Abstract 3520: Evidence-based Therapy For Myocardial Infarction: Medication Adherence In The Community
Background: Hospital quality core measures assess cardiac medications prescribed at discharge in patients post myocardial infarction (MI) since these medications decrease the risk for future adverse events. However, little is known about intermediate and long-term adherence rates.
Methods: Using prescription drug claims for 391 residents of Olmsted County, MN enrolled in an employer-sponsored health plan with MI (1/97– 6/06), we measured adherence to ACE-inhibitors, beta-blockers, and statins among patients discharged on these medications and evaluated demographic, clinical, and health services factors associated with adherence.
Results: At 6-months, adherence to statins was 94%, but by 3 years only 42% of patients continued taking statins. Similarly, adherence to beta-blocker decreased from 91% at 6 months to 46% at 3 years and adherence to ACE-inhibitor decreased from 85% at 6 months to 36% at 3 years. In multivariable models, coronary revascularization was associated with 24-month adherence to statins (OR=2.3; 95% CI=1.2– 4.1), beta-blockers (OR=2.1; 95% CI=1.2– 4.2), and ACE-inhibitors (OR=2.0; 95% CI=1.1– 4.4). Participation in cardiac rehabilitation was associated with statin continuation at 6 months (OR=2.2; 95% CI=1.3–3.7). Current smokers were most likely to discontinue all medications at 6 months (OR=0.62; 95% CI=0.34 – 0.83).
Conclusion: In this population-based cohort, adherence to evidence-based therapy after MI is suboptimal. Cardiac rehabilitation is associated with improved adherence, while smoking is associated with lower adherence, underscoring the importance of secondary prevention programs.