1. Long-term medication adherence in patients with ST-elevation myocardial infarction and primary percutaneous coronary intervention.
- Author
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Reuter H, Markhof A, Scholz S, Wegmann C, Seck C, Adler C, Michels G, Hoepp HW, Baldus S, and Pfister R
- Subjects
- Aged, Aged, 80 and over, Cardiovascular Agents adverse effects, Chi-Square Distribution, Drug Prescriptions, Female, Germany, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction diagnosis, Myocardial Infarction mortality, Myocardial Infarction physiopathology, Prospective Studies, Registries, Risk Factors, Sex Factors, Time Factors, Treatment Outcome, Cardiovascular Agents therapeutic use, Medication Adherence, Myocardial Infarction therapy, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality
- Abstract
Aims: Besides early percutaneous coronary intervention (PCI) long-term medical treatment is crucial for outcomes after ST-elevation myocardial infarction (STEMI). The present study aimed to identify predictors of adherence to evidence-based medication in this high risk population., Methods and Results: A total of 1025 consecutive patients with adjudicated STEMI treated by primary PCI in a single centre as part of the Cologne Infarction Model (KIM) were prospectively analysed. Gender-specific multivariate predictors of long-term medication adherence were identified. Follow-up with available information on drug use was completed for 610 of 738 (82.7%) patients confirmed to be alive after a median period of 36 months. Adherence was persistently high for evidence-based medication with 90.8% for acetylsalicylic acid (ASA), 88.2% for statins, 87.5% for beta-blockers and 79.2% for ACE-inhibitors or angiotensin-receptor blockers (ARBs). Patients with a history of heart failure had a higher medication adherence to beta-blockers, ACE-inhibitors/ARBs and diuretics, whereas long-term prescription rates for calcium channel blockers (CCBs) were lower in patients with reduced versus preserved ejection fraction. Patients with a history of hypertension presented higher medication adherence to CCBs, ACE-inhibitors/ARBs and diuretics but not to beta-blockers. On multivariate analysis, age, body mass index (BMI), hypertension, chronic kidney disease and lack of PCI were independently associated with prescription of diuretics at follow-up. In women, adherence was lower to beta-blockers and higher to CCBs compared to men., Conclusion: In the high risk population of STEMI patients long-term adherence to evidence-based medication is high. The lower adherence to beta-blockers and higher prescription rate for CCBs in women needs particular attention., (© The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)
- Published
- 2015
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