Abstract 13160: Persistence of Secondary Prevention Medications after Acute Myocardial Infarction: Insights from the TRANSLATE-ACS Study

Abstract

Background: Persistence of evidence-based therapies is critical to optimizing long-term outcomes after acute MI and likely reflects the interaction of patient, provider, and health system factors.

Methods: We assessed 6-month medication persistence among 4,482 MI patients treated with PCI in the TRANSLATE-ACS observational study. Persistence was defined as continuation of all secondary prevention medications prescribed at discharge: aspirin, ADP receptor antagonists, β-blockers, statins, and ACEIs/ARBs. We examined independent clinical and socioeconomic factors that are associated with non-persistence.

Results: At 6 months, overall persistence of all secondary prevention medications prescribed at discharge was reported in 3142 (70%) of patients. Persistence was highest with aspirin (96%), followed by ADP receptor antagonists (92%), beta blockers (90%), statins (90%) and ACEIs/ARBs (84%). Patients who were not persistent with their medications were more often black, less likely to have health insurance, and more often reported financial hardship with medication costs (Table). In contrast, those who were persistent more often reported that providers explained the reasons for medications. After multivariate adjustment, black patients remained less likely to be persistent (OR 0.71, 95% CI 0.56-0.90, p=0.004), while patients with insurance coverage of medication costs, were more likely to be persistent (OR 1.64, 95% CI 1.31-2.06, p<0.001). Interestingly, employment status, education, and out-of-pocket costs did not appear to be associated with persistence to medications.

Conclusions: Up to one-third of patients are not persistent with their secondary prevention medications 6 months after acute MI discharge. Our study helps identify patients at risk for non-persistence and demonstrates that patient, provider, and system factors can influence persistence to therapies.