Medication adherence and its determinants in patients after myocardial infarction

Abstract

Non-adherence to prescribed medication is a serious limitation of long-term treatment in patients after myocardial infarction (MI), which can be associated with medical, social and economical consequences. Improvement of medication adherence has been shown to be a challenge for healthcare providers. The aim of this study was to evaluate changes in medication adherence and variability of adherence determinants during follow-up in patients after MI. A single-center, cohort observational study was conducted in 225 post-MI patients treated with primary coronary intervention (PCI) (27% women and 73% men) aged 30-91 years. Adherence was defined as availability of evaluated drugs within 1-year after discharge from hospital, based on completed prescriptions data obtained from the National Health Fund. The analysis of therapeutic plan realization (adherence to medication prescribed at discharge from hospital) embraced only reimbursed drugs: ACEIs (ramipril, perindopril), P2Y12 receptor inhibitors (clopidogrel) and statins (atorvastatin, simvastatin, rosuvastatin). Sufficient adherence was defined as ≥ 80%. During 1-year follow-up, adherence for all three drug classes was 64 ± 25%, with 67 ± 32% for ACEIs, 62 ± 34% for P2Y12 receptor inhibitor and 64 ± 32% for statins. A gradual decline in adherence was observed from 65% ± 26% in the first quarter of follow-up to 51% ± 34% in the last quarter of follow-up (p < 0.00001). Sufficient adherence for all drugs classes was found only in 29% of patients throughout the whole follow-up period (44% for ACEI, 36% for P2Y12 receptor inhibitor and 41% for statins). According to a multivariate analysis, age, prior CABG, level of education, place of residence, economic status and marital status were independent predictors of drug adherence. Whereas patients > 65 years and having a history of prior CABG more often had an insufficient adherence to drugs, married and hypertensive patients, city inhabitants and patients with higher education tended to have a sufficient drug adherence. Adherence to pharmacotherapy after myocardial infarction decreases over time in a similar manner for all pivotal groups of drugs prescribed after MI. A number of socioeconomic and clinical factors have been identified to affect medication adherence over time. The long-term treatment of patients after myocardial infarction (MI) is based on implementation of a therapeutic plan including lifestyle changes and pharmacotherapy 1-3. According to the of European Society of Cardiology guidelines for the management of patients with acute myocardial infarction, therapy in this subset of patients includes dual antiplatelet treatment (DAPT) for 12 months, angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) if ACEI are contraindicated, beta-blockers, and statins 4. However, data available on patient adherence to the therapeutic plan (medication prescribed at discharge from hospital) raise concern. A meta-analysis by Naderi et al. 5 including 20 studies and assessing the extent of adherence ...

Impact of readiness for discharge from the hospital on the implementation of the therapeutic plan

“…In line with our observations, other reports also indicate the third and fourth quarters of treatment after myocardial infarction as the moment of adherence deterioration [6,18,37,[46][47][48][49][50]. The previously published studies identifying non-adherence determinants, did not include into account the readiness for discharge from the hospital [6,18,37,[46][47][48][49][50][51][52][53][54]. Further research is needed to explain the reasons for lower adherence in patients with higher RHD MIS scores, even if it only concerns some aspects of the assessment.…”

“…The presented data were collected as a part of the research project "Impact of educational intervention on adherence to therapeutic recommendations". Some results of this project have already been published [11][12][13][14].…”

Therapy Discontinuation after Myocardial Infarction

“…Its elimination might largely improve the clinical and economical outcomes of treatment [ 8 , 16 ]. Recognizing the importance of this problem, our team have conducted a wide spectrum research in this field [ 6 , 17 , 18 , 19 , 20 , 21 ].…”

Prolonged antithrombotic therapy in patients after acute coronary syndrome: A critical appraisal of current European Society of Cardiology guidelines

“…Regardless of the treatment strategy chosen, the basis of effectiveness is patient adherence to medication. Therefore, health education aimed at explaining the purpose of therapy should be applied [49][50][51][52][53][54].…”