Adherence to evidence-based therapies after discharge for acute coronary syndromes: an ongoing prospective, observational study
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Authors
Eagle, Kim A.Kline-Rogers, Eva M.
Goodman, Shaun G.
Gurfinkel, Enrique P.
Avezum, Alvaro
Flather, Marcus D.
Granger, Christopher B.
Erickson, Steve
White, Kami
Steg, Phillippe Gabriel
GRACE Investigators
UMass Chan Affiliations
Center for Outcomes ResearchDocument Type
Journal ArticlePublication Date
2004-07-06Keywords
Acute DiseaseAdrenergic beta-Antagonists
Aged
Aged, 80 and over
Americas
Angiotensin-Converting Enzyme Inhibitors
Aspirin
Australasia
Coronary Disease
Europe
*Evidence-Based Medicine
Female
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Male
Middle Aged
Myocardial Infarction
*Patient Compliance
Platelet Aggregation Inhibitors
Prospective Studies
Syndrome
Treatment Outcome
Health Services Research
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PURPOSE: To determine the rates of patient adherence to key evidence-based therapies at 6 months after hospital discharge for an acute coronary syndrome. METHODS: In this nonrandomized, prospective, multinational, multicenter study, adherence to aspirin, beta-blockers, statins, or angiotensin-converting enzyme (ACE) inhibitors 6 months after discharge for myocardial infarction or unstable angina was assessed in 21,408 patients aged 18 years or older. Patients were enrolled at 104 tertiary and community hospitals representing a broad range of care facilities and practice settings (e.g., teaching vs. nonteaching). RESULTS: Of 13,830 patients, discontinuation of therapy was observed at 6-month follow-up in 8% of those taking aspirin on discharge, 12% of those taking beta-blockers, 20% of those taking ACE inhibitors, and 13% of those taking statins. In a multivariate analysis, adherence to beta-blocker therapy was higher in patients with a myocardial infarction (odds ratio [OR] = 1.25; 95% confidence interval [CI]: 1.06 to 1.47), hypertension (OR = 1.33; 95% CI: 1.15 to 1.54), ST-segment elevation myocardial infarction (OR = 1.33; 95% CI: 1.11 to 1.61), or non-ST-segment elevation myocardial infarction (OR = 1.25; 95% CI: 1.08 to 1.45). Aspirin adherence was higher among patients cared for by cardiologists (OR = 1.45; 95% CI: 1.19 to 1.75; P <0.001) than among those cared for by nonspecialists. Male sex and prior heart failure were associated with improved adherence to ACE inhibitor therapy. Hypertension was associated with poorer adherence to statin therapy (OR = 0.85; 95% CI: 0.74 to 0.99; P = 0.04). CONCLUSION: Among patients prescribed key evidence-based medications at discharge, 8% to 20% were no longer taking their medication after 6 months. The reasons for noncompliance are complex, and may be elucidated by future studies of medical and social determinants.Source
Am J Med. 2004 Jul 15;117(2):73-81. Link to article on publisher's siteDOI
10.1016/j.amjmed.2003.12.041Permanent Link to this Item
http://hdl.handle.net/20.500.14038/27256PubMed ID
15234641Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.amjmed.2003.12.041