Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.
Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
Res Social Adm Pharm. 2021 Sep;17(9):1631-1635. doi: 10.1016/j.sapharm.2021.01.003. Epub 2021 Jan 7.
Medication adherence to guideline-recommended therapy is important and associated with a lower rate of death and major adverse cardiovascular events (MACE) among patients with acute coronary syndrome (ACS).
This retrospective study aimed to evaluate medication adherence in four classes of guideline-recommended medicines (antiplatelets, ACEIs/ARBs, beta-blockers, and statins) among patients discharged with ACS and to assess the association between patients' adherence to each medication and the occurrence of MACE including all causes of death, myocardial infarction, unstable angina, heart failure, stroke, atrial fibrillation or coronary revascularization.
The electronic medical records of patients with ACS admitted at a tertiary teaching hospital in northern Thailand between January 1, 2010 and December 31, 2015 were reviewed. Medication adherence was evaluated from a hospital database of prescription refills using the medication gap technique with ≥90% as a cut-off for full adherence and <90% as partial adherence.
Of 256 patients, the mean age was 65.9 (±13.0) years. The median percentage of medication adherence in the dual antiplatelet group, ACEI/ARB group, beta-blocker group, and statin group were 94.7, 93.6, 93.1, and 93.1%, respectively. Sixty-two patients (24.2%) experienced MACE after a median follow-up of 1.5 years. Patients with ≥90% adherence of beta-blockers had a significantly lower risk of MACE than those with <90% adherence: HR = 0.47, 95% Cl, 0.26-0.87, p = 0.016, adjusted with potential confounders. No other significant associations were observed.
Medication adherence of each medication was above 90%. ACS patients with at least 90% adherence to beta-blockers had a lower risk of MACE than those having less than 90% adherence, but no other significant associations were found for other medications.
在急性冠状动脉综合征（ACS）患者中，遵循指南推荐的治疗方案进行药物治疗十分重要，这与较低的死亡率和主要不良心血管事件（MACE）发生率有关。
本回顾性研究旨在评估出院时接受 ACS 治疗的患者对指南推荐的四类药物（抗血小板药物、ACEI/ARB、β受体阻滞剂和他汀类药物）的药物依从性，并评估每位患者对每种药物的依从性与 MACE（包括所有原因的死亡、心肌梗死、不稳定型心绞痛、心力衰竭、卒中和心房颤动或冠状动脉血运重建）发生之间的关联。
回顾性分析 2010 年 1 月 1 日至 2015 年 12 月 31 日期间在泰国北部一家三级教学医院住院的 ACS 患者的电子病历。使用药物间隙技术从医院的处方补充数据库中评估药物依从性，以≥90%作为完全依从的截止值，<90%作为部分依从。
256 例患者的平均年龄为 65.9（±13.0）岁。双联抗血小板组、ACEI/ARB 组、β受体阻滞剂组和他汀类药物组的中位药物依从率分别为 94.7%、93.6%、93.1%和 93.1%。中位随访 1.5 年后，62 例患者（24.2%）发生 MACE。与<90%依从性相比，β受体阻滞剂≥90%依从性的患者 MACE 风险显著降低：HR=0.47，95%Cl，0.26-0.87，p=0.016，经潜在混杂因素校正后。未观察到其他显著关联。
每种药物的药物依从性均超过 90%。与<90%依从性相比，β受体阻滞剂至少 90%依从性的 ACS 患者发生 MACE 的风险较低，但其他药物未发现显著关联。
