Adherence to evidence-based secondary prevention pharmacotherapy in patients after an acute coronary syndrome: A systematic review

Chen, Han-Yang; Saczynski, Jane S.; Lapane, Kate L.; Kiefe, Catarina I.; Goldberg, Robert J.

doi:10.1016/j.hrtlng.2015.02.004

Cited by 48 publications

(50 citation statements)

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“…To the best of our knowledge, there are no studies assessing medication adherence after hospitalization for CHD using GBTM. Traditional studies assessing adherence to secondary prevention pharmacotherapy after an ACS showed suboptimal figures (ranging from 54% to 86% at one year) [17], although such figures are not directly comparable to those of the present study, as they do not provide information on adherence behaviors over time.…”

Section: Discussioncontrasting

confidence: 95%

“…Coronary heart disease (CHD) provides an opportunity to explore the potential of these alternatives. In spite of great efforts from the scientific community and professional societies through clear guideline recommendations and quality of care policies based on solid evidence, underprescribing and low adherence to evidence-based therapies remain a significant problem in the management of patients who have suffered hospitalization for CHD [4,17], either because physicians fail to prescribe these medications and/or because patients fail to obtain and/or consume them.…”

Section: Introductionmentioning

confidence: 99%

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Medication Adherence Patterns after Hospitalization for Coronary Heart Disease. A Population-Based Study Using Electronic Records and Group-Based Trajectory Models

2016

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ObjectiveTo identify adherence patterns over time and their predictors for evidence-based medications used after hospitalization for coronary heart disease (CHD).Patients and MethodsWe built a population-based retrospective cohort of all patients discharged after hospitalization for CHD from public hospitals in the Valencia region (Spain) during 2008 (n = 7462). From this initial cohort, we created 4 subcohorts with at least one prescription (filled or not) from each therapeutic group (antiplatelet, beta-blockers, ACEI/ARB, statins) within the first 3 months after discharge. Monthly adherence was defined as having ≥24 days covered out of 30, leading to a repeated binary outcome measure. We assessed the membership to trajectory groups of adherence using group-based trajectory models. We also analyzed predictors of the different adherence patterns using multinomial logistic regression.ResultsWe identified a maximum of 5 different adherence patterns: 1) Nearly-always adherent patients; 2) An early gap in adherence with a later recovery; 3) Brief gaps in medication use or occasional users; 4) A slow decline in adherence; and 5) A fast decline. These patterns represented variable proportions of patients, the descending trajectories being more frequent for the beta-blocker and ACEI/ARB cohorts (16% and 17%, respectively) than the antiplatelet and statin cohorts (10% and 8%, respectively). Predictors of poor or intermediate adherence patterns were having a main diagnosis of unstable angina or other forms of CHD vs. AMI in the index hospitalization, being born outside Spain, requiring copayment or being older.ConclusionDistinct adherence patterns over time and their predictors were identified. This may be a useful approach for targeting improvement interventions in patients with poor adherence patterns.

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Section: Discussioncontrasting

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Medication Adherence Patterns after Hospitalization for Coronary Heart Disease. A Population-Based Study Using Electronic Records and Group-Based Trajectory Models

2016

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“…Our results were consistent with the finding of other registries in Switzerland with a general high rate of prescription of recommended drugs [14]. Compared to registries from other countries, we found a better optimal prescription rate at discharge and at 1 year [20,21]. However, the results of registries are highly dependent on the method used to assess optimal drug prescription.…”

Section: Discussionsupporting

confidence: 90%

Long-Term Quality of Prescription for ST-Segment Elevation Myocardial Infarction (STEMI) Patients: A Real World 1-Year Follow-Up Study

Bruggmann

Iglesias

Gex‐Fabry

et al. 2019

Am J Cardiovasc Drugs

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Aim American and European associations of cardiology published specific guidelines about recommended drugs for secondary prevention in ST-segment elevation myocardial infarction (STEMI) patients. Our aim was to assess whether drug prescription for STEMI patients was in accordance with the guidelines at discharge and after 1 year. Method We used data of 361 patients admitted for STEMI in a tertiary hospital in Switzerland from 2014 to 2016. We assessed the adequacy of prescription of recommended drugs at two time points: discharge and after 1 year. Medications assessed were aspirin, P2Y12 inhibitors, statin, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and β-blockers. We took into account several criteria like statin dosage (low versus high intensity) and presence of contraindication for consideration of optimal therapy. Predictors of incomplete prescription of guideline medications were then assessed with multivariate logistic regression models. Results From discharge (n = 358) to 1-year follow-up (n = 303), rate of optimal prescription was reduced from 98.6 to 91.7% for aspirin, from 93.9 to 79.1% for P2Y12 inhibitors, from 83.8 to 65.7% for statins, from 98.6 to 95.6% for ACEIs/ ARBs, and from 97.1 to 96.9% for β-blockers. Predictors of incomplete prescription of guideline medications at discharge were female sex (odds ratio [OR] 2.54, p = 0.007), active or former smoker status (OR 2.29, p = 0.017), multivessel disease (OR 2.07, p = 0.022), left ventricular ejection fraction < 40% (OR 2.49, p = 0.008), and transfer to cardiac surgery (OR 9.66, p = 0.018). At 1 year, age > 65 (OR 1.92, p = 0.036) remained the only significant predictor. Conclusion The present study showed a high prescription rate of guideline-recommended medications in a referral center for primary percutaneous coronary intervention. At discharge, women and co-morbid patients were at the highest risk of incomplete prescription of guideline medications, whereas long-term prescription was suboptimal for elderly. A drug lacking at time of discharge was rarely introduced within the year, which underscores the paramount importance of optimal prescription at time of discharge. Strategies like implementing a standardized prescription could reduce the proportion of suboptimal prescription. It could therefore be one way to improve the long-term quality of care of our patients to the highest level. This study used local data from AMIS Plus-National Registry of Acute Myocardial Infarction in Switzerland (NCT01305785).

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“…The reasons for patient non‐adherence to medications are complex. Some studies have highlighted the importance of patient‐related factors such as poor motivation, forgetfulness, co‐existing conditions, socio‐economic status, lack of education about the therapies, complicated polypharmacy regimens and depression, whereas others have identified the treating physician as playing a major role in the patient's decision to stop treatment . The purpose of this study was to identify the relative importance of clinical and treatment factors as predictors of patient adherence to secondary prevention medications at 6 months following an ACS, and thereby define the most efficient strategies to optimise adherence in this high‐risk population.…”

Section: Introductionmentioning

confidence: 99%

Improving patient adherence to secondary prevention medications 6 months after an acute coronary syndrome: observational cohort study

Brieger

Chow

Gullick

et al. 2018

Internal Medicine Journal

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Adherence to evidence-based secondary prevention pharmacotherapy in patients after an acute coronary syndrome: A systematic review

Abstract: Adherence to secondary prevention pharmacotherapy was suboptimal in patients after hospital discharge for an ACS. Risk factors associated with non-adherence were examined in a limited number of studies, and the associations varied between these investigations.

Cited by 48 publications

References 50 publications

Medication Adherence Patterns after Hospitalization for Coronary Heart Disease. A Population-Based Study Using Electronic Records and Group-Based Trajectory Models

Medication Adherence Patterns after Hospitalization for Coronary Heart Disease. A Population-Based Study Using Electronic Records and Group-Based Trajectory Models

Long-Term Quality of Prescription for ST-Segment Elevation Myocardial Infarction (STEMI) Patients: A Real World 1-Year Follow-Up Study

Improving patient adherence to secondary prevention medications 6 months after an acute coronary syndrome: observational cohort study

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