on January 9, 2006
Published online before print January 9, 2006, doi: 10.1161/CIRCULATIONAHA.105.505636
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on September 8, 2004
From the Duke Centers for Education and Research on Therapeutics at the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. * To whom correspondence should be addressed. E-mail: newby001{at}mc.duke.edu.
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, 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.
Revised on August 9, 2005
Accepted on August 12, 2005
Long-Term Adherence to Evidence-Based Secondary Prevention Therapies in Coronary Artery Disease
L. Kristin Newby MD, MHS*,
-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%, -blocker use; 63%, lipid-lowering therapy use; 54%, aspirin and -blocker use; and 39%, use of all 3. Consistent use was as follows: For aspirin, 71%; -blockers, 46%; lipid-lowering therapy, 44%; aspirin and -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; -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 -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.
Key words: coronary disease • atherosclerosis • drugs • prevention
Find additional patient-related information at:
Related Article:
-
Issue Highlights
Circulation 2006 113: 177.[Extract] [Full Text]
This article has been cited by other articles:
 |
|
 |
|
  E. D. Peterson, J. A. Spertus, D. J. Cohen, M. A. Hlatky, A. S. Go, B. G. Vickrey, J. L. Saver, and P. C. Hinton Vision and Creation of the American Heart Association Pharmaceutical Roundtable Outcomes Research Centers Circ Cardiovasc Qual Outcomes, November 1, 2009; 2(6): 663 - 670. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. B. Granger, I. Ekman, C. B. Granger, J. Ostergren, B. Olofsson, E. Michelson, J. J.V. McMurray, S. Yusuf, M. A. Pfeffer, and K. Swedberg Adherence to medication according to sex and age in the CHARM programme Eur J Heart Fail, November 1, 2009; 11(11): 1092 - 1098. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Melloni and L K. Newby Risk factor management after acute coronary syndromes Heart, September 1, 2009; 95(17): 1382 - 1384. [Full Text] [PDF]
|
|
|
|
 |
|
 J A Singh, J S Hodges, and S M Asch Opportunities for improving medication use and monitoring in gout Ann Rheum Dis, August 1, 2009; 68(8): 1265 - 1270. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. M A. LaPointe, J. A Stafford, P. A Pappas, S. M Al-Khatib, and K. J Anstrom Use of {beta}-Blockers in Patients with an Implantable Cardioverter Defibrillator Ann. Pharmacother., July 1, 2009; 43(7): 1189 - 1196. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Ho, C. L. Bryson, and J. S. Rumsfeld Medication Adherence: Its Importance in Cardiovascular Outcomes Circulation, June 16, 2009; 119(23): 3028 - 3035. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. P. Alexander, M. A. Blazing, R. S. Rosenson, E. Hazard, W. S. Aronow, S. C. Smith Jr, and E. M. Ohman Management of Hyperlipidemia in Older Adults Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2009; 14(1): 49 - 58. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Cohen Expanding the Recognition and Assessment of Bleeding Events Associated With Antiplatelet Therapy in Primary Care Mayo Clin. Proc., February 1, 2009; 84(2): 149 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Giannuzzi, P. L. Temporelli, R. Marchioli, A. P. Maggioni, G. Balestroni, V. Ceci, C. Chieffo, M. Gattone, R. Griffo, C. Schweiger, et al. Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction: Results of the GOSPEL Study, a Multicenter, Randomized Controlled Trial From the Italian Cardiac Rehabilitation Network Arch Intern Med, November 10, 2008; 168(20): 2194 - 2204. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. M. Albert Improving Medication Adherence in Chronic Cardiovascular Disease Crit. Care Nurse, October 1, 2008; 28(5): 54 - 64. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Stafford, H. J. Jackson, and M. Berk Illness Beliefs About Heart Disease and Adherence to Secondary Prevention Regimens Psychosom Med, October 1, 2008; 70(8): 942 - 948. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Berger, T. Dor, Y. Nevo, and G. Goldzweig Attitudes Toward Attention-Deficit Hyperactivity Disorder (ADHD) Treatment: Parents' and Children's Perspectives J Child Neurol, September 1, 2008; 23(9): 1036 - 1042. [Abstract] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
G. E. Kikano and M. T. Brown Antiplatelet Therapy for Atherothrombotic Disease: An Update for the Primary Care Physician Mayo Clin. Proc., May 1, 2007; 82(5): 583 - 593. [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]
|
|