Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease
Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease
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DOI：
10.1016/j.ahj.2007.12.011
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发表时间：
2008-04-01
影响因子：
4.8
通讯作者：
Rumsfeld, John S.
中科院分区：
文献类型：
--
作者：
Ho, P. Michael;Magid, David J.;Rumsfeld, John S.
背景很少有人知道的影响，非遵守冠状动脉疾病（CAD）患者的结果，包括心血管死亡率，心血管住院，和revascularizations.Methods这是一个回顾性队列研究15767例CAD患者的广谱。药物依从性计算为β受体阻滞剂、血管紧张素转换酶（ACE）抑制剂和他汀类药物的处方天数比例。多变量考克斯回归评估了药物不依从性作为随时间变化的协变量与广泛结局之间的相关性，并对人口统计学和临床特征进行了调整。中位随访时间为4.1年。结果：β受体阻滞剂、ACE抑制剂和他汀类药物的用药不依从率分别为28.8%、21.6%和26.0%。在未校正的分析中，不依从每一类药物与较高的全因和心血管死亡率相关。在多变量分析中，β受体阻滞剂（风险比[HR] 1.50，95% CI 1.33-1.71）、ACE抑制剂（HR 1.74，95% CI 1.52-1.98）和他汀类药物（HR 1.85，95% CI 1.63-2.09）的不依从性仍与全因死亡风险增加显著相关。此外，β受体阻滞剂（HR 1.53，95% CI 1.16-2.01）、ACE抑制剂（HR 1.66，95% CI 1.26-2.20）和他汀类药物（HR 1.62，95% CI 1.124-2.13）的不依从性仍与心血管死亡风险较高显著相关。与不依从相关的风险增加的结果是一致的心血管住院和血运重建procedure.Conclusions不依从心脏保护药物是常见的，在临床实践中，并与广泛的不良后果。这些研究结果表明，药物治疗不依从性应该是一个目标的质量改善干预措施，以最大限度地提高与CAD患者的结果。
Background Little is known about the effect of nonadherence among patients with coronary artery disease (CAD) on a broad spectrum of outcomes including cardiovascular mortality, cardiovascular hospitalizations, and revascularization procedures.Methods This was a retrospective cohort study of 15767 patients with CAD. Medication adherence was calculated as proportion of days covered for filled prescriptions of)beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and statin medications. Multivariable Cox regression assessed the association between medication nonadherence as a time-varying covariate and a broad range of outcomes, adjusting for demographics and clinical characteristics. Median follow-up was 4.1 years.Results Rates of medication nonadherence were 28.8% for beta-blockers, 21.6% for ACE inhibitors, and 26.0% for statins. In unadjusted analysis, nonadherence to each class of medication was associated with higher all-cause and cardiovascular mortality. In multivariable analysis, nonadherence remained significantly associated with increased all-cause mortality risk for (beta-blockers (hazard ratio [HR] 1.50, 95 % CI 1.33-1.71), ACE inhibitors (HR 1.74, 95 % CI 1.52-1.98), and statins (HR 1.85, 95 % CI 1.63-2.09). In addition, nonadherence remained significantly associated with higher risk of cardiovascular mortality for (beta-blockers (HR 1.53, 95% CI 1.16-2.01), ACE inhibitors (HR 1.66, 95% CI 1.26-2.20), and statins (HR 1.62, 95 % CI 1.124-2.13). The findings of increased risk associated with nonadherence were consistent for cardiovascular hospitalization and revascularization procedures.Conclusions Nonadherence to cardioprotective medications is common in clinical practice and associated with a broad range of adverse outcomes. These findings suggest that medication nonadherence should be a target for quality improvement interventions to maximize the outcomes of patients with CAD.