Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease - The heart and soul study
Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease - The heart and soul study
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DOI：
10.1001/archinte.167.16.1798
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发表时间：
2007-09-10
影响因子：
--
通讯作者：
Whooley, Mary A.
中科院分区：
文献类型：
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作者：
Gehi, Anil K.;Ali, Sadia;Whooley, Mary A.
背景：不遵循医生的治疗建议日益被认为是不良后果和医疗成本增加的原因，尤其是在心血管疾病患者中。患者自我报告是否能准确评估稳定型冠心病门诊患者的药物依从性尚不清楚。
方法：我们对来自“心灵研究”的1015名已确诊冠心病的门诊患者进行了前瞻性评估，以了解自我报告的药物不依从性与心血管事件风险之间的关系。我们问参与者一个问题：“在过去一个月里，你按照医生的处方服药的频率是多少？”不依从性定义为按处方服药的时间占比为75%或更低。心血管事件（冠心病死亡、心肌梗死或中风）是通过对3.9年随访期间的医疗记录进行审查确定的。我们使用考克斯比例风险分析来确定自我报告的药物不依从性与不良心血管事件相关的风险。
结果：在1015名参与者中，83人（8.2%）报告不依从药物治疗，146人（14.4%）发生了心血管事件。在3.9年的随访期间，不依从的参与者比依从的参与者更有可能发生心血管事件（22.9%对13.8%，P = 0.03）。在对基线心脏病严重程度、传统危险因素和抑郁症状进行调整后，自我报告的不依从性仍然是不良心血管事件的独立预测因素（风险比，2.3；95%置信区间，1.3 - 4.3；P = 0.006）。
结论：在稳定型冠心病门诊患者中，自我报告的药物不依从性与随后心血管事件发生率增加2倍以上相关。一个关于药物依从性的简单问题可能是一种识别不良心血管事件高风险患者的简单而有效的方法。
Background: Nonadherence to physician treatment recommendations is an increasingly recognized cause of adverse outcomes and increased health care costs, particularly among patients with cardiovascular disease. Whether patient self-report can provide an accurate assessment of medication adherence in outpatients with stable coronary heart disease is unknown.Methods: We prospectively evaluated the risk of cardiovascular events associated with self-reported medication nonadherence in 1015 outpatients with established coronary heart disease from the Heart and Soul Study. We asked participants a single question: "In the past month, how often did you take your medications as the doctor prescribed?" Nonadherence was defined as taking medications as prescribed 75% of the time or less. Cardiovascular events (coronary heart disease death, myocardial infarction, or stroke) were identified by review of medical records during 3.9 years of follow-up. We used Cox proportional hazards analysis to determine the risk of adverse cardiovascular events associated with self-reported medication nonadherence.Results: Of the 1015 participants, 83 (8.2%) reported nonadherence to their medications, and 146 (14.4%) developed cardiovascular events. Nonadherent participants were more likely than adherent participants to develop cardiovascular events during 3.9 years of follow-up (22.9% vs 13.8%, P = . 03). Self-reported nonadherence remained independently predictive of adverse cardiovascular events after adjusting for baseline cardiac disease severity, traditional risk factors, and depressive symptoms ( hazards ratio, 2.3; 95% confidence interval, 1.3-4.3; P = . 006).Conclusions: In outpatients with stable coronary heart disease, self-reported medication nonadherence is associated with a greater than 2-fold increased rate of subsequent cardiovascular events. A single question about medication adherence may be a simple and effective method to identify patients at higher risk for adverse cardiovascular events.