Prevalence and association of medication nonadherence with major adverse cardiovascular events in patients with myocardial infarction

Persistence with Antiplatelet and Risk of Major Adverse Cardiac and Cerebrovascular Events in Acute Coronary Syndrome Patients after Percutaneous Coronary Intervention in Indonesia: A Retrospective Cohort Study

BACKGROUND: Acute coronary syndrome (ACS) is a life-threatening condition that carries high risk of recurrent cardiovascular events and death. Persistence with treatment is known to reduce morbidity and mortality in patients with ACS. AIM: This study focuses on ACS patients undergoing their first percutaneous coronary intervention (PCI) to investigate the association between persistence with antiplatelet therapy and clinical outcomes. MATERIALS AND METHODS: A retrospective cohort study with 2 years of follow-up was conducted with 367 patients recruited. Patients were deemed as having persistence with antiplatelet therapy (WHO ATC code: B0A1C), if the gap between prescriptions was ≤30 days. The clinical outcomes were defined as a composite of major adverse cardiac event (MACE), major adverse cardiovascular and cerebrovascular events (MACCE), myocardial infarction, recurrent PCI, stroke, all-cause death, cardiovascular death, and hospitalization. RESULTS: Cumulative persistence with antiplatelet showed that 72.3% of all ACS patients were still taking antiplatelet 1 year after PCI. Persistence to treatment with antiplatelet therapy can be used as a predictor of MACE or MACCE, because it was associated with recurrent PCI (RR 3.09, 95% CI = 1.18−8.05). History of cardiovascular disease in non-persistence patients was associated with increased risk of MACE (RR 4.90 95% CI = 1.37−17.48) and MACCE (RR 3.67 95% CI = 1.12−11.98) events. CONCLUSION: After PCI, not all ACS patients continued taking their drug exactly as prescribed. Our study indicates that among ACS patients who underwent their first PCI, non-persistence with antiplatelet therapy might lead to worse clinical outcomes. This data will help promote secondary prevention among ACS patients after PCI.

Effect of multidimensional comprehensive intervention on medication compliance, social function and incidence of MACE in patients undergoing PCI

OBJECTIVE

To analyze the effect of multidimensional comprehensive intervention on medication compliance, social function and incidence of major adverse cardiovascular events (MACE) in patients undergoing percutaneous coronary intervention (PCI).

METHODS

Ninety-eight patients with coronary heart disease (CHD) who underwent PCI in our hospital were selected and divided into the regular group (n=46, receiving regular nursing intervention) and the comprehensive group (n=52, receiving multidimensional comprehensive nursing intervention) according to the different nursing intervention methods. The medication compliance, social function, quality of life, and incidence of MACE were compared between the two groups.

RESULTS

The comprehensive group showed significantly higher rates of taking medication on time, taking medication according to the proper amount, taking medication at the recomended times, no increase or decrease in the amount of medication, and taking medication without interruption than the regular group (P < 0.05). The comprehensive group exhibited significantly higher scores of medication compliance than the regular group (P < 0.05). The Social Disability Screening Schedule (SDSS) scores of both groups during intervention for 8 weeks were lower than those before intervention and after intervention for 2 and 4 weeks (P < 0.05). The SDSS scores of intervention for 2, 4, and 8 weeks in the comprehensive group were significantly lower than that in the regular group (P < 0.05). After intervention, the comprehensive group showed significantly higher scores of physiological function, psychological function, cognitive function, emotional function, role function, and total quality of life than the regular group (P < 0.05). The incidence of MACE in the comprehensive group was significantly lower than that in the regular group (P < 0.05).

CONCLUSION

The use of multidimensional comprehensive intervention for patients undergoing PCI can effectively improve patients' medication compliance, social function and quality of life, and reduce the incidence of MACE.

Going beyond the mean: economic benefits of myocardial infarction secondary prevention

BACKGROUND

Using the example of secondary prophylaxis of myocardial infarction (MI), our aim was to establish a framework for assessing cost consequences of compliance with clinical guidelines; thereby taking cost trajectories and cost distributions into account.

METHODS

Swiss mandatory health insurance claims from 1840 persons with hospitalization for MI in 2014 were analysed. Included persons were predominantly male (74%), had a median age of 73 years, and 71% were pre-exposed to drugs for secondary prophylaxis, prior to index hospitalization. Guideline compliance was defined as being prescribed recommended 4-class drug prophylaxis including drugs from the following four classes: beta-blockers, statins, aspirin or P2Y₁₂ inhibitors, and angiotension-converting enzyme inhibitors or angiotensin receptor blockers. Health care expenditures (HCE) accrued over 1 year after index hospitalization were compared by compliance status using two-part regression, trajectory analysis, and counterfactual decomposition analysis.

RESULTS

Only 32% of persons received recommended 4-class prophylaxis. Compliant persons had lower HCE (- 4865 Swiss Francs [95% confidence interval - 8027; - 1703]) and were more likely to belong to the most favorable HCE trajectory (with 6245 Swiss Francs average annual HCE and comprising 78% of all studied persons). Distributional analyses showed that compliance-associated HCE reductions were more pronounced among persons with HCE above the median.

CONCLUSIONS

Compliance with recommended prophylaxis was robustly associated with lower HCE and more favorable cost trajectories, but mainly among persons with high health care expenditures. The analysis framework is easily transferrable to other diseases and provides more comprehensive information on HCE consequences of non-compliance than mean-based regressions alone.