Long-term medication adherence in patients with ST-elevation myocardial infarction and primary percutaneous coronary intervention

Abstract

Aims

Besides early percutaneous coronary intervention (PCI) long-term medical treatment is crucial for outcomes after ST-elevation myocardial infarction (STEMI). The present study aimed to identify predictors of adherence to evidence-based medication in this high risk population.

Methods and results

A total of 1025 consecutive patients with adjudicated STEMI treated by primary PCI in a single centre as part of the Cologne Infarction Model (KIM) were prospectively analysed. Gender-specific multivariate predictors of long-term medication adherence were identified. Follow-up with available information on drug use was completed for 610 of 738 (82.7%) patients confirmed to be alive after a median period of 36 months. Adherence was persistently high for evidence-based medication with 90.8% for acetylsalicylic acid (ASA), 88.2% for statins, 87.5% for beta-blockers and 79.2% for ACE-inhibitors or angiotensin-receptor blockers (ARBs). Patients with a history of heart failure had a higher medication adherence to beta-blockers, ACE-inhibitors/ARBs and diuretics, whereas long-term prescription rates for calcium channel blockers (CCBs) were lower in patients with reduced versus preserved ejection fraction. Patients with a history of hypertension presented higher medication adherence to CCBs, ACE-inhibitors/ARBs and diuretics but not to beta-blockers. On multivariate analysis, age, body mass index (BMI), hypertension, chronic kidney disease and lack of PCI were independently associated with prescription of diuretics at follow-up. In women, adherence was lower to beta-blockers and higher to CCBs compared to men.

Conclusion

In the high risk population of STEMI patients long-term adherence to evidence-based medication is high. The lower adherence to beta-blockers and higher prescription rate for CCBs in women needs particular attention.

Keywords

ST-elevation myocardial infarction medication adherence secondary prevention gender

Get full access to this article

View all access options for this article.

References

Steg

James

Atar

. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart 2012; 33: 2569–2619.

Van der Elst

Bouvy

De Blaey

. Effect of drug combinations on admission for recurrent myocardial infarction. Heart 2007; 93: 1226–1230.

Zeymer

James

Berkenboom

. Differences in the use of guideline-recommended therapies among 14 European countries in patients with acute coronary syndromes undergoing PCI. Eur J Prev Cardiol 2013; 20: 218–228.

Akincigil

Bowblis

Levin

Jan

. Long-term adherence to evidence based secondary prevention therapies after acute myocardial infarction. J Gen Intern Med 2008; 23: 115–121.

Shah

Dunlay

Ting

. Long-term medication adherence after myocardial infarction: Experience of a community. Am J Med 2009; 122: 961 e7–e13.

Thygesen

Alpert

Jaffe

. Third universal definition of myocardial infarction. Nat Rev Cardiol 2012; 9: 620–633.

Flesch

Hagemeister

Berger

. Implementation of guidelines for the treatment of acute ST-elevation myocardial infarction: The Cologne Infarction Model Registry. Circ Cardiovasc Interv 2008; 1: 95–102.

Tuppin

Neumann

Danchin

. Evidence-based pharmacotherapy after myocardial infarction in France: Adherence-associated factors and relationship with 30-month mortality and rehospitalization. Arch Cardiovasc Dis 2010; 103: 363–375.

Magid

Shetterly

. Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease. Am Heart J 2008; 155: 772–779.

10.

König

Lowel

Lewis

. Long-term survival after myocardial infarction: Relationship with thrombolysis and discharge medication. Results of the Augsburg Myocardial Infarction Follow-up Study 1985 to 1993. Eur Heart J 1996; 17: 1199–1206.

11.

Eagle

Kline-Rogers

Goodman

. Adherence to evidence-based therapies after discharge for acute coronary syndromes: An ongoing prospective, observational study. Am J Med 2004; 117: 73–81.

12.

National Institute of Health Excellence. Hypertension: Management of hypertension in adults in primary care. http://wwwniceorguk/CG034 (2006, accessed May 2013).

13.

Moubarak

Ernande

Godin

. Impact of comorbidity on medication use in elderly patients with cardiovascular diseases: The OCTOCARDIO study. Eur J Prev Cardiol 2013; 20: 524–530.

14.

Jackevicius

. Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction. Circulation. 2008; 117: 1028–1036.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.24 MB