Abstract 16556: Factors Associated with Adherence to Evidence Based Medications (EBM) and Mortality after AMI: A Nationwide French Survey of Administrative Data.
Purpose: To assess correlations between patient characteristics and adherence to EBM (betablockers; statins; antiplatelet agents; ACE-inhibitors or ARB) after AMI.
Methods: 30-month follow-up of pts admitted for AMI in France in the 1st half of 2006. National hospital discharge, outpatient medications reimbursement and national mortality databases were linked for all patients covered by the general health insurance scheme. Pts who filled a prescription for each of the four EBM medication groups and were alive at 6 months (8,249 pts) were selected and classified in adherent (proportion of days covered by a filled prescription > 80% for each medication group) and non-adherent. Multivariate logistic regression was used to compare groups. Time to death or readmission for acute coronary syndrome (ACS) was compared, adjusting by multivariate Cox regression.
Results: Overall, 50% of pts were non-adherent to the totality of EBM. Adjusted factors significantly associated with a low adherence were : older age, low income with full heathcare coverage, neoplasia, renal disease, chronic obstructive pulmonary disease, Alzheimer disease, depression, previous hospitalisation with stent implantation vs no cardiovascular hospitalisation, prior use of EBM, stent implantation during hospitalisation for AMI. Younger age (<45 years) was associated with a non significant trend to lower adherence (OR: 0.86), Rates of mortality or admission for ACS during the follow-up period were 11.1% (95%CI: 10.2%−12.1%) for non-adherent pts and 6.0% (95%CI: 5.3%−6.8%) for adherent pts. After adjustement, rates were 9.9% (95%CI: 9.1%−10.8%) and 6.7% (95%CI: 5.9%−7.5%) respectively and the Hazard-Ratio for non-adherence was 1.43****. *p<0.05, **p<0.01, *** p<0.001, **** p<0.0001
Conclusions: Non-adherence to EBM is common and associated with a significant increase in mortality. Older age and comorbidities are major determinants of non adherence, while use of PCI is associated with adherence. Very young age (<45 years) is also associated with poor adherence, although the independent effect of younger age disappears when comorbidities and social status are taken into account. Cost-effective strategies for adherence improvement should be developped for focused groups of pts.
- © 2010 by American Heart Association, Inc.