4.7 Article

Association of Medication Adherence With Health Outcomes in the ISCHEMIA Trial

Journal

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 80, Issue 8, Pages 755-765

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2022.05.045

Keywords

chronic coronary disease; clinical trial; health status; medication adherence

Funding

  1. National Heart, Lung, and Blood Institute of the National Institutes of Health [5T32H110837]

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The ISCHEMIA trial examined the association between medication adherence and health status outcomes in patients with chronic coronary disease. The study found that nonadherence to medication was associated with worse health status at baseline and 12 months, regardless of treatment strategy. Strategies to improve medication adherence are needed to improve health status outcomes in patients with chronic coronary disease.
BACKGROUND The ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial randomized participants with chronic coronary disease (CCD) to guideline-directed medical therapy with or without angiography and revascularization. The study examined the association of nonadherence with health status outcomes. OBJECTIVES The study sought to compare 12-month health status outcomes of adherent and nonadherent participants with CCD with an a priori hypothesis that nonadherent patients would have better health status if randomized to invasive management. METHODS Self-reported medication-taking behavior was assessed at randomization with a modified 4-item MoriskyGreen-Levine Adherence Scale, and participants were classified as adherent or nonadherent. Twelve-month health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ-7) summary score (SS), which ranges from 0 to 100 (higher score = better). The association of adherence with outcomes was evaluated using Bayesian proportional odds models, including an interaction by study arm (conservative vs invasive). RESULTS Among 4,480 randomized participants, 1,245 (27.8%) were nonadherent at baseline. Nonadherent participants had worse baseline SAQ-7 SS in both conservative (72.9 +/- 19.3 vs 75.6 +/- 18.4) and invasive (71.0 +/- 19.8 vs 74.2 +/- 18.7) arms. In adjusted analyses, adherence was associated with higher 12-month SAQ-7 SS in both treatment groups (mean difference in SAQ-7 SS with conservative treatment = 1.6 [95% credible interval: 0.3-2.9] vs with invasive management =1.9 [95% credible interval: 0.8-3.1]), with no interaction by treatment. CONCLUSIONS More than 1 in 4 participants reported medication nonadherence, which was associated with worse health status in both conservative and invasive treatment strategies at baseline and 12 months. Strategies to improve medication adherence are needed to improve health status outcomes in CCD, regardless of treatment strategy. (C) 2022 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.

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