Long-term Medication Adherence after Myocardial Infarction: Experience of a Community

被引：140

作者：

Shah, Nilay D. ^{[1
,2
]}

Dunlay, Shannon M. ^{[3
]}

Ting, Henry H. ^{[2
,3
]}

Montori, Victor M. ^{[2
,4
]}

Thomas, Randal J. ^{[3
]}

Wagie, Amy E. ^{[1
]}

Roger, Veronique L. ^{[3
,5
]}

机构：

[1] Mayo Clin, Coll Med, Div Hlth Care Policy & Res, Rochester, MN 55905 USA

[2] Mayo Clin, Coll Med, Knowledge & Encounter Res Unit, Rochester, MN 55905 USA

[3] Mayo Clin, Coll Med, Div Cardiovasc Dis, Rochester, MN 55905 USA

[4] Mayo Clin, Coll Med, Div Endocrinol Diabet Metab & Nutr, Rochester, MN 55905 USA

[5] Mayo Clin, Coll Med, Dept Hlth Sci Res, Rochester, MN 55905 USA

来源：

AMERICAN JOURNAL OF MEDICINE | 2009年 / 122卷 / 10期

关键词：

Adherence; Cardiac rehabilitation; Drugs; Myocardial infarction; CORONARY-ARTERY-DISEASE; CARDIAC REHABILITATION; AMERICAN-COLLEGE; HEART-DISEASE; SECONDARY PREVENTION; GUIDELINE UPDATE; OLMSTED COUNTY; FOLLOW-UP; MANAGEMENT; ASSOCIATION;

D O I：

10.1016/j.amjmed.2008.12.021

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Adherence to evidence-based medications after myocardial infarction is associated with improved outcomes. However, long-term data on factors affecting medication adherence after myocardial infarction are lacking. METHODS: Olmsted County residents hospitalized with myocardial infarction from 1997-2006 were identified. Adherence to HMG-CoA reductase inhibitors (statins), beta blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers, were examined. Cox proportional hazard regression was used to determine the factors associated with medication adherence over time. RESULTS: Among 292 subjects with incident myocardial infarction (63% men, mean age 65 years), patients were followed for an average of 52 +/- 31 months. Adherence to guideline-recommended medications decreased over time, with 3-year medication continuation rates of 44%, 48%, and 43% for statins, beta-blockers, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, respectively. Enrollment in a cardiac rehabilitation program was associated with an improved likelihood of continuing medications, with adjusted hazard ratio (95% confidence interval) for discontinuation of statins and beta-blockers among cardiac rehabilitation participants of 0.66 (0.45-0.92) and 0.70 (0.49-0.98), respectively. Smoking at the time of myocardial infarction was associated with a decreased likelihood of continuing medications, although results did not reach statistical significance. There were no observed associations between demographic characteristics, clinical characteristics of the myocardial infarction, and medication adherence. CONCLUSIONS: After myocardial infarction, a large proportion of patients discontinue use of medications over time. Enrollment in cardiac rehabilitation after myocardial infarction is associated with improved medication adherence. (C) 2009 Elsevier Inc. All rights reserved. . The American Journal of Medicine (2009) 122, 961.e7-961.e12

引用

页码：961.e7 / 961.e13

页数：7

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