Abstract 15957: Prospective Assessment of the Relationship Between Use of Evidence-Based Secondary Prevention Therapies and Long-Term (4-Year) Clinical Outcomes in Stable Outpatients With Established Atherothrombotic Disease: Insights from the International REduction of Atherothrombosis for Continued Health (REACH) Registry
Objectives: Significant variations exist in the use of long-term evidence-based secondary prevention therapies such as antiplatelet agents, statins, and anti-hypertensive medications in patients with established atherosclerotic disease. We sought to assess if lack of use of these treatments was associated with long-term adverse outcomes in stable outpatients with established coronary (CAD), cerebrovascular (CVD) or peripheral (PAD) arterial disease, enrolled in the international, prospective REACH registry.
Methods: We assessed the use of all ACC/AHA class I recommended medications in eligible patients at 1-year follow-up in the REACH registry. We then assessed the impact of lack of use of these medications on the composite endpoint of cardiovascular (CV) death/myocardial infarction (MI)/ stroke at 4 years in a multivariate Cox regression model, adjusting for age, gender, smoking, diabetes, body mass index, congestive heart failure, timing of prior ischemic event, number of diseased vascular territories, and geographic distribution.
Results: A total of 33,633 patients were included. Overall compliance with all evidence-based therapies at 1 year ranged from 44.4% (stroke) to 69.6% (post-CABG). On adjusted multivariate analysis, lack of use of secondary prevention therapies at 1 year was significantly associated with an increased long-term risk of CV death/MI/stroke in all patients (hazard ratio = 1.22, 95% confidence interval 1.13 - 1.32, p<0.0001). This was also true for various subgroups, including those with unstable angina, MI, prior percutaneous coronary intervention, stroke, or claudication (Table).
Conclusions: Lack of use of evidence-based secondary prevention therapies at 1 year is associated with a 22% excess in long-term adverse clinical events in patients with established atherosclerosis. Efforts to improve compliance, and research to understand barriers, are urgently needed to improve outcomes for patients with vascular disease.
- © 2011 by American Heart Association, Inc.