Persistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study

Abstract

Background: Persistent use of secondary prevention therapies after acute myocardial infarction (MI) is critical to optimizing long-term outcomes.

Methods: Medication persistence was assessed among 7,955 MI patients in 216 hospitals participating in the Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome study from 2010 to 2012. Persistence was defined as continuation of aspirin, adenosine diphosphate receptor inhibitors, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins from discharge to 6 months post-MI. Multivariable logistic regression modeling was used to determine factors associated with nonpersistence, defined as <80% persistence with all medication classes.

Results: Overall, 31% of MI patients stopped taking a least 1 medication by 6 months. The most common reasons cited for medications discontinuation were side effects and physician instruction (57%), whereas financial concerns were cited in 8% overall. After multivariable modeling, black race (odds ratio 1.36, 95% CI 1.15-1.62), older age (odds ratio 1.07, 95% CI 1.02-1.12), atrial fibrillation (odds ratio 1.67, 95% CI 1.33-2.09), dialysis (odds ratio 1.79, 95% CI 1.15-2.78), and depression (odds ratio 1.22, 95% CI 1.02-1.45) were associated with lower likelihood of persistence. Private insurance (odds ratio 0.85, 95% 0.76-0.95), prescription cost assistance (odds ratio 0.63, 95% CI 0.54-0.75), and outpatient follow-up arranged before discharge (odds ratio 0.89, 95% CI 0.80-0.99) were associated with higher persistence.

Conclusions: Nearly one-third of MI patients are no longer persistent with their prescribed medications by 6 months. Patients at high risk for nonpersistence may be identified by clinical and sociodemographic features. These observations underscore key opportunities to optimize longitudinal use of secondary prevention therapies.

Trial registration: ClinicalTrials.gov NCT01088503.

Conflict of interest statement

Conflict of Interest Disclosures

R Mathews: Dr. Mathews has no relevant disclosures to report.

TY Wang: Dr. Wang reports research funding from AstraZeneca, Gilead, Lilly, The Medicines Company, and Canyon Pharmaceuticals (all significant); educational activities or lectures (generates money for Duke) for AstraZeneca (modest); consulting (including CME) for Medco (modest) and American College of Cardiology (significant).

E Honeycutt: Ms. Honeycutt has no relevant disclosures to report.

TD Henry: Dr. Henry has no relevant disclosures to report.

M Zettler: Dr. Zettler reports being an employee of Eli Lilly & Company.

M Chang: Dr. Chang has no relevant disclosures to report.

GC Fonarow: Dr. Fonarow reports being a consultant to Novartis (significant) and Janssen (modest).

ED Peterson: Dr. Peterson reports research funding for the American College of Cardiology, American Heart Association, Eli Lilly & Company, Janssen Pharmaceuticals, and Society of Thoracic Surgeons (all significant); consulting (including CME) for Merck & Co. (modest), Boehringer Ingelheim, Genentech, Janssen Pharmaceuticals, and Sanofi-Aventis (all significant).

Copyright © 2015 Elsevier Inc. All rights reserved.

Figures

Figure. Forest Plot

This figure displays significant factors associated with medication non-persistence. Other variables included in model: gender, ejection fraction, financial hardship with medication expenses, non-Hispanic, prior myocardial infarction, prior percutaneous intervention, prior heart failure, diabetes, hypertension, prior cerebrovascular accident/transient ischemic attack, smoker, dyslipidemia, gastrointestinal/genitourinary bleed, in-hospital bleeding, peripheral artery disease, discharge to home, cardiac rehab referral, EQ5D score, married, ≥ high school graduation, employed, written discharge medication list/instructions, explanation for medication and potential side effects, out of pocket med expenses. Moderate exercise = at least 1 day a week of ≥20 minutes of exercise. OR listed with 95% confidence intervals. CABG, coronary artery bypass graft surgery; EQ-5D, EuroQol-5 Dimensions; OR, odds ratio