Therapy Discontinuation after Myocardial Infarction

Abstract

The discontinuation of recommended therapy after myocardial infarction predisposes patients to serious thrombotic complications. The aim of this study was a comprehensive analysis of permanent as well as short- and long-term discontinuation of pharmacotherapy, taking into consideration the basic groups of medications and nonadherence determinants in a one-year follow-up in post-myocardial infarction (MI) patients. Material and methods: The study was a single center cohort clinical trial with a one-year follow-up including 225 patients (73.3% men, 26.7% women) aged 62.9 ± 11.9 years. In eight cases (3.6%), the follow-up duration was less than one year due to premature death. The following factors were analyzed: lack of post-discharge therapy initiation; short-term therapy discontinuation (<30 days); long-term therapy discontinuation (≥30 days); and permanent cessation of therapy. The analysis of therapy discontinuation was performed based on prescription filling data. Results: Occupational activity (Odds Ratio (OR) 5.15; 95% Confidence interval (CI) 1.42–18.65; p = 0.013) and prior MI (OR 5.02; 95% CI 1.45–16.89; p = 0.009) were found to be independent predictors of a lack of post-discharge therapy initiation with P2Y12 receptor inhibitors. We found no independent predictors of lack of post-discharge therapy initiation with other medications, whether analyzed separately or together. Age above 65 years (Hazard Ratio (HR)—1.59; 95% CI 1.15–2.19; p = 0.0049) and prior revascularization (HR—1.44; 95% CI 1.04–2.19; p = 0.0273) were identified as independent predictors of therapy discontinuation. Multilogistic regression analysis showed no independent predictors of the cessation of any of the medications as well as the permanent or temporary simultaneous discontinuation of all medications. Conclusions: The vast majority of post-MI patients discontinue, either temporarily or permanently, one of the essential medications within one year following myocardial infarction. The most likely medication class to be discontinued are statins. Older age and prior cardiac revascularization are independent determinants of therapy discontinuation.

The therapeutic plan implementation in patients discharged from the hospital after myocardial infarction

“…Over time, a gradual decline in adherence was observed for all groups of medications. Sufficient adherence for all medication groups was found only in 29.4% of patients throughout the whole follow-up period [15][16][17][18]. These findings are in line with those obtained by Naderi et al [2] in a meta-analysis of 20 studies evaluating 7 groups of drugs showing a mean adherence level of 57.0% and its decline over consecutive quarters of follow-up.…”

“…The series of recent publications reporting results of a single centre, observational, cohort clinical trial with 1-year follow-up, was intended to reflect 'real world' practice [15][16][17][18]. All study participants received in-hospital educational and motivational verbal interventions on ischemic heart disease, focusing on its symptoms and management supported by an educational brochure entitled "Myocardial infarction" that was handed out at the beginning of hospitalization.…”

“…According to the authors' best knowledge, this research [15][16][17][18] is the first one to comprehensively analyse the level of adherence to medication and its determinants as well as the variability of these determinants during the follow-up after hospital discharge.…”

“…The multivariate analysis defined determinants of medication adherence: age under 65 years in the first quarter of follow-up for ACEI, P2Y12 receptor inhibitor and statin; prior CABG in the 1st quarter of follow up for ACEI and P2Y12 receptor inhibitor; level of education and place of residence for P2Y12 receptor inhibitor in the 1st quarter of follow-up; economic status for all assessed drugs in the 2nd quarter; marital status for ACEI in the 1st quarter of follow-up; arterial hypertension for ACEI in the 1st quarter of follow-up [15][16][17][18]. Identifying the factors responsible for the decline in adherence in the sequential quarters helps better understand the mechanisms governing this phenomenon and apply targeted corrective interventions.…”

“…Additional educational and motivational efforts should be directed to elderly, less educated, living alone patients and those after CABG in order to increase the likelihood of implementation of prescribed medication after discharge from the hospital. Maintenance of medication during long term treatment requires special support in rural residents and patients with lower economic status [15][16][17][18].…”