Abstract 1592: Adherence to Medications After Acute Coronary Events
Introduction: Secondary prevention of coronary artery disease (CAD) using statins (STA), beta-blockers (BB) and aspirin (ASA) is effective; yet poor adherence, particularly in the first month, may limit their benefit to all populations. We investigated the characteristics associated with non-adherence of critical chemoprophylaxis after an acute CAD event in patients to whom free medications were provided at hospital discharge.
Methods: We enrolled 152 acute CAD patients who were prescribed STA, BB and ASA at hospital discharge. Medications were provided free of charge and adherence after one month was determined in a face-to-face visit using standard adherence questionnaires and pill counts. Logistic regression analysis using sociodemographic variables (race, sex, age, education) was used to predict non-adherence.
Results: The sample was comprised of 32% women, 40%African Americans, and 3% of other ethnicities. Non-adherence for any drug for at least one day was reported by 38%. The mean (SD) days missed were 3.2 (5.6) for STA, 5.6 (9.0) for BB, 5.6 (8.0) for ASA. The non-adherence for each pair of drugs was significantly correlated (tetrachoric correlation for dichotomous variables - STA-BB: r=0.40, p=0.027; STA-ASA: r=0.50, p=0.005; BB-ASA: r=0.83, p<0.001). Among whites, women were significantly more likely to be non-adherent, but among non-whites, women were significantly more likely to be adherent than men (Table⇓). In adjusted models, the ethnicity by gender interaction was significant (p=0.001). Older age was associated with lower odds of non-adherence (OR: 0.69 per decade, p=0.028).
Conclusion: Gender-ethnicity and age differences exist in medication adherence in the first month after hospital discharge, in spite of access to free medications. The sociocultural or biomedical causes for this difference remain to be determined, but the results suggest that free access to medications does not solve the problem of nonadherence after an acute CAD event.
This research has received full or partial funding support from the American Heart Association, National Center.