Secondary adherence to beta-blockers after ST-elevation myocardial infarction without ventricular dysfunction

Introduction and objectives: Adequate medication intake affects treatment effectiveness. The aim of this study was to establish the impact of prescription and secondary adherence to beta-blockers on medium-and long-term and long-term cardiovascular outcomes, after a first type 1 ST-elevation myocardial infarction (STEMI) episode without heart failure or left ventricular ejection fraction >= 40%. Methods: A retrospective observational study was conducted in a cohort of patients admitted from 2008 to 2013 to the University Clinical Hospital in Valencia. Competing risk analysis assessed the relationship between cardiovascular mortality or new vascular event with beta-blocker prescription and secondary adherence, defined as a proportion of days covered. Results: During after the first year following discharge, beta-blocker prescription was not significantly associated with better health outcomes in the 460 patients included. However, cardiovascular mortality was lower in adherent patients compared to non-adherent patients, at 0.6% vs. 6.6% (HR = 0.083; 95% CI, 0.015-0.448; p = 0.003), and in adherent patients compared to those who did not receive the treatment due to lack of prescription or lack of adherence, with 0.6% vs. 4.8% (HR = 0.115; 95% CI, 0.022-0.587; p = 0.009). These results were not observed when the complete follow-up period was analysed (median 46.7 months). Conclusions: Secondary adherence to beta-blockers improves 1-year prognosis after STEMI with preserved left ventricular function. (C) 2019 Elsevier Espana, S.L.U. All rights reserved.