Evidence-based pharmacotherapy after myocardial infarction in France: Adherence-associated factors and relationship with 30-month mortality and rehospitalization

Tuppin, Philippe; Neumann, Anke; Danchin, Nicolás; Peretti, Christine de; Weill, Alain; Ricordeau, P.; Allemand, H.

doi:10.1016/j.acvd.2010.05.003

Cited by 117 publications

(100 citation statements)

References 30 publications

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“…The population of MI patients in our study were, on average, younger than that in the Italian study. Younger patients tend to be more adherent to treatment than older patients 28, as also shown in the present study. However, even the older patients in the present study showed a high adherence to antiplatelet drugs.…”

Section: Discussionsupporting

confidence: 89%

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Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Yasmina

Boer

Deneer

et al. 2016

Brit J Clinical Pharma

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AimsThe aims of the present study were to assess antiplatelet drug use patterns after a first myocardial infarction (MI) and to evaluate the determinants of antiplatelet nonpersistence.MethodsThe present study was conducted in 4690 patients from the Utrecht Cardiovascular Pharmacogenetics cohort with a first MI between 1986 and 2010, who were followed for a maximum of 10 years. Medication use and event diagnosis were obtained from the Dutch PHARMO Record Linkage System. Antiplatelet drug users were classified as persistent users (gap between prescriptions ≤90 days), nonpersistent users (>90‐day gap and no refills), and restarters (a new prescription after a >90‐day gap). The association between potential determinants and antiplatelet nonpersistence was analysed using Cox regression.ResultsThe proportions of persistent users decreased from 84.0% at the 1‐year follow‐up to 32.8% at 10 years for any antiplatelet drug, and 77.3% to 27.5% for aspirin; and 39.0% to 6.4% for clopidogrel at 6 years. Most nonpersistent users restarted antiplatelet drugs later, leading to 89.3% overall antiplatelet drug users at 10 years after MI. Diabetes (hazard ratio [HR] 0.44; 0.32–0.60), hypertension (HR 0.77; 0.60–0.99), hypercholesterolaemia (HR 0.49; 0.39–0.62) and more recent MI diagnosis period (2003–2007: HR 0.69, 0.61–0.79; 2008–2010: HR 0.38, 0.19–0.77, compared to ≤ 2002 period) lowered the risk of antiplatelet nonpersistence, while vitamin K antagonist (VKA) comedication (HR 18.97; 16.91–21.28) increased this risk.ConclusionsA large proportion of patients with a first MI still used antiplatelet drugs after 10 years. The frequent discontinuations during this time frame are expected to reduce the effectiveness of antiplatelet drugs as secondary prevention of cardiovascular diseases. Diabetes, hypertension, hypercholesterolaemia, VKA comedication and MI diagnosis period were determinants of antiplatelet nonpersistence.

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Section: Discussionsupporting

confidence: 89%

“…A study by Tuppin et al 28, in France, showed an approximately similar proportion (81.7%) of adherent users of antiplatelet drugs (aspirin and clopidogrel) to that in our study (78.9%). Another study, in Italy, showed a lower proportion of adherent antiplatelet drug users (58.7%) 29.…”

Section: Discussionsupporting

confidence: 87%

Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Yasmina

Boer

Deneer

et al. 2016

Brit J Clinical Pharma

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“…A publikált adherenciaértékek különösen a sztatinok esetén igen hasonlóak és megegyeznek az általunk talált értékkel, annak ellenére, hogy az adherencia definíciója és a vizsgálati módszer számos vizsgálatban különbözött [8,[17][18][19]. [19,[21][22][23]. Anyagunkban a legmagasabb terápiahűséget a 60-70 év közötti betegeknél tapasztaltuk, a fiatalabb, illetve a 70 évnél idősebb betegek adherenciája alacsonyabb volt.…”

Section: Megbeszélésunclassified

“…Anyagunkban a legmagasabb terápiahűséget a 60-70 év közötti betegeknél tapasztaltuk, a fiatalabb, illetve a 70 évnél idősebb betegek adherenciája alacsonyabb volt. Megfigyelésünk igen hasonló Tuppin és mtsai [22] közléséhez, akik a 74 év feletti betegek esetén észlelték az adherencia csökkenését. Többváltozós analízis felhasználásával vizsgáltuk az adherencia jelentőségét az újabb infarktus, a halál bekövet-kezése szempontjából.…”

Section: Megbeszélésunclassified

Szívinfarktust túlélt betegek terápiahűsége a másodlagos megelőzés szempontjából fontos gyógyszeres kezelésekhez

