Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction
Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction
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DOI：
10.1161/circulationaha.107.706820
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发表时间：
2008-02-26
期刊：
影响因子：
37.8
通讯作者：
Tu, Jack V.
中科院分区：
文献类型：
--
作者：
Jackevicius, Cynthia A.;Li, Ping;Tu, Jack V.
急性心肌梗死（AMI）后的二级预防主要通过药物治疗来实现.但是，患者必须服用药物才能获益。药物依从性研究主要集中在继续用药，而不是不填写第一个处方（主要不依从）。我们的目标是表征，以确定因素，并衡量与原发性不遵守AMI.Methods和结果后，我们进行了一项基于人群的队列研究，使用AMI登记与行政数据在安大略，加拿大。主要结局是1年死亡率。纳入4591例年龄> 65岁的AMI后患者，共开具处方12832张，其中73%和79%分别在7天和120天内完成。出院后120天，心脏类处方的使用率高于非心脏类处方（分别为82%和35%; P < 0.0001）。只有74%的患者在排除乙酰水杨酸后120天内填写了所有出院处方，乙酰水杨酸在安大略也可以在柜台上买到。与填写所有处方相比，填写所有处方的相关因素包括年龄较小、低收入、出院药物咨询、住院心脏病专家和AMI前药物较少。与全部病例相比，部分病例的调整后1年死亡率更高（比值比，1.44; 95%置信区间，1.15至1.79; P = 0.001）和无与所有（比值比，1.80; 95%置信区间，1.35至2.42;结论：患者在AMI后1周内填写了大部分出院处方。急性心肌梗死后未完成出院药物治疗的患者的1年死亡率较高。出院时的药物咨询和出院后的随访等因素可能有助于提高AMI后的药物填充率。
Background- Secondary prevention after acute myocardial infarction (AMI) is achieved primarily through medications. However, patients must take their medications to benefit. Medication adherence research has focused primarily on continuation of medications rather than not filling the first prescription written (primary nonadherence). Our objectives were to characterize, to determine factors of, and to measure outcomes associated with primary nonadherence after AMI.Methods and Results- We conducted a population-based cohort study using an AMI registry linked with administrative data in Ontario, Canada. The primary outcome was 1-year mortality. There were 4591 post-AMI patients > 65 years of age included with 12 832 prescriptions written, of which 73% and 79% were filled within 7 and 120 days, respectively. By 120 days after discharge, more cardiac than noncardiac prescriptions were filled (82% versus 35%, respectively; P < 0.0001). Only 74% of patients filled all their discharge prescriptions by 120 days after discharge after the exclusion of acetylsalicylic acid, which is also available over the counter in Ontario. Factors associated with filling all compared with filling no discharge prescriptions included younger age, low income, discharge medication counseling, in-hospital attending cardiologist, and fewer medications before AMI. The adjusted 1-year mortality rate was higher in patients who filled some versus all (odds ratio, 1.44; 95% confidence interval, 1.15 to 1.79; P = 0.001) and none versus all (odds ratio, 1.80; 95% confidence interval, 1.35 to 2.42; P < 0.0001) of their discharge medications.Conclusions- Patients fill most of their discharge prescriptions within 1 week after AMI. The 1-year mortality rate was higher for those patients who did not fill all of their discharge medications after AMI. Factors such as discharge medication counseling and postdischarge follow-up may help to increase the filling rate of medications after AMI.