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. 2008 Dec;17(12):1189-96.
doi: 10.1002/pds.1671.

Trends in adherence to secondary prevention medications in elderly post-myocardial infarction patients

Niteesh K Choudhry  1 , Soko Setoguchi, Raisa Levin, Wolfgang C Winkelmayer, William H Shrank
Affiliations

Trends in adherence to secondary prevention medications in elderly post-myocardial infarction patients

Niteesh K Choudhry et al. Pharmacoepidemiol Drug Saf. 2008 Dec.

Abstract

Background: Poor levels of medication adherence for patients with coronary heart disease (CHD) have been documented but it is unclear whether adherence has improved over time.

Methods: We assembled a retrospective cohort of lower-income Medicare beneficiaries who were discharged from the hospital after their first acute myocardial infarction (MI) between 1 January 1995 and 31 December 2003. For patients prescribed a statin, ACEI/ARB, beta-blocker, and all 3 of these medications after the hospital discharge, we evaluated medication adherence by determining the proportion of days covered (PDC) for each medication in the subsequent year.

Results: Our cohort consisted of a total of 33 646 patients. Adherence rates for statins and beta-blockers, but not ACEI/ARB, increased significantly over time but remained suboptimal. For example, among those patients that received a statin after discharge, 38.6% were fully adherent with therapy in 1995 in contrast to 56.2% in 2003 (p value for trend<0.001). Of patients prescribed all 3 of statin, beta-blocker, and ACEI/ARB, 29.1% and 46.4% were fully adherent in 1995 and 2003, respectively (p value for trend<0.001).

Conclusions: Our analysis demonstrates statistically significant but modest improvements in medication adherence for statins and beta-blockers, but not ACEI/ARBs, among patients discharged from hospital after acute MI. Despite these improvements, rates of non-adherence to these highly effective therapies remain extremely high. Given the health and economic consequences of non-adherence, the development of cost-effective strategies to improve medication adherence should be a clear priority.

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Figures

Figure 1
Figure 1
Trends in 1 year adherence to post-myocardial infarction medications by year of hospital discharge
See this image and copyright information in PMC

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