et al. 2017

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Bevezetés és célkitűzés:A szerzők szívinfarktust túlélt betegek terápiahűségét (adherencia) vizsgálták a másodlagos prevenció szempontjából szóba jövő gyógyszerek esetén. Módszer: A Nemzeti Szívinfarktus Regiszterben 2013. január 1. és 2014. december 31. között regisztrált szívinfark-tusos betegek közül azok kerültek a vizsgált betegcsoportba, akik a heveny myocardialis infarctust túlélték és a kór-házi kezelést követően 180 napig nem volt újabb eseményük. Ezen kritériumoknak 14 843 beteg felelt meg, akiket egy évig követtek. Vizsgálták a sztatin, a béta-blokkoló, a thrombocytaaggregáció-gátló, valamint az angiotenzinkonvertáló enzim/angiotenzinreceptor-blokkoló kezeléshez való adherenciát. A "gyógyszerszedést" az Egészségbiztosí-tó Pénztár gyógyszer-finanszírozási adatbázisa alapján követték. Az adherenciát az indexeseménytől a végpontig (vagy a cenzorálásig) eltelt idő és a kiváltott készítményekkel való ellátottsági idő hányadosaként határozták meg. Végpontnak a halált vagy az újabb infarktus előfordulását tekintették. Többváltozós modellel elemezték az adherenciát és a túlélést. Eredmények: Jó adherenciát (>80%) találtak a klopidogrel, sztatin, béta-blokkoló, aszpirin és ACEI/ARB esetén a betegek 64,9%, 54,4%, 36,5%, 31,7% és 64,0%-ánál. Azoknál a betegeknél, akiknél az infarktus kezelésekor percutan intervenció történt, magasabb terápiahűséget találtak (p<0,01) minden gyógyszer esetén, kivéve a béta-blokkolókat (p = 0,484). A többváltozós elemzés során igazolták, hogy a sztatin, klopidogrel, ACEI/ARB adherencia 25 száza-lékpontos növekedése a végpontok bekövetkezésének 10,1%-kal (p<0,0001), 10,4%-kal (p = 0,0002), 15,8%-kal (p<0,0001) kisebb kockázatával járt együtt. Az aszpirin-és a béta-blokkoló kezelés esetén az adherencia nem függött össze a végpontok bekövetkezésének kockázatával. Következtetés: A sztatin, klopidogrel, ACEI/ARB kezelés esetén a magasabb adherencia jobb hosszú távú prognózis-sal járt együtt. Orv Hetil. 2017; 158(27) Adherence to medication after myocardial infarction and its impact on outcome: a registry-based analysis from the Hungarian Myocardial Infarction RegistryIntroduction and aim: The aim was to study the patients' adherence to some evidence-based medication (statins, beta blockers, platelet and RAS inhibitors) after suffering a myocardial infarction, and its impact on the outcome. Method: Retrospective observational cohort study was carried out from the data of the Hungarian Myocardial Infarction Registry between January 1, 2013, and December 31, 2014. 14,843 patients were alive at the end of hospital treatment, from them, those who had no myocardial infarction or death until 180 days were followed for one year. The adherence was defined as the proportion of time from the index event to the endpoint (or censoring) covered with prescription fillings. The endpoint was defined as death or reinfarction. Information on filling prescriptions for statins, platelet aggregation inhibitors, beta blockers and ARB/ACEI-inhibitors were obtained. Multivariate regression was used to model ad...

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“…Adherence was defined as the proportion of drug availability (the number of purchased clopidogrel tablets) to drug requirement (the number of clopidogrel tablets needed to complete the treatment = number of follow-up days). Following previously published studies [15][16][17][18], adherence was arbitrarily judged adequate when the proportion exceeded 80%.…”

Section: Study Design and Patient Characteristicsmentioning

confidence: 99%

Prediction of high risk of non-adherence to antiplatelet treatment

et al. 2016

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A b s t r a c tBackground: Dual antiplatelet therapy with acetylsalicylic acid (ASA) and clopidogrel is the standard of care for secondary prevention. Premature discontinuation of clopidogrel is associated with an increased risk of myocardial infarction (MI) or death, and greater health care expenditure. Aim:To develop an objective method for identification of patients with high risk of non-adherence to clopidogrel after MI. Methods:A total of 189 patients were enrolled into a prospective, observational, single-centre study with a nine-month follow-up. Patients received a 600-mg loading dose and 75-mg maintenance dose of clopidogrel in combination with ASA doses of 300 mg and 75 mg, respectively. Adenosine diposphate-induced platelet aggregation (ADP-PA) was assessed during baseline hospitalisation and at three, six, and nine months after discharge. Adherence to medication with clopidogrel was defined as the proportion of drug availability based on data from the National Health Fund regarding prescribed drug purchases. Adherence was arbitrarily judged adequate when the proportion exceeded 80%.Results: According to our hypothesis, ADP-PA in non-adherent patients should be higher at follow-up visits (at least once) as compared with measurement at hospitalisation. Based on the ROC curve analysis, the optimal cut-off point equal to 4 U was defined (p < 0.0001, 95% CI 0.562-0.654; sensitivity: 60.6%, specificity: 57.1%, positive predictive value: 63.3%, negative predictive value: 54.2%). The prevalence of true adherence to medication in groups of high and low probability of adherence defined according to developed criteria amounted 60 (50.8%) and 23 (32.4%) cases, respectively (p = 0.01). Conclusions:The newly developed method of objective identification of patients with high risk of non-adherence to clopidogrel after MI is easily applicable and cheap, and, despite relatively low sensitivity and specificity, it efficiently differentiates patients with regard to clinical end-points during follow-up.

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Evidence-based pharmacotherapy after myocardial infarction in France: Adherence-associated factors and relationship with 30-month mortality and rehospitalization

Abstract: After MI, nonadherence to EBT is associated with a marked increase in all-cause mortality and readmission for acute coronary syndrome. Cost-effective strategies for adherence improvement should be developed among patient groups with poor adherence.

Cited by 117 publications

References 30 publications

Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Patterns of antiplatelet drug use after a first myocardial infarction during a 10‐year period

Szívinfarktust túlélt betegek terápiahűsége a másodlagos megelőzés szempontjából fontos gyógyszeres kezelésekhez

Prediction of high risk of non-adherence to antiplatelet treatment

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