Untangling the relationship between medication adherence and post–myocardial infarction outcomes

Choudhry, Niteesh K.; Glynn, Robert J.; Avorn, Jerry; Lee, Joy; Brennan, Troyen A.; Reisman, Lonny; Toscano, Michele; Levin, Raisa; Matlin, Olga S.; Antman, Elliott M.; Shrank, William H.

doi:10.1016/j.ahj.2013.09.014

Cited by 161 publications

(132 citation statements)

References 21 publications

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“…Adherence to a medication regimen in postmyocardial infarction patients is one of the most significant challenges of secondary prevention in cardiovascular medicine [1,2]. Due to the high prevalence of comorbidities, and the multifactorial nature of cardiovascular diseases, the majority of patients often require combination therapy [3].…”

Section: Introductionmentioning

confidence: 99%

Medication adherence in patients after percutaneous coronary intervention due to acute myocardial infarction: From research to clinical implications

Świeczkowski

Mogielnicki²,

Cwalina

et al. 2013

Cardiol J

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Section: Introductionmentioning

confidence: 99%

Medication adherence in patients after percutaneous coronary intervention due to acute myocardial infarction: From research to clinical implications

Świeczkowski

Mogielnicki²,

Cwalina

et al. 2013

Cardiol J

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“…Fewer than half of patients continue to take medications for common chronic conditions, even within 1 year after initiating treatment 23 Since poor adherence is associated with potentially avoidable morbidity, mortality and healthcare costs, early identification and intervention in patients who are at risk of non-adherence is essential 4–6. Even though a number of patient demographic, clinical and economic characteristics have been thought to affect adherence, many patients still stop taking their medications without a reason that is easily identifiable to physicians and other healthcare professionals 2…”

Section: Introductionmentioning

confidence: 99%

Potentially disruptive life events: what are the immediate impacts on chronic disease management? A case-crossover analysis

et al. 2016

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ObjectiveTo explore the association between unexpected potentially disruptive life events in a patient or family member that may challenge an individual's ability to take medications as prescribed and the discontinuation of evidence-based medications for common, chronic conditions. Understanding the relationship between medication adherence and life stressors, especially those that can be identified using administrative data, may help identify patients at risk of non-adherence.DesignObservational self-controlled case-crossover design.SettingIndividuals in a nationally representative US commercial health insurance database.ParticipantsAdult individuals who initiated an oral hypoglycaemic, antihypertensive and/or statin and subsequently stopped the medication for ≥90 days.Main outcome measurePotentially disruptive life events among patients and their family members measured in the 30 days just before the medication was discontinued (‘hazard period’) compared with the 30 days before this period (‘control period’). These events included personal injury, hospitalisation, emergency room visits, changes in insurance coverage, acute stress or acute anxiety.ResultsAmong the 326 519 patients meeting study criteria who discontinued their chronic disease medications, 88 896 (27.2%) experienced at least one potentially disruptive life event. Newly experiencing an injury (OR: 1.26, 95% CI 1.12 to 1.42), an emergency room visit (OR: 1.19, 95% CI 1.13 to 1.26) and acute stress (OR: 1.19, 95% CI 1.08 to 1.31) were associated with discontinuation. Life events among patients’ family members did not appear to be associated with medication discontinuation or occurred less frequently just prior to discontinuation.ConclusionsPotentially disruptive life events among individuals identified using routinely collected claims data are associated with discontinuation of chronic disease medications. Awareness of these events may help providers or payers identify patients at risk of non-adherence to maximise patient outcomes.

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“…[15] Current guidelines recognize that monotherapies provide satisfactory reduction of CVD risk in only a limited proportion of the secondary prevention population and that the majority of these patients require combinations of effective drugs to achieve risk factor control and reduction of risk of future cardiovascular events. [16][17][18] The beneficial effects of statins, ASA and ACE inhibitors on the cardiovascular system have been shown in a variety of large studies. [19][20][21][22] There is also some evidence of synergistic effect of statins and ACE inhibitors in preventing new cardiovascular events in patients with established CVD.…”

Section: Undertreatment Is Still a Problemmentioning

confidence: 99%

The polypill: an emerging treatment alternative for secondary prevention of cardiovascular disease

2016

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Untangling the relationship between medication adherence and post–myocardial infarction outcomes

Cited by 161 publications

References 21 publications

Medication adherence in patients after percutaneous coronary intervention due to acute myocardial infarction: From research to clinical implications

Medication adherence in patients after percutaneous coronary intervention due to acute myocardial infarction: From research to clinical implications

Potentially disruptive life events: what are the immediate impacts on chronic disease management? A case-crossover analysis

The polypill: an emerging treatment alternative for secondary prevention of cardiovascular disease

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