Adherence to secondary prevention medications and four-year outcomes in outpatients with atherosclerosis

Dharam J. Kumbhani, Ph Gabriel Steg, Christopher P. Cannon, Kim A. Eagle, Sidney C. Smith, Elaine Hoffman, Shinya Goto, E. Magnus Ohman, Deepak L. Bhatt

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Background: Although nonadherence with evidence-based secondary prevention medications is common in patients with established atherothrombotic disease, long-term outcomes studies are scant. We assessed the prevalence and long-term outcomes of nonadherence to secondary prevention (antiplatelet agents, statins, and antihypertensive agents) medications in stable outpatients with established atherothrombosis (coronary, cerebrovascular, or peripheral artery disease) enrolled in the international REduction of Atherothrombosis for Continued Health registry. Methods: Adherence with these medications in eligible patients at baseline and 1-year follow-up was assessed. The primary outcome was a composite of cardiovascular death, myocardial infarction, or stroke at 4 years. Results: A total of 37,154 patients with established atherothrombotic disease were included. Adherence rates with all evidence-based medications at baseline and 1 year were 46.7% and 48.2%, respectively. Nonadherence with any medication at baseline (hazard ratio, 1.18; 95% confidence interval, 1.11-1.25) and at 1 year (hazard ratio, 1.19; 95% confidence interval, 1.11-1.28) were both significantly associated with an increased risk of the primary end point. The risk of all-cause mortality was similarly elevated. Corresponding numbers needed to treat were 31 and 25 patients for the composite end point and total mortality, respectively. This also was true for each disease-specific subgroup. Patients who were fully adherent at both time points had the lowest incidence of adverse outcomes, whereas patients who were nonadherent at both time points had the worst outcomes (P <.01). Conclusions: Our analysis of a large international registry demonstrates that nonadherence with evidence-based secondary prevention therapies in patients with established atherothrombosis is associated with a significant increase in long-term adverse events, including mortality.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
Volume126
Issue number8
DOIs
StatePublished - Aug 2013

Fingerprint

Secondary Prevention
Atherosclerosis
Outpatients
Registries
Mortality
Confidence Intervals
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Numbers Needed To Treat
Medication Adherence
Peripheral Arterial Disease
Platelet Aggregation Inhibitors
Antihypertensive Agents
Coronary Artery Disease
Stroke
Myocardial Infarction
Outcome Assessment (Health Care)
Incidence
Health

Keywords

  • Atherosclerosis
  • Cardiovascular disease
  • Compliance/adherence
  • Registry
  • Secondary prevention

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Adherence to secondary prevention medications and four-year outcomes in outpatients with atherosclerosis. / Kumbhani, Dharam J.; Steg, Ph Gabriel; Cannon, Christopher P.; Eagle, Kim A.; Smith, Sidney C.; Hoffman, Elaine; Goto, Shinya; Ohman, E. Magnus; Bhatt, Deepak L.

In: American Journal of Medicine, Vol. 126, No. 8, 08.2013.

Research output: Contribution to journalArticle

Kumbhani, Dharam J. ; Steg, Ph Gabriel ; Cannon, Christopher P. ; Eagle, Kim A. ; Smith, Sidney C. ; Hoffman, Elaine ; Goto, Shinya ; Ohman, E. Magnus ; Bhatt, Deepak L. / Adherence to secondary prevention medications and four-year outcomes in outpatients with atherosclerosis. In: American Journal of Medicine. 2013 ; Vol. 126, No. 8.
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T1 - Adherence to secondary prevention medications and four-year outcomes in outpatients with atherosclerosis

AU - Kumbhani, Dharam J.

AU - Steg, Ph Gabriel

AU - Cannon, Christopher P.

AU - Eagle, Kim A.

AU - Smith, Sidney C.

AU - Hoffman, Elaine

AU - Goto, Shinya

AU - Ohman, E. Magnus

AU - Bhatt, Deepak L.

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N2 - Background: Although nonadherence with evidence-based secondary prevention medications is common in patients with established atherothrombotic disease, long-term outcomes studies are scant. We assessed the prevalence and long-term outcomes of nonadherence to secondary prevention (antiplatelet agents, statins, and antihypertensive agents) medications in stable outpatients with established atherothrombosis (coronary, cerebrovascular, or peripheral artery disease) enrolled in the international REduction of Atherothrombosis for Continued Health registry. Methods: Adherence with these medications in eligible patients at baseline and 1-year follow-up was assessed. The primary outcome was a composite of cardiovascular death, myocardial infarction, or stroke at 4 years. Results: A total of 37,154 patients with established atherothrombotic disease were included. Adherence rates with all evidence-based medications at baseline and 1 year were 46.7% and 48.2%, respectively. Nonadherence with any medication at baseline (hazard ratio, 1.18; 95% confidence interval, 1.11-1.25) and at 1 year (hazard ratio, 1.19; 95% confidence interval, 1.11-1.28) were both significantly associated with an increased risk of the primary end point. The risk of all-cause mortality was similarly elevated. Corresponding numbers needed to treat were 31 and 25 patients for the composite end point and total mortality, respectively. This also was true for each disease-specific subgroup. Patients who were fully adherent at both time points had the lowest incidence of adverse outcomes, whereas patients who were nonadherent at both time points had the worst outcomes (P <.01). Conclusions: Our analysis of a large international registry demonstrates that nonadherence with evidence-based secondary prevention therapies in patients with established atherothrombosis is associated with a significant increase in long-term adverse events, including mortality.

AB - Background: Although nonadherence with evidence-based secondary prevention medications is common in patients with established atherothrombotic disease, long-term outcomes studies are scant. We assessed the prevalence and long-term outcomes of nonadherence to secondary prevention (antiplatelet agents, statins, and antihypertensive agents) medications in stable outpatients with established atherothrombosis (coronary, cerebrovascular, or peripheral artery disease) enrolled in the international REduction of Atherothrombosis for Continued Health registry. Methods: Adherence with these medications in eligible patients at baseline and 1-year follow-up was assessed. The primary outcome was a composite of cardiovascular death, myocardial infarction, or stroke at 4 years. Results: A total of 37,154 patients with established atherothrombotic disease were included. Adherence rates with all evidence-based medications at baseline and 1 year were 46.7% and 48.2%, respectively. Nonadherence with any medication at baseline (hazard ratio, 1.18; 95% confidence interval, 1.11-1.25) and at 1 year (hazard ratio, 1.19; 95% confidence interval, 1.11-1.28) were both significantly associated with an increased risk of the primary end point. The risk of all-cause mortality was similarly elevated. Corresponding numbers needed to treat were 31 and 25 patients for the composite end point and total mortality, respectively. This also was true for each disease-specific subgroup. Patients who were fully adherent at both time points had the lowest incidence of adverse outcomes, whereas patients who were nonadherent at both time points had the worst outcomes (P <.01). Conclusions: Our analysis of a large international registry demonstrates that nonadherence with evidence-based secondary prevention therapies in patients with established atherothrombosis is associated with a significant increase in long-term adverse events, including mortality.

KW - Atherosclerosis

KW - Cardiovascular disease

KW - Compliance/adherence

KW - Registry

KW - Secondary prevention

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