Medication adherence after myocardial infarction: A single center retrospective cohort study

Abstract

Aim: The study is designed to compare the discharge prescriptions of ST-elevated (STEMI) and non ST-elevated (NSTEMI) myocardial infarction patients and the medications used end of first year and also to investigate the relationship between MI type, gender, age groups and drug adherence. Material and Methods: In retrospect, data from 413 patients were collected via epicrisis and phone visits. Discharge and the outpatient medications end of one year were compared. Results: Of the 413 patients included in the study, 312 (%75) were male. MI type distribution was NSTEMI with a ratio of 38.5% (n = 159) and STEMI with a ratio of 61.5% (n = 254). Only 2 (0.5%) patients did not receive acetylsalicylic acid (ASA) at discharge. The rate of beta-blocker, statin, clopidogrel users were %94.4, %97.1 and %97.8, respectively. The rate of patients who used five drugs (ASA, beta blocker, ACEI/ARB, statin, clopidogrel) at discharge was 78.7% (n = 325). At the end of first year, the rate of ASA, statin, beta blocker, angiotensin converting enzyme inhibitors/aldosterone receptor blocker(ACEI/ARB) and clopidogrel users dropped down to 88.1% (n = 364), 66% (n = 273), 80.9% (n = 334), 69.7% (n = 288) and 81.3% (n = 336), respectively(p<0.05 for all parameters). After one year, the number of patients using five drugs dropped to %45(p<0.05). Beta-blocker target dose was achieved in 68(16.5%) patients and ACEI / ARB target dose was achieved in 74(17.9%) patients. Patients with renal failure were not able to reach the target doses of ACEI/ARB at the end of first year (p: 0,033). And also renal failure is considered as an impediment to proper drug use at discharge and end of the first year (p <0.01 and p<0.01 respectively). Conclusion: It was determined that treatment compliance was impaired at the end of one year in a significant proportion of patients with acute coronary syndrome. One year later, compliance with treatment was higher in females than in males and was inversely related to age and renal failure. It is observed that follow-up training programs are needed to succeed in drug adherence.