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on January 9, 2006

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Submitted on September 8, 2004
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^*, Nancy M. Allen LaPointe PharmD, Anita Y. Chen MS, Judith M. Kramer MD, MS, Bradley G. Hammill MA, Elizabeth R. DeLong PhD, Lawrence H. Muhlbaier PhD, and Robert M. Califf MD

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, -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.

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

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Long-Term Adherence to Evidence-Based Secondary Prevention Therapies in Coronary Artery Disease

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