Medication Nonadherence Is Associated With A Broad Range Of Adverse Outcomes In Patients With Corona

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Medication Non-adherence Is Associated With A
Broad Range Of Adverse Outcomes In Patients With
Coronary Artery Disease

• P. Michael Ho, MD, PhD1-3, David J. Magid, MD,
  MPH2,3, Susan M. Shetterly, MS3, Kari L. Olson,
  PharmD, BCPS3, Thomas M. Maddox, MD, MSc1-3,
  Pamela N. Peterson, MD, MSPH2-4, Frederick A.
  Masoudi, MD, MSPH2-4
• John S. Rumsfeld, MD, PhD1-3
• Denver VA Medical Center
• University of Colorado Health Sciences Center
• Institute for Health Research, Kaiser Permanente
  of Colorado
• Denver Health Medical Center

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Disclosure Information
DISCLOSURE INFORMATION This work was supported
by an American Heart Association Scientist
Development Grant (0535086N)
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Background and Objectives

• Efficacy of ß-blockers, ACE-inhibitors, and
  statins demonstrated in clinical trials
• Gap between benefits demonstrated in clinical
  trials and effectiveness of medications in
  clinical practice
• Objective To evaluate the association between
  non-adherence to ß-blockers, ACE-inhibitors, and
  statin medications with a broad range of CV
  adverse outcomes

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Methods

• Setting Integrated, nonprofit managed care
  organization in the Denver, Colorado metropolitan
  area
• Patients 15,567 patients with coronary artery
  disease
• Study design Retrospective cohort study
• Median follow-up 4.1 years
• Medication adherence proportion of days covered
  for ß-blockers, ACE-inhibitors, and statin
  medications
• Non-adherence defined as PDClt0.80
• Outcomes
• All-cause mortality
• Cardiovascular mortality
• Cardiovascular hospitalization for AMI or heart
  failure
• Revascularization procedures including PCI or CABG

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Baseline characteristics
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Rates of non-adherence
n11,865
n13,596
n10,021
Non-adherent patients were younger and more
likely to have COPD and depression
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Non-adherence to cardioprotective medications is
associated with adverse outcomes
B-blockers
Statins
ACE-inhibitors
Coronary Revascularization n2,117
CV Hospitalization n2,008
CV mortality n372
All-cause mortality n1,889
0.5
1.0
2.0
Hazards Ratio
Hospitalization for AMI or heart failure PCI or
CABG
8
Non-adherence to H2 antagonists or proton pump
inhibitors not associated with adverse outcomes
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Conclusions

• 1 in 4 patients were non-adherent
• Non-adherence to cardioprotective medications
  associated with higher risk of adverse outcomes
• Non-adherence to GI medications not associated
  with adverse outcomes
• Suggest lower risk associated with adherence due
  to benefits of cardioprotective medications
  rather than healthy adherer effect
• Expanding current quality of care measures to
  include the assessment of medication adherence
  may be an important quality metric