statins and beta-blockers among cardiac rehabilitation participants of 0.66 (0.45-0.92) and 0.70 (0.49-0.98), respectively. Smoking at the time of myocardial infarction was associated with a decreased likelihood of continuing medications, although results did not reach statistical significance. There were no observed associations between demographic characteristics, clinical characteristics of the myocardial infarction, and medication adherence. Conclusions: After myocardial infarction, a large proportion of patients discontinue use of medications over time. Enrollment in cardiac rehabilitation after myocardial infarction is associated with improved medication adherence.
AB - Background: Adherence to evidence-based medications after myocardial infarction is associated with improved outcomes. However, long-term data on factors affecting medication adherence after myocardial infarction are lacking. Methods: Olmsted County residents hospitalized with myocardial infarction from 1997-2006 were identified. Adherence to HMG-CoA reductase inhibitors (statins), beta blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers, were examined. Cox proportional hazard regression was used to determine the factors associated with medication adherence over time. Results: Among 292 subjects with incident myocardial infarction (63% men, mean age 65 years), patients were followed for an average of 52 ± 31 months. Adherence to guideline-recommended medications decreased over time, with 3-year medication continuation rates of 44%, 48%, and 43% for statins, beta-blockers, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, respectively. Enrollment in a cardiac rehabilitation program was associated with an improved likelihood of continuing medications, with adjusted hazard ratio (95% confidence interval) for discontinuation of statins and beta-blockers among cardiac rehabilitation participants of 0.66 (0.45-0.92) and 0.70 (0.49-0.98), respectively. Smoking at the time of myocardial infarction was associated with a decreased likelihood of continuing medications, although results did not reach statistical significance. There were no observed associations between demographic characteristics, clinical characteristics of the myocardial infarction, and medication adherence. Conclusions: After myocardial infarction, a large proportion of patients discontinue use of medications over time. Enrollment in cardiac rehabilitation after myocardial infarction is associated with improved medication adherence.
KW - Adherence
KW - Cardiac rehabilitation
KW - Drugs
KW - Myocardial infarction
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U2 - 10.1016/j.amjmed.2008.12.021
DO - 10.1016/j.amjmed.2008.12.021
M3 - Article
C2 - 19560749
AN - SCOPUS:70349515344
SN - 0002-9343
VL - 122
SP - 961.e7-961.e13
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 10
ER -