Prevalence, Predictors, and Outcomes of Primary Nonadherence After Acute Myocardial Infarction

Abstract

Background-Secondary prevention after acute myocardial infarction (AMI) is achieved primarily through medications. However, patients must take their medications to benefit. Medication adherence research has focused primarily on continuation of medications rather than not filling the first prescription written (primary nonadherence). Our objectives were to characterize, to determine factors of, and to measure outcomes associated with primary nonadherence after AMI. Methods and Results-We conducted a population-based cohort study using an AMI registry linked with administrative data in Ontario, Canada. The primary outcome was 1-year mortality. There were 4591 post-AMI patients Ͼ65 years of age included with 12 832 prescriptions written, of which 73% and 79% were filled within 7 and 120 days, respectively. By 120 days after discharge, more cardiac than noncardiac prescriptions were filled (82% versus 35%, respectively; PϽ0.0001). Only 74% of patients filled all their discharge prescriptions by 120 days after discharge after the exclusion of acetylsalicylic acid, which is also available over the counter in Ontario. Factors associated with filling all compared with filling no discharge prescriptions included younger age, low income, discharge medication counseling, in-hospital attending cardiologist, and fewer medications before AMI. The adjusted 1-year mortality rate was higher in patients who filled some versus all (odds ratio, 1.44; 95% confidence interval, 1.15 to 1.79; Pϭ0.001) and none versus all (odds ratio, 1.80; 95% confidence interval, 1.35 to 2.42; PϽ0.0001) of their discharge medications. Conclusions-Patients fill most of their discharge prescriptions within 1 week after AMI. The 1-year mortality rate was higher for those patients who did not fill all of their discharge medications after AMI. Factors such as discharge medication counseling and postdischarge follow-up may help to increase the filling rate of medications after AMI.

Adherence to Evidence-Based Therapies After Acute Coronary Syndrome: A Retrospective Population-Based Cohort Study Linking Hospital, Outpatient, and Pharmacy Health Information Systems in Valencia, Spain

“…45 In addition to patient-specific factors, several organizational factors have been shown to be associated with medication adherence: drug prescription in the ACS hospital admission 46 or at the time of discharge, 47 coordination of care between general practitioners and cardiologists and early outpatient follow-up visits, 48 and discharge medication counseling. 26 We have found no studies on geographical variation in adherence to CHD secondary prevention. In our study, health care delivery areas show a notable variability in adherence that remains after adjustment by a propensity score constructed with several covariables.…”

The readiness for hospital discharge of patients after acute myocardial infarction: a new self-reported questionnaire

“…Effective education should have a favourable influence on patients' behaviour concerning risk factor reduction and medication [17]. Schmocker et al [18] evaluated the association of readiness for discharge with patient satisfaction and readmission.…”

The Adherence to Recommended Therapy in Patients After Acute Coronary Syndrome, and Risk of Cardiovascular Complications Within a Year After Hospital Admission

“…Результаты нашего исследования в значительной сте-пени совпадают с известными данными, что после пе-ренесенного ИМ четверть пациентов перестают при-нимать предписанные препараты уже через 7 дн после выписки из стационара [20], а среди больных с ИМ, ко-торым при выписке были назначены АСК, статины и БАБ, 34% больных прекращают прием одного, а 12% -всех трех препаратов в течение 1 мес после госпи-тализации [21].…”