Does age modify the relationship between adherence to secondary prevention medications and mortality after acute myocardial infarction? A nested case-control study

Lenzi, Jacopo; Rucci, Paola; Castaldini, Ilaria; Protonotari, Adalgisa; Pasquale, Giuseppe Di; Martino, Mirko Di; Perrone, Enrica; Forti, Paola; Fantini, Maria Pia

doi:10.1007/s00228-014-1793-8

Cited by 25 publications

(31 citation statements)

References 32 publications

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“…Thus, our findings suggest that long-term adherence to ACEI/ARBs and statins may be more important than adherence to beta-blockers after AMI. Prior, smaller studies from the United States (1,21) and other countries (3,9,22) also showed larger reductions in all-cause mortality for adherence to statins and ACEI/ARBs than adherence to beta-blockers. Accordingly, in a large observational study (>44,000 patients), beta-blockers were not associated with mortality benefit in patients with prior MI or those without a history of AMI (23).…”

Section: Discussionmentioning

confidence: 99%

“…Many seem to do so already during the first 6 months (6). Studies from other countries also suggest sub-optimal adherence to preventive therapies for the secondary prevention of cardiovascular disease (CVD) (7–9). …”

Section: Introductionmentioning

confidence: 99%

“…Patients may have trade-offs in adherence; in other words, they may choose to adhere to some post-AMI preventive therapies but not to others. Studies have shown notable variation in adherence across post-AMI preventive therapies (1,5,9,14,15). Clinicians who manage patients with complex treatment regimens are required to balance benefits and risks of preventive therapies, because evidence from randomized clinical trials mostly relates to the efficacy of a single preventive therapy on survival following AMI rather than combinations of therapies (16,17).…”

Section: Introductionmentioning

confidence: 99%

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Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction

Korhonen

Robinson

Annis

et al. 2017

Journal of the American College of Cardiology

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BACKGROUND Angiotensin converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB), beta-blockers and statins are recommended after acute myocardial infarction (AMI). Patients may adhere to some but not all therapies. OBJECTIVE We investigated the effect of trade-offs in adherence to ACEI/ARBs, beta-blockers, and statins on survival among older people after AMI. METHODS We identified 90,869 Medicare beneficiaries aged ≥65 who had prescription of ACEI/ARBs, beta-blockers and statins and survived ≥180 days after AMI hospitalization in 2008−2010. Adherence was measured by proportion of days covered (PDC) during 180 days following hospital discharge. Mortality follow-up extended up to 18 months after this period. We used Cox proportional hazards models to estimate hazard ratios of mortality for groups adherent to 2, 1 or none of the therapies versus group adherent to all 3 therapies. RESULTS Only 49% of the patients adhered (PDC ≥80%) to all 3 therapies. Compared to being adherent to all 3 therapies, multivariable-adjusted hazard ratios (95% confidence intervals [95%CI]) for mortality were 1.12 (1.04 to 1.21) for being adherent to ACEI/ARBs and beta-blockers only, 0.98 (0.91 to 1.07) for ACEI/ARBs and statins only, 1.17 (1.10 to 1.25) beta-blockers and statins only, 1.19 (1.07 to 1.32) for ACEI/ARBs only, 1.32 (1.21 to 1.44) for beta-blockers only, 1.26 (1.15 to 1.38) statins only, and 1.65 (1.54 to 1.76) for being nonadherent (PDC <80%) to all 3 therapies. CONCLUSIONS Patients adherent to ACEI/ARBs and statins only had similar mortality as those adherent to all 3 therapies, suggesting limited additional benefit for beta-blockers in patients who were adherent to statins and ACE/ARBs. Nonadherence to ACEI/ARBs and/or statins was associated with higher mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction

Korhonen

Robinson

Annis

et al. 2017

Journal of the American College of Cardiology

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“…28 Good adherence to polytherapy is associated with lower mortality. 29 The risk reduction associated with antiplatelet therapy was reported to decline, however, at the age of 70-75 years. 20 The polypharmacy persistence is also lower in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical factors associated with initiation of and persistence with ADP receptor-inhibiting oral antiplatelet treatment after acute coronary syndrome: a nationwide cohort study from Finland

