Abstract
BackgroundMedication adherence is a recognized key factor of secondary cardiovascular disease prevention. Cardiac rehabilitation increases medication adherence and adherence to lifestyle changes. This study aimed to evaluate the impact of in-hospital cardiac rehabilitation (IH-CR) on medication adherence as well as other cardiovascular outcomes, following an acute myocardial infarction (AMI).MethodsThis is a population-based study. Data were obtained from the Health Information Systems of the Lazio Region, Italy (5 million inhabitants). Hospitalized patients aged ≥ 18 years with an incident AMI in 2013–2015 were investigated. We divided the whole cohort into 4 groups of patients: ST-elevation AMI (STEMI) and non-ST-elevation AMI (NSTEMI) who underwent or not percutaneous coronary intervention (PCI) during the hospitalization. Primary outcome was medication adherence. Adherence to chronic poly-therapy, based on prescription claims for both 6- and 12-month follow-up, was defined as Medication Possession Ratio (MPR) ≥ 75% to at least 3 of the following medications: antiplatelets, β-blockers, ACEI/ARBs, statins. Secondary outcomes were all-cause mortality, hospital readmission for cardiovascular and cerebrovascular event (MACCE), and admission to the emergency department (ED) occurring within a 3-year follow-up period.ResultsA total of 13.540 patients were enrolled. The median age was 67 years, 4.552 (34%) patients were female. Among the entire cohort, 1.101 (8%) patients attended IH-CR at 33 regional sites. Relevant differences were observed among the 4 groups previously identified (from 3 to 17%). A strong association between the IH-CR participation and medication adherence was observed among AMI patients who did not undergo PCI, for both 6- and 12-month follow-up. Moreover, NSTEMI-NO-PCI participants had lower risk of all-cause mortality (adjusted IRR 0.76; 95% CI 0.60–0.95), hospital readmission due to MACCE (IRR 0.78; 95% CI 0.65–0.94) and admission to the ED (IRR 0.80; 95% CI 0.70–0.91).ConclusionsOur findings highlight the benefits of IH-CR and support clinical guidelines that consider CR an integral part in the treatment of coronary artery disease. However, IH-CR participation was extremely low, suggesting the need to identify and correct the barriers to CR participation for this higher-risk group of patients.
Highlights
Medication adherence is a recognized key factor of secondary cardiovascular disease prevention
The study results showed that IH-Cardiac rehabilitation (CR) participation, was associated with 24% of risk reduction of mortality (IRR 0.76; 95% confidence intervals (95% CI) 0.60–0.95; p value: 0.021), 22% of MACCE readmission (IRR 0.78; 95% CI 0.65–0.94; p value: 0.011), and 20% of emergency department (ED) admission (IRR 0.80; 95% CI 0.70–0.91; p value: 0.001)
We revealed the association between in-hospital cardiac rehabilitation (IH-CR) and clinical outcomes among subgroups of acute myocardial infarction (AMI) patients
Summary
Medication adherence is a recognized key factor of secondary cardiovascular disease prevention. Several studies have shown that participation in CR after acute myocardial infarction (AMI) is safe and effective to reduce morbidity, mortality, and hospital readmission rates by improving both risk factors’ control and adherence to treatments [2,3,4,5]. Despite these proven benefits, the referral of patients to CR is surprisingly low both in the hospital and in the ambulatory settings [6,7,8]. Adherence and persistence to chronic poly-therapy is a key factor in secondary prevention since it is associated with a lower risk of mortality and recurrent events [11,12,13,14,15]
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