Long-term Medication Adherence after Myocardial Infarction: Experience of a Community

Nilay D Shah, Shannon M Dunlay, Henry H. Ting, Victor Manuel Montori, Randal J. Thomas, Amy E. Wagie, Veronique Lee Roger

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
Volume122
Issue number10
DOIs
StatePublished - Oct 2009

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Medication Adherence
Myocardial Infarction
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Guideline Adherence
Smoking
Demography
Confidence Intervals

Keywords

  • Adherence
  • Cardiac rehabilitation
  • Drugs
  • Myocardial infarction

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Long-term Medication Adherence after Myocardial Infarction : Experience of a Community. / Shah, Nilay D; Dunlay, Shannon M; Ting, Henry H.; Montori, Victor Manuel; Thomas, Randal J.; Wagie, Amy E.; Roger, Veronique Lee.

In: American Journal of Medicine, Vol. 122, No. 10, 10.2009.

Research output: Contribution to journalArticle

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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.

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