Association of multiple preventive therapies postdischarge and long-term health outcomes after acute myocardial infarction

Abstract

Background: Statins, beta-blockers, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers have been advocated by guidelines as secondary prevention medications to improve the long-term outcomes of post-acute myocardial infarction (AMI) patients. However, adequate drug adherence has always been challenging, and different treatment regimens may lead to divergent outcomes that remain unclear under current myocardial infarction (MI) care standards. This study investigated the association between use of different preventive regimens post-AMI and patients’ long-term outcomes. Methods: This cohort study used data files from the Taiwan National Health Insurance Research Database. A total of 77 520 people who were hospitalized with AMI between 2002 and 2015 were assessed. On the basis of medication possession ratio (MPR) to individual medications, eight treatment groups were examined in this study. Receiving therapy was defined as MPR ≥40%. We investigated the association between different treatment groups and all-cause mortality in 24 months. Results: Overall, 51 322 patients with ST-elevation MI and 26 198 with non-ST-elevation MI were included in the study. Patients received all three preventive medications show the lowest mortality in 24 months follow-up periods among all treatment groups. Patients who did not usage of any of these three preventive medications had the highest mortality in 24 months (adjusted hazard ratio, 1.78; 95% CI, 1.64-1.93). This mortality rate had the same pattern across the three cohort generations (2002-2005, 2006-2010, and 2011-2015). Conclusion: In this large population-based real-world study, usage of three preventive therapies post-MI was associated with the lowest rate of all-cause mortality.

Variation in revascularisation use and outcomes of patients in hospital with acute myocardial infarction across six high income countries: cross sectional cohort study

“…While differential rates of smoking are an attractive explanation for increased mortality in the US and Taiwan, data from the Global Burden of Disease Study group and OECD suggest relatively modest smoking rates in the US compared with the other IHSRC countries, though smoking rates in Taiwan are fairly high, particularly among men 4647. While large international comparative studies of secondary prevention strategies are limited, data are not clear and convincing that use of statins, angiotensin converting enzyme inhibitors, and β blockers are markedly lower in the US and Taiwan48495051 than countries with lower mortality 852. While it is possible that poorer outcomes in the US and Taiwan can be attributable to social determinants of health, such a supposition requires rigorous evaluation.…”

Assessing Concurrent Adherence to Combined Essential Medication and Clinical Outcomes in Patients With Acute Coronary Syndrome. A Population-Based, Real-World Study Using Group-Based Trajectory Models

“…The former factor is very important, as assessing drugs prescribed in combination, separately, could lead to overestimation of adherence. The two studies assessing 3 medications altogether: ACEI/ARB, beta-blockers, and statins (although using the traditional PDC or MPR) ( 15 , 16 ), found that 49% and 34% of patients, respectively, adhere to all three therapies ( 15 , 16 ). However, those figures are not directly comparable to our findings, as it does not provide information on adherence behaviors over time.…”

“…On the other hand, our results show that increasing adherence to preventive therapies is associated with a significantly decreased risk of mortality in post-AMI patients similar to the previous study ( 10 ). It is important to note that outcomes were assessed during the second year after the index date, which is a common approach ( 15 , 16 ). Therefore, we did not provide information regarding the impact of adherence to recommended therapies in the longer term, which should be further studied.…”

“…Furthermore, improving medication adherence is a challenge that requires methods that can reliably identify and predict when non-adherence could occur in order to customize interventions. To our knowledge, only two studies have concurrently assessed adherence to multiple therapies (statins, beta-blockers, and ACE/ARB) and tried to elucidate its relationship with clinical outcomes (all-cause mortality) ( 15 , 16 ). The population groups of these studies were also conducted in patients with ACS and both used conventional measures of adherence.…”

“…The population groups of these studies were also conducted in patients with ACS and both used conventional measures of adherence. One study was set in the US and used the proportion of days covered (PDC) ( 15 ), while the other was a population-based, nationwide study set in Taiwan and used medication possession ratio (MPR) ( 16 ) to assess adherence.…”