Prami¹,

Khanfir²,

Deleskog

et al. 2016

BMJ Open

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ObjectivesTo study patient selection for and persistence with ADP receptor-inhibiting oral antiplatelet (OAP) treatment after acute coronary syndrome (ACS).DesignObservational, retrospective, cohort study linking real-life patient-level register data.SettingNationwide drug usage study using data of patients with ACS discharged from hospitals in Finland.ParticipantsThe study population consisted of 54 416 patients (aged ≥18 years) following hospital admission for unstable angina pectoris or myocardial infarction during 2009–2013. Patients were classified as either OAP or non-OAP users based on drug purchases within 7 days of discharge.Outcome measuresInitiation of and a 12-month persistence with OAP medication.ResultsIn total, 49% of patients with ACS received OAP treatment after hospital discharge. Women represented 40% of the population, but only 32% of them became OAP users (adjusted OR for initiation compared with men 0.8; p<0.001). Patients not treated with percutaneous coronary intervention (PCI), elderly and patients with dementia/Alzheimer's disease, atrial fibrillation or warfarin treatment were less likely to be treated with OAP. If initiated, they were less likely to complete the recommended 12 months’ medication (adjusted risk increment >38% and p<0.001 for all). The OAP users showed good compliance with immediate initiation (92% within 1 day of discharge) and high mean medication possession rate (99%). Among OAP users, the usage of other secondary prevention drugs after ACS was more common than in non-OAP-treated patients (difference >20 percentage points for each).ConclusionsOnly half of the patients with ACS received guideline-recommended ADP receptor-inhibiting OAP treatment after hospital discharge, suggesting suboptimal treatment practices. Non-PCI-treated patients and patients with increased age, unstable angina, dementia or atrial fibrillation appear to have the highest risk of deficient treatment with OAPs. OAP users, however, showed good compliance during drug usage.

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“…The included studies focussed on a wide range of disease areas including pulmonary diseases, osteoporosis, depression, cardiovascular diseases, Parkinson's disease, epilepsy, chronic kidney disease, cancer and diabetes mellitus . Two studies did not measure disease‐specific medication (non‐)adherence .…”

Section: Resultsmentioning

confidence: 99%

The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis

Walsh

Cahir

Tecklenborg

et al. 2019

Brit J Clinical Pharma

152

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Aims The aim of this systematic review and meta‐analysis was to synthesise the evidence relating to medication non‐adherence and its association with health outcomes in people aged ≥50 years. Methods Seven databases were searched up to February 2019 for observational studies that measured medication (non‐)adherence as a predictor of the following health outcomes in adults aged ≥50 years: healthcare utilisation (hospitalisation, emergency department visits, outpatient visits and general practitioner visits), mortality, adverse clinical events and quality of life. Screening and quality assessment using validated criteria were completed by 2 reviewers independently. Random effects models were used to generate pooled estimates of association using adjusted study results. The full methodological approach was published on PROSPERO (ID: CRD42017077264). Results Sixty‐six studies were identified for qualitative synthesis, with 11 of these studies eligible for meta‐analyses. A meta‐analysis including 3 studies measuring medication non‐adherence in adults aged ≥55 years showed a significant association with all‐cause hospitalisation (adjusted odds ratio 1.17, 95% confidence interval [CI] 1.12, 1.21). A meta‐analysis including 2 studies showed that medication non‐adherence was not significantly associated with an emergency department visit (adjusted odds ratio 1.05, 95% CI 0.90, 1.22). Good adherence was associated with a 21% reduction in long‐term mortality risk in comparison to medication non‐adherence (adjusted hazard ratio 0.79, 95% CI 0.63, 0.98). Conclusion Medication non‐adherence may be significantly associated with all‐cause hospitalisation and mortality in older people. Medication adherence should be monitored and addressed in this cohort to minimise hospitalisation, improve clinical outcomes and reduce healthcare costs.

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Does age modify the relationship between adherence to secondary prevention medications and mortality after acute myocardial infarction? A nested case-control study

Abstract: The beneficial effect of evidence-based polytherapy on mortality following AMI is observed also in older populations. Nevertheless, the risk-benefit ratio associated with antiplatelet therapy is less favorable with increasing age.

Cited by 25 publications

References 32 publications

Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction

Adherence Tradeoff to Multiple Preventive Therapies and All-Cause Mortality After Acute Myocardial Infarction

Clinical factors associated with initiation of and persistence with ADP receptor-inhibiting oral antiplatelet treatment after acute coronary syndrome: a nationwide cohort study from Finland

The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis

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