Choudhry Niteesh K, Setoguchi Soko, Levin Raisa, Winkelmayer Wolfgang C, Shrank William H
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA.
Pharmacoepidemiol Drug Saf. 2008 Dec;17(12):1189-96. doi: 10.1002/pds.1671.
Poor levels of medication adherence for patients with coronary heart disease (CHD) have been documented but it is unclear whether adherence has improved over time.
We assembled a retrospective cohort of lower-income Medicare beneficiaries who were discharged from the hospital after their first acute myocardial infarction (MI) between 1 January 1995 and 31 December 2003. For patients prescribed a statin, ACEI/ARB, beta-blocker, and all 3 of these medications after the hospital discharge, we evaluated medication adherence by determining the proportion of days covered (PDC) for each medication in the subsequent year.
Our cohort consisted of a total of 33 646 patients. Adherence rates for statins and beta-blockers, but not ACEI/ARB, increased significantly over time but remained suboptimal. For example, among those patients that received a statin after discharge, 38.6% were fully adherent with therapy in 1995 in contrast to 56.2% in 2003 (p value for trend<0.001). Of patients prescribed all 3 of statin, beta-blocker, and ACEI/ARB, 29.1% and 46.4% were fully adherent in 1995 and 2003, respectively (p value for trend<0.001).
Our analysis demonstrates statistically significant but modest improvements in medication adherence for statins and beta-blockers, but not ACEI/ARBs, among patients discharged from hospital after acute MI. Despite these improvements, rates of non-adherence to these highly effective therapies remain extremely high. Given the health and economic consequences of non-adherence, the development of cost-effective strategies to improve medication adherence should be a clear priority.
已有文献记载冠心病（CHD）患者的药物依从性较差，但尚不清楚依从性是否随时间有所改善。
我们收集了1995年1月1日至2003年12月31日期间首次急性心肌梗死（MI）后出院的低收入医疗保险受益人的回顾性队列。对于出院后开具他汀类药物、ACEI/ARB、β受体阻滞剂以及这三种药物全部三种的患者，我们通过确定随后一年中每种药物的覆盖天数比例（PDC）来评估药物依从性。
我们的队列共有33646名患者。他汀类药物和β受体阻滞剂的依从率随时间显著增加，但ACEI/ARB的依从率未增加，且依从率仍不理想。例如，在出院后接受他汀类药物治疗的患者中，1995年38.6%的患者完全依从治疗，而2003年这一比例为56.2%（趋势p值<0.001）。开具他汀类药物、β受体阻滞剂和ACEI/ARB全部三种药物的患者中，1995年和2003年分别有29.1%和46.4%的患者完全依从（趋势p值<0.001）。
我们的分析表明，急性心肌梗死后出院的患者中，他汀类药物和β受体阻滞剂的药物依从性有统计学意义但改善幅度不大，而ACEI/ARB的依从性未改善。尽管有这些改善，但对这些高效疗法的不依从率仍然极高。鉴于不依从的健康和经济后果，制定具有成本效益的策略来提高药物依从性应成为明确的优先事项。
