Abstract
Objective: To investigate long-term adherence to guideline-recommended cardioprotective medications following hospitalization for an acute myocardial infarction (AMI), and identify characteristics associated with adherence. Methods: An Australian population-based cohort study was used to identify participants who had their first AMI between 2006 and 2014 and were alive after 12 months. Linked routinely collected hospital, and prescription medication claims data was used to study adherence over time. Predictors and rates of adherence to both lipid-lowering medication and renin-angiotensin system blockade at 12 months post-AMI was assessed. Results: 14,200 people (mean age 69.9 years, 38.7% female) were included in our analysis. At 12 months post-AMI, 29.5% (95% CI: 28.8–30.3%) of people were adherent to both classes of medication. Individuals receiving treatment with both lipid-lowering medication and renin-angiotensin system blockade during the 6 months prior to their AMI were over 9 times more likely to be adherent to both medications at 12 months post-AMI (66.2% 95% CI: 64.8–67.5%) compared to those with no prior medication use (treatment naïve) (7.1%, 95% CI: 6.4–7.9%). Prior cardiovascular treatment was the strongest predictor of long-term adherence even after adjusting for age, sex, education and income. Conclusions: Despite efforts to improve long-term medication adherence in patients who have experienced an acute coronary event, considerable gaps remain. Of particular concern are people who are commencing guideline-recommended cardioprotective medication at the time of their AMI. The relationship between prior cardiovascular treatments and post AMI adherence offers insight into the support needs for the patient. Health care intervention strategies, strengthened by enabling policies, are needed to provide support to patients through the initial months following their AMI.
Highlights
Cardiovascular disease (CVD) remains the leading cause of death globally, despite considerable advances in effective preventive treatments
The 45 and Up Study is an Australian populationbased cohort study of 267,153 men and women aged ≥45 years who were randomly sampled from the general population of New South Wales (NSW), using the Services Australia enrolment database
14,200 individuals were identified as surviving an index Acute myocardial infarction (AMI) between 2006 and 2014 and meeting the eligibility criteria (Supplementary Appendix Supplementary Figure S2)
Summary
Cardiovascular disease (CVD) remains the leading cause of death globally, despite considerable advances in effective preventive treatments. Guidelines for the management of absolute cardiovascular disease risk, 2012; Roffi et al, 2016; Ibanez et al, 2017; Karmali and Lloyd-Jones, 2017) These include both lipid-lowering and blood pressure-lowering medications. Relative risk reductions in subsequent coronary events are estimated to be around 20% for every 10 mmHg reduction in blood pressure (Karmali and Lloyd-Jones, 2017) and 24% for every 1 mmol/L decline in low density lipoprotein (LDL) cholesterol (Armitage et al, 2019; Yusuf et al, 2000). Despite this compelling evidence, gaps in recommended medication use of up to 50% have been observed. Gaps in recommended medication use of up to 50% have been observed. (Sabate, 2003; Heeley et al, 2010; Hall et al, 2016)
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