Akincigil A, Bowblis JR, Levin C, Jan S, Patel M, Crystal S. Long-term adherence to evidence based secondary prevention therapies after acute myocardial infarction.
J Gen Intern Med 2008;
23:115-21. [PMID:
17922172 DOI:
10.1007/s11606-007-0351-9]
[Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 12/27/2006] [Accepted: 08/16/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND
After acute myocardial infarction (AMI), treatment with beta-blockers and angiotensin-converting enzyme inhibitors (ACEI) is widely recognized as crucial to reduce risk of a subsequent AMI. However, many patients fail to consistently remain on these treatments over time, and long-term adherence has not been well described.
OBJECTIVE
To examine the duration of treatment with beta-blockers and ACEI within the 24 months after an AMI.
DESIGN
A retrospective, observational study using medical and pharmacy claims from a large health plan operating in the Northeastern United States.
SUBJECTS
Enrollees with an inpatient claim for AMI who initiated beta-blocker (N = 499) or ACEI (N = 526) therapy.
MEASUREMENT
Time from initiation to discontinuation was measured with pharmacy refill records. Associations between therapy discontinuation and potential predictors were estimated using a Cox proportional hazards model.
RESULTS
ACEI discontinuation rates were high: 7% stopped within 1 month, 22% at 6 months, 32% at 1 year and 50% at 2 years. Overall discontinuation rates for beta-blockers were similar, but predictors of discontinuation differed for the two treatment types. For beta-blockers, the risk of discontinuation was highest among males and those from low-income neighborhoods; patients with comorbid hypertension and peripheral vascular disease were less likely to discontinue therapy. These factors were not associated with ACEI discontinuation.
CONCLUSION
Many patients initiating evidence-based secondary prevention therapies after an AMI fail to consistently remain on these treatments. Adherence is a priority area for development of better-quality measures and quality-improvement interventions. Barriers to beta-blocker adherence for low-income populations need particular attention.
Collapse