TY - JOUR
T1 - The association of pre- and posthospital medication adherence in myocardial infarction patients
AU - Doll, Jacob A.
AU - Hellkamp, Anne S.
AU - Thomas, Laine
AU - Fonarow, Gregg C.
AU - Peterson, Eric
AU - Wang, Tracy Y.
N1 - Funding Information:
J. A. Doll, A. S. Hellkamp, and L. Thomas have no potential conflicts of interest to disclose. G. C. Fonarow reports consulting from Amgen (modest), Bayer (modest), Janssen (modest), and Novartis (significant). E. D. Peterson reports research grants from Abiomed (modest), Amgen (modest), AstraZeneca (modest), Bayer AG (modest), Genentech (modest), Janssen Pharmaceutical (modest), Merck (modest), Novartis (modest), Regeneron (modest), Sanofi-Aventis (modest), and Society of Thoracic Surgeons (modest), and consulting/honoraria from Bayer AG (significant), Janssen Pharmaceutical (significant), Sanofi-Aventis (significant), and Livongo (modest). T. Y. Wang reports research grants from AstraZeneca (modest), Boston Scientific Corporation (modest), CryoLife Inc (modest), Daiichi Sankyo Company (modest), Eli Lilly & Company (modest), Gilead (modest), Novartis Pharmaceutical (modest), and Regeneron Pharmaceuticals (modest), and consulting/honoraria from AstraZeneca (significant), Bristol Myers Squibb (significant), Gilead (significant), Merck (significant), Pfizer (significant), and Sanofi-Aventis (significant).
Funding Information:
Funding source: This project was supported by grant U19HS021092 from the Agency for Healthcare Research and Quality (AHRQ). The AHRQ had no role in the design and conduct of the study.We used administrative claims from a 5% random sample of Medicare beneficiaries aged greater than or equal to 65 years to assess clinical characteristics and pharmacy fill history of patients hospitalized with MI from 2007 to 2013. Patients were eligible for inclusion if admitted with primary or secondary diagnosis code for MI (410.x1) and enrolled in Medicare Part A (inpatient) and B (outpatient) for at least 1 year prior to admission.15,16 Claims from the year preceding MI were used to define medical comorbid conditions. This project was supported by grant U19HS021092 from the Agency for Healthcare Research and Quality (AHRQ). The AHRQ had no role in the design and conduct of the study.
Publisher Copyright:
© 2018
PY - 2019/2
Y1 - 2019/2
N2 - Background: Nonadherence to optimal medical therapy following myocardial infarction (MI) is associated with adverse clinical outcomes such as stent thrombosis, recurrent cardiovascular events, and death. Whether adherence to medications prior to MI predicts post-MI medication adherence is unknown. Methods: We assessed adherence to P2Y 12 inhibitors and statins before and after admission for MI among 8,147 MI patients who had Medicare insurance with Part D prescription coverage. Adherence was defined as a proportion of days covered with medication fills ≥80%. Multivariable logistic regression was used to assess the association between pre- and post-MI P2Y 12 inhibitor adherence. As few patients were on P2Y 12 inhibitors pre-MI, we also examined the association of pre-MI statin adherence with post-MI P2Y 12 inhibitor and statin adherence. Results: Pre-MI medication nonadherence was observed in 427 of 2,633 (16%) patients on preadmission P2Y 12 inhibitors and 1,233 of 6,934 (18%) patients on preadmission statins. Nonadherent patients were more likely to be of nonwhite race and have multiple prior hospital admissions. Patients who were nonadherent to P2Y 12 inhibitors pre-MI were substantially less likely to adhere to P2Y 12 inhibitors at 90 days (adjusted odds ratio [OR] 0.33, 95% CI 0.25-0.43) and 1 year post-MI (adjusted OR 0.29, 95% CI 0.21–0.39) compared with patients who were adherent pre-MI. Pre-MI statin nonadherence was also associated with lower post-MI adherence to P2Y 12 inhibitors at 90 days (adjusted OR 0.65, 95% CI 0.53-0.79) and 1 year (adjusted OR 0.37, 95% CI 0.29-0.54). Conclusions: Prior medication adherence predicts post-MI adherence to P2Y 12 inhibitors. Increasing accessibility of medication adherence data in the medical record may be an important tool to identify patients at higher risk for post-MI medication nonadherence and target efforts to improve adherence.
AB - Background: Nonadherence to optimal medical therapy following myocardial infarction (MI) is associated with adverse clinical outcomes such as stent thrombosis, recurrent cardiovascular events, and death. Whether adherence to medications prior to MI predicts post-MI medication adherence is unknown. Methods: We assessed adherence to P2Y 12 inhibitors and statins before and after admission for MI among 8,147 MI patients who had Medicare insurance with Part D prescription coverage. Adherence was defined as a proportion of days covered with medication fills ≥80%. Multivariable logistic regression was used to assess the association between pre- and post-MI P2Y 12 inhibitor adherence. As few patients were on P2Y 12 inhibitors pre-MI, we also examined the association of pre-MI statin adherence with post-MI P2Y 12 inhibitor and statin adherence. Results: Pre-MI medication nonadherence was observed in 427 of 2,633 (16%) patients on preadmission P2Y 12 inhibitors and 1,233 of 6,934 (18%) patients on preadmission statins. Nonadherent patients were more likely to be of nonwhite race and have multiple prior hospital admissions. Patients who were nonadherent to P2Y 12 inhibitors pre-MI were substantially less likely to adhere to P2Y 12 inhibitors at 90 days (adjusted odds ratio [OR] 0.33, 95% CI 0.25-0.43) and 1 year post-MI (adjusted OR 0.29, 95% CI 0.21–0.39) compared with patients who were adherent pre-MI. Pre-MI statin nonadherence was also associated with lower post-MI adherence to P2Y 12 inhibitors at 90 days (adjusted OR 0.65, 95% CI 0.53-0.79) and 1 year (adjusted OR 0.37, 95% CI 0.29-0.54). Conclusions: Prior medication adherence predicts post-MI adherence to P2Y 12 inhibitors. Increasing accessibility of medication adherence data in the medical record may be an important tool to identify patients at higher risk for post-MI medication nonadherence and target efforts to improve adherence.
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U2 - 10.1016/j.ahj.2018.11.004
DO - 10.1016/j.ahj.2018.11.004
M3 - Article
C2 - 30580129
AN - SCOPUS:85058958866
VL - 208
SP - 74
EP - 80
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
ER -