Published online before print January 9, 2006, doi: 10.1161/CIRCULATIONAHA.105.505636
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2006;113:203-212.)
© 2006 American Heart Association, Inc.
Health Services and Outcomes Research |
Long-Term Adherence to Evidence-Based Secondary Prevention Therapies in Coronary Artery Disease
From the Duke Centers for Education and Research on Therapeutics at the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
Correspondence to L. Kristin Newby, MD, MHS, Duke Clinical Research Institute, PO Box 17969, Durham, NC, 27715-7969. E-mail newby001{at}mc.duke.edu
Received September 8, 2004; revision received August 9, 2005; accepted August 12, 2005.
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, ß-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 
2 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. In 2002, 83% reported aspirin use; 61%, ß-blocker use; 63%, lipid-lowering therapy use; 54%, aspirin and ß-blocker use; and 39%, use of all 3. Consistent use was as follows: For aspirin, 71%; ß-blockers, 46%; lipid-lowering therapy, 44%; aspirin and ß-blockers, 36%; and all 3, 21%. Among patients without heart failure, 39% reported ACEI use in 2002; consistent use was 20%. Among heart failure patients, ACEI use was 51% in 2002 and consistent use, 39%. Except for ACEIs among patients without heart failure, consistent use was associated with lower adjusted mortality: Aspirin hazard ratio (HR), 0.58 and 95% confidence interval (CI), 0.54 to 0.62; ß-blockers, HR, 0.63 and 95% CI, 0.59 to 0.67; lipid-lowering therapy, HR, 0.52 and 95% CI, 0.42 to 0.65; all 3, HR, 0.67 and 95% CI, 0.59 to 0.77; aspirin and ß-blockers, HR, 0.61 and 95% CI, 0.57 to 0.65; and ACEIs among heart failure patients, HR, 0.75 and 95% CI, 0.67 to 0.84.
Conclusions— Use of evidence-based therapies for CAD has improved but remains suboptimal. Although improved discharge prescription of these agents is needed, considerable attention must also be focused on understanding and improving long-term adherence.
Key Words: coronary disease • atherosclerosis • drugs • prevention
Find additional patient-related information at:
Related Article:
-
Issue Highlights
Circulation 2006 113: 177.[Full Text]
This article has been cited by other articles:
 |
|
 |
|
  N. K. Choudhry, A. R. Patrick, E. M. Antman, J. Avorn, and W. H. Shrank Cost-Effectiveness of Providing Full Drug Coverage to Increase Medication Adherence in Post-Myocardial Infarction Medicare Beneficiaries Circulation, March 11, 2008; 117(10): 1261 - 1268. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. L. Daugherty, P. M. Ho, J. A. Spertus, P. G. Jones, R. G. Bach, H. M. Krumholz, E. D. Peterson, J. S. Rumsfeld, and F. A. Masoudi Association of Early Follow-up After Acute Myocardial Infarction With Higher Rates of Medication Use Arch Intern Med, March 10, 2008; 168(5): 485 - 491. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. H. Curtis, D. J. Whellan, B. G. Hammill, A. F. Hernandez, K. J. Anstrom, A. M. Shea, and K. A. Schulman Incidence and Prevalence of Heart Failure in Elderly Persons, 1994-2003 Arch Intern Med, February 25, 2008; 168(4): 418 - 424. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Capewell and M O'Flaherty Maximising secondary prevention therapies in patients with coronary heart disease Heart, January 1, 2008; 94(1): 8 - 9. [Full Text] [PDF]
|
|
|
|
 |
|
