Predictors of long-term adherence to evidence-based cardiovascular disease medications in outpatients with stable atherothrombotic disease

Findings from the REACH registry

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

Research output: Contribution to journalArticle

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Abstract

Background Despite overall improvements in cardiovascular-disease therapies and outcomes, medication nonadherence remains an important barrier to effective secondary prevention of atherothrombotic disease. Hypothesis Long-term medication adherence in outpatients with stable atherothrombotic disease is impacted by demographic and clinical factors. Methods We examined data from the prospective international Reduction of Atherothrombosis for Continued Health (REACH) Registry. Analyses were derived from 25 737 patients with established atherothrombotic disease with complete adherence data at enrollment and at year 4. Adherence was defined as patients' self-report of taking medications based on class I American College of Cardiology/American Heart Association guidelines for secondary prevention as defined, including antiplatelet agents, statins, and antihypertensive medications. Results Among patients with atherothrombotic disease, 12 500 (48.6%) were deemed adherent to guideline-recommended medications. Adherent patients were younger, white, and had less polyvascular disease. Hispanic and East Asian patients were less likely to be adherent as compared with white patients (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.59-0.88; and OR: 0.67, 95% CI: 0.53-0.83, respectively). Patients who had a nonfatal MI or underwent coronary angioplasty/stenting during follow-up were more likely to be adherent compared with patients without these events (OR: 1.73, 95% CI: 1.25-2.38; and OR: 2.15, 95% CI: 1.72-2.67, respectively). On the other hand, nonfatal stroke during follow-up was inversely associated with adherence (OR: 0.77, 95% CI: 0.61-0.97). Conclusions Using a large international registry of outpatients with atherothrombotic disease, we found that age, region, race/ethnicity, and incident cardiovascular events were predictive of long-term guideline adherence for secondary prevention, suggesting that certain patient groups may benefit from targeted interventions to improve adherence.

Original languageEnglish (US)
Pages (from-to)721-727
Number of pages7
JournalClinical Cardiology
Volume36
Issue number12
DOIs
StatePublished - Dec 2013

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Registries
Outpatients
Cardiovascular Diseases
Health
Odds Ratio
Confidence Intervals
Secondary Prevention
Medication Adherence
Guidelines
Guideline Adherence
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Platelet Aggregation Inhibitors
Angioplasty
Hispanic Americans
Self Report
Antihypertensive Agents
Stroke
Demography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Predictors of long-term adherence to evidence-based cardiovascular disease medications in outpatients with stable atherothrombotic disease : Findings from the REACH registry. / Rodriguez, Fátima; Cannon, Christopher P.; Steg, Ph Gabriel; Kumbhani, Dharam J.; Goto, Shinya; Smith, Sidney C.; Eagle, Kim A.; Ohman, E. Magnus; Umez-Eronini, Amarachi A.; Hoffman, Elaine; Bhatt, Deepak L.

In: Clinical Cardiology, Vol. 36, No. 12, 12.2013, p. 721-727.

Research output: Contribution to journalArticle

Rodriguez, F, Cannon, CP, Steg, PG, Kumbhani, DJ, Goto, S, Smith, SC, Eagle, KA, Ohman, EM, Umez-Eronini, AA, Hoffman, E & Bhatt, DL 2013, 'Predictors of long-term adherence to evidence-based cardiovascular disease medications in outpatients with stable atherothrombotic disease: Findings from the REACH registry', Clinical Cardiology, vol. 36, no. 12, pp. 721-727. https://doi.org/10.1002/clc.22217
Rodriguez, Fátima ; Cannon, Christopher P. ; Steg, Ph Gabriel ; Kumbhani, Dharam J. ; Goto, Shinya ; Smith, Sidney C. ; Eagle, Kim A. ; Ohman, E. Magnus ; Umez-Eronini, Amarachi A. ; Hoffman, Elaine ; Bhatt, Deepak L. / Predictors of long-term adherence to evidence-based cardiovascular disease medications in outpatients with stable atherothrombotic disease : Findings from the REACH registry. In: Clinical Cardiology. 2013 ; Vol. 36, No. 12. pp. 721-727.
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abstract = "Background Despite overall improvements in cardiovascular-disease therapies and outcomes, medication nonadherence remains an important barrier to effective secondary prevention of atherothrombotic disease. Hypothesis Long-term medication adherence in outpatients with stable atherothrombotic disease is impacted by demographic and clinical factors. Methods We examined data from the prospective international Reduction of Atherothrombosis for Continued Health (REACH) Registry. Analyses were derived from 25 737 patients with established atherothrombotic disease with complete adherence data at enrollment and at year 4. Adherence was defined as patients' self-report of taking medications based on class I American College of Cardiology/American Heart Association guidelines for secondary prevention as defined, including antiplatelet agents, statins, and antihypertensive medications. Results Among patients with atherothrombotic disease, 12 500 (48.6{\%}) were deemed adherent to guideline-recommended medications. Adherent patients were younger, white, and had less polyvascular disease. Hispanic and East Asian patients were less likely to be adherent as compared with white patients (odds ratio [OR]: 0.72, 95{\%} confidence interval [CI]: 0.59-0.88; and OR: 0.67, 95{\%} CI: 0.53-0.83, respectively). Patients who had a nonfatal MI or underwent coronary angioplasty/stenting during follow-up were more likely to be adherent compared with patients without these events (OR: 1.73, 95{\%} CI: 1.25-2.38; and OR: 2.15, 95{\%} CI: 1.72-2.67, respectively). On the other hand, nonfatal stroke during follow-up was inversely associated with adherence (OR: 0.77, 95{\%} CI: 0.61-0.97). Conclusions Using a large international registry of outpatients with atherothrombotic disease, we found that age, region, race/ethnicity, and incident cardiovascular events were predictive of long-term guideline adherence for secondary prevention, suggesting that certain patient groups may benefit from targeted interventions to improve adherence.",
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AU - Steg, Ph Gabriel

AU - Kumbhani, Dharam J.

AU - Goto, Shinya

AU - Smith, Sidney C.

AU - Eagle, Kim A.

AU - Ohman, E. Magnus

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