期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 70, 期 13, 页码 1543-1554出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2017.07.783
关键词
medication adherence; myocardial infarction; older adults; secondary prevention
资金
- National Institute of Aging (NIA) [1R01AG046267-01A1, 1R21AG043668-01A1]
- Australian National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Frailty and Healthy Ageing
- Amarin
- Amgen
- AstraZeneca
- Eli Lilly
- Esai
- Esperion
- GlaxoSmithKline
- Merck
- Pfizer
- Regeneron/Sanofi
- Takeda
- Biosense Webster
- Medtronic
- St. Jude Medical
- Boehringer Ingelheim
- Merck Sharp and Dohme
BACKGROUND Angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB), beta-blockers and statins are recommended after acute myocardial infarction (AMI). Patients may adhere to some, but not all, therapies. OBJECTIVES The authors investigated the effect of tradeoffs in adherence to ACE inhibitors/ARBs, beta-blockers, and statins on survival among older people after AMI. METHODS The authors identified 90,869 Medicare beneficiaries >= 65 years of age who had prescriptions for ACE inhibitors/ARBs, beta-blockers, and statins, and survived >= 180 days after AMI hospitalization in 2008 to 2010. Adherence was measured by proportion of days covered (PDC) during 180 days following hospital discharge. Mortality follow-up extended up to 18 months after this period. The authors used Cox proportional hazards models to estimate hazard ratios of mortality for groups adherent to 2, 1, or none of the therapies versus group adherent to all 3 therapies. RESULTS Only 49% of the patients adhered (PDC >= 80%) to all 3 therapies. Compared with being adherent to all 3 therapies, multivariable-adjusted hazard ratios (95% confidence intervals [ CIs]) for mortality were 1.12 (95% CI: 1.04 to 1.21) for being adherent to ACE inhibitors/ARBs and beta-blockers only, 0.98 (95% CI: 0.91 to 1.07) for ACEI/ARBs and statins only, 1.17 (95% CI: 1.10 to 1.25) beta-blockers and statins only, 1.19 (95% CI: 1.07 to 1.32) for ACE inhibitors/ARBs only, 1.32 (95% CI: 1.21 to 1.44) for beta-blockers only, 1.26 (95% CI: 1.15 to 1.38) statins only, and 1.65 (95% CI: 1.54 to 1.76) for being nonadherent (PDC <80%) to all 3 therapies. CONCLUSIONS Patients adherent to ACE inhibitors/ARBs and statins only had similar mortality rates as those adherent to all 3 therapies, suggesting limited additional benefit for beta-blockers in patients who were adherent to statins and ACE inhibitors/ARBs. Nonadherence to ACE inhibitors/ARBs and/or statins was associated with higher mortality. (C) 2017 by the American College of Cardiology Foundation.
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