VA Puget Sound Health Care System, Seattle, WA; Division of Cardiology, University of Washington, Seattle, WA.
Duke Clinical Research Institute, Durham, NC.
Am Heart J. 2019 Feb;208:74-80. doi: 10.1016/j.ahj.2018.11.004. Epub 2018 Nov 15.
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.
We assessed adherence to P2Y 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 inhibitor adherence. As few patients were on P2Y inhibitors pre-MI, we also examined the association of pre-MI statin adherence with post-MI P2Y inhibitor and statin adherence.
Pre-MI medication nonadherence was observed in 427 of 2,633 (16%) patients on preadmission P2Y 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 inhibitors pre-MI were substantially less likely to adhere to P2Y 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 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).
Prior medication adherence predicts post-MI adherence to P2Y 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.
心肌梗死后（MI）不遵医嘱服用最佳药物治疗与支架血栓形成、心血管事件再发和死亡等不良临床结局相关。在心肌梗死后，患者是否在 MI 前就遵医嘱服用药物，这是否会预测 MI 后患者的服药依从性尚不清楚。
我们评估了 8147 例医疗保险（Medicare）中有 Part D 处方覆盖的 MI 患者在 MI 入院前后对 P2Y 抑制剂和他汀类药物的服用依从性。服用依从性定义为药物覆盖率≥80%的天数比例。多变量逻辑回归用于评估 MI 前和 MI 后 P2Y 抑制剂服用依从性之间的关联。由于很少有患者在 MI 前使用 P2Y 抑制剂，我们还检查了 MI 前他汀类药物服用依从性与 MI 后 P2Y 抑制剂和他汀类药物服用依从性之间的关联。
在 2633 例接受 MI 前 P2Y 抑制剂治疗的患者中，有 427 例（16%）和 6934 例接受 MI 前他汀类药物治疗的患者中，有 1233 例（18%）患者存在药物不依从性。不依从的患者更可能是非白人种族，且有多次住院史。MI 前 P2Y 抑制剂不依从的患者在 90 天（校正比值比[OR]0.33，95%CI 0.25-0.43）和 MI 后 1 年（校正 OR 0.29，95%CI 0.21-0.39）时，更不可能依从 P2Y 抑制剂治疗，与 MI 前依从的患者相比。MI 前他汀类药物不依从与 MI 后 90 天（校正 OR 0.65，95%CI 0.53-0.79）和 1 年（校正 OR 0.37，95%CI 0.29-0.54）时 P2Y 抑制剂的依从性降低相关。
既往药物服用依从性可预测 MI 后 P2Y 抑制剂的服用依从性。增加医疗记录中药物服用依从性数据的可及性可能是识别 MI 后药物服用依从性较差的高危患者并将改善药物服用依从性作为治疗目标的重要工具。
