Long-Term Adherence to Evidence-Based Secondary Prevention Therapies in Coronary Artery Disease

Abstract

Background-Studies have examined the use of evidence-based therapies for coronary artery disease (CAD) in the short term and at hospital discharge, but few have evaluated long-term use. Methods and Results-Using the Duke Databank for Cardiovascular Disease for the years 1995 to 2002, we determined the annual prevalence and consistency of self-reported use of aspirin, ␤-blockers, lipid-lowering agents, and their combinations in all CAD patients and of angiotensin-converting enzyme inhibitors (ACEIs) in those with and without heart failure. Logistic-regression models identified characteristics associated with consistent use (reported on Ն2 consecutive follow-up surveys and then through death, withdrawal, or study end), and Cox proportional-hazards models explored the association of consistent use with mortality. Use of all agents and combinations thereof increased yearly.

Medication Non-Adherence After Myocardial Infarction: An Exploration of Modifying Factors

“…5,[9][10][11][12] Noting the differences between this analysis and prior studies may help to contextualize these divergent findings. First, our population is distinct from the European or multinational populations examined in some studies.…”

“…Further, our strategy for assessing adherence differed from prior analyses that used pharmacy refill data 10,11 or simply reported current medication use . 5,12 While these measures likely accurately reflect medication prescribing, we used a validated measure that explores patient attitudes toward medicationtaking, 21,22 which in this case may better capture true medication adherence. Though some have questioned the correlation between self-reported and objective medication adherence, 23,24 self-reporting remains among the most common strategies for assessing medication adherence because it is simple and reliable.…”

“…Further, our adherence measure assessed general medication-taking behavior and did not distinguish between specific medication classes for which adherence may differ. 5 …”

“…In one report, over 50 % of patients with cardiovascular disease were not consistently taking recommended medications. 5 Medication non-adherence in this patient population is associated with poorer risk factor control, a higher incidence of mortality and recurrent cardiac events, and higher costs. 4,6,7 Improving medication adherence among patients with cardiovascular disease could improve risk factor control and reduce complications and costs.…”

“…Known correlates of suboptimal medication adherence among patients with cardiovascular disease include demographic factors, 5,9-12 certain socioeconomic factors (e.g., under-insurance, education level), 9,10 and medical comorbidities. 5,9 Most available evidence regarding factors associated with medication non-adherence among cardiovascular disease patients derives from registries, clinical data repositories, and administrative datasets. While these large data sources ensure ample power, they reveal little about certain types of modifying factors, including specific behaviors, knowledge deficits, attitudes, and beliefs, that may influence medication adherence.…”