 J. C. Geller, S. Cassens, M. Brosz, U. Keil, J. Bernarding, S. Kropf, R. A. Bierwirth, B. Lippmann-Grob, H.-P. Schultheiss, K. Schluter, et al. Achievement of guideline-defined treatment goals in primary care: the German Coronary Risk Management (CoRiMa) study Eur. Heart J., December 2, 2007; 28(24): 3051 - 3058. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Aboa-Eboule, C. Brisson, E. Maunsell, B. Masse, R. Bourbonnais, M. Vezina, A. Milot, P. Theroux, and G. R. Dagenais Job Strain and Risk of Acute Recurrent Coronary Heart Disease Events JAMA, October 10, 2007; 298(14): 1652 - 1660. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kulik, R. Levin, M. Ruel, T. G. Mesana, D. H. Solomon, and N. K. Choudhry Patterns and predictors of statin use after coronary artery bypass graft surgery. J. Thorac. Cardiovasc. Surg., October 1, 2007; 134(4): 932 - 938. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. H. Gislason, J. N. Rasmussen, S. Z. Abildstrom, T. K. Schramm, M. L. Hansen, P. Buch, R. Sorensen, F. Folke, N. Gadsboll, S. Rasmussen, et al. Persistent Use of Evidence-Based Pharmacotherapy in Heart Failure Is Associated With Improved Outcomes Circulation, August 14, 2007; 116(7): 737 - 744. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L K. Newby Review: high dose statins reduce risk of non-fatal cardiovascular events more than standard dose statins Evid. Based Med., April 1, 2007; 12(2): 42 - 42. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Goyal, J. H. Alexander, G. E. Hafley, S. H. Graham, R. H. Mehta, M. J. Mack, R. K. Wolf, L. H. Cohn, N. T. Kouchoukos, R. A. Harrington, et al. Outcomes Associated With the Use of Secondary Prevention Medications After Coronary Artery Bypass Graft Surgery Ann. Thorac. Surg., March 1, 2007; 83(3): 993 - 1001. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. N. Rasmussen, A. Chong, and D. A. Alter Relationship Between Adherence to Evidence-Based Pharmacotherapy and Long-term Mortality After Acute Myocardial Infarction JAMA, January 10, 2007; 297(2): 177 - 186. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Touze, J.-L. Mas, J. Rother, S. Goto, A. T. Hirsch, Y. Ikeda, C.-S. Liau, E. M. Ohman, A. J. Richard, P. W. F. Wilson, et al. Impact of Carotid Endarterectomy on Medical Secondary Prevention After a Stroke or a Transient Ischemic Attack: Results from the Reduction of Atherothrombosis for Continued Health (REACH) Registry Stroke, December 1, 2006; 37(12): 2880 - 2885. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. M. Krumholz and F. A. Masoudi The Year in Epidemiology, Health Services Research, and Outcomes Research J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1886 - 1895. [Full Text] [PDF]
|
|
|
|
|
|
G. G.L. Biondi-Zoccai, M. Lotrionte, P. Agostoni, A. Abbate, M. Fusaro, F. Burzotta, L. Testa, I. Sheiban, and G. Sangiorgi A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease Eur. Heart J., November 2, 2006; 27(22): 2667 - 2674. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Harrington and R. M. Califf Late Ischemic Events After Clopidogrel Cessation Following Drug-Eluting Stenting: Should We Be Worried? J. Am. Coll. Cardiol., November 1, 2006; (2006) j.jacc.2006.10.025v2. [Full Text] [PDF]
|
|
|
|
|
|
G. H. Tofler and J. E. Muller Triggering of Acute Cardiovascular Disease and Potential Preventive Strategies Circulation, October 24, 2006; 114(17): 1863 - 1872. [Full Text] [PDF]
|
|
|
|
|
|
P. M. Ho, J. A. Spertus, F. A. Masoudi, K. J. Reid, E. D. Peterson, D. J. Magid, H. M. Krumholz, and J. S. Rumsfeld Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med, September 25, 2006; 166(17): 1842 - 1847. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Jezior and L. E. Sullenberger Letter Regarding Article by Newby et al, "Long-Term Adherence to Evidence-Based Secondary Prevention Therapies in Coronary Artery Disease" Circulation, August 8, 2006; 114(6): e240 - e240. [Full Text] [PDF]
|
|
|
|
|
|
L. K. Newby, N. M. Allen-LaPointe, A. Y. Chen, J. M. Kramer, B. G. Hammill, E. R. DeLong, L. H. Muhlbaier, and R. M. Califf Response to Letter Regarding Article, "Long-Term Adherence to Evidence-Based Secondary Prevention Therapies in Coronary Artery Disease" Circulation, August 8, 2006; 114(6): e241 - e241. [Full Text] [PDF]
|
|
|
|
|
|
S. C. Smith Jr Evidence-Based Medicine: Making the Grade: Miles to Go Before We Sleep Circulation, January 17, 2006; 113(2): 178 - 179. [Full Text] [PDF]
|
|