The association of pre- and posthospital medication adherence in myocardial infarction patients.
The association of pre- and posthospital medication adherence in myocardial infarction patients.
复制标题
心肌梗死患者院前和院后药物依从性的关联。
DOI：
10.1016/j.ahj.2018.11.004
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发表时间：
2019
影响因子：
4.8
通讯作者：
Wang,TracyY
中科院分区：
文献类型：
--
作者：
Doll,JacobA;Hellkamp,AnneS;Thomas,Laine;Fonarow,GreggC;Peterson,Eric;Wang,TracyY
背景心肌梗死（MI）后不遵守最佳药物治疗与支架血栓形成、复发性心血管事件和死亡等不良临床结果相关。 MI 之前的药物依从性是否可以预测 MI 后的药物依从性尚不清楚。方法我们评估了 8,147 名 MI 患者在 MI 入院前后对 P2Y12 抑制剂和他汀类药物的依从性，这些患者拥有包含 D 部分处方保险的 Medicare 保险。依从性定义为服药天数比例≥80%。使用多变量逻辑回归来评估 MI 前后 P2Y12 抑制剂依从性之间的关联。由于很少有患者在 MI 前服用 P2Y12 抑制剂，我们还检查了 MI 前他汀类药物依从性与 MI 后 P2Y12 抑制剂和他汀类药物依从性的关系。结果 2,633 名入院前服用 P2Y12 抑制剂的患者中，有 427 名 (16%) 患者观察到 MI 前药物不依从性，而 6,934 名入院前患者中，有 1,233 名 (18%) 患者观察到 MI 前药物不依从性 他汀类药物。不依从的患者更有可能是非白人，并且之前曾多次入院。与 MI 前坚持使用 P2Y12 抑制剂的患者相比，MI 前不坚持使用 P2Y12 抑制剂的患者在 90 天（调整后比值比 [OR] 0.33，95% CI 0.25-0.43）和 MI 后 1 年（调整后 OR 0.29，95% CI 0.21-0.39）坚持使用 P2Y12 抑制剂的可能性显着降低。心肌梗死前他汀类药物不依从性也与心肌梗死后 90 天（调整后 OR 0.65，95% CI 0.53-0.79）和 1 年（调整后 OR 0.37，95% CI 0.29-0.54）较低的 P2Y12 抑制剂依从性相关。 结论 先前的用药依从性可预测心肌梗死后对 P2Y12 抑制剂的依从性。增加病历中药物依从性数据的可访问性可能是识别心梗后药物不依从性较高风险的患者的重要工具，并有针对性地努力提高依从性。
BackgroundNonadherence 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.MethodsWe assessed adherence to P2Y12inhibitors 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 P2Y12inhibitor adherence. As few patients were on P2Y12inhibitors pre-MI, we also examined the association of pre-MI statin adherence with post-MI P2Y12inhibitor and statin adherence.ResultsPre-MI medication nonadherence was observed in 427 of 2,633 (16%) patients on preadmission P2Y12inhibitors 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 P2Y12inhibitors pre-MI were substantially less likely to adhere to P2Y12inhibitors 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 P2Y12inhibitors 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).ConclusionsPrior medication adherence predicts post-MI adherence to P2Y12inhibitors. 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.