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

被引:112
作者
Choudhry, Niteesh K. [1 ,2 ]
Setoguchi, Soko [1 ,2 ]
Levin, Raisa [1 ,2 ]
Winkelmayer, Wolfgang C. [1 ,2 ,3 ]
Shrank, William H. [1 ,2 ]
机构
[1] Brigham & Womens Hosp, Dept Med, Div Pharmacoepidemiol & Pharmacoecon, Boston, MA 02120 USA
[2] Harvard Univ, Sch Med, Boston, MA USA
[3] Brigham & Womens Hosp, Dept Med, Div Renal, Boston, MA 02120 USA
关键词
adherence; myocardial infarction; preventice therapy; drug utilization;
D O I
10.1002/pds.1671
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
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 Stalin 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. Copyright (C) 2008 John Wiley & Sons, Ltd.
引用
收藏
页码:1189 / 1196
页数:8
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