Predictors of Long-term Adherence to Evidence-based Cardiovascular Disease Medications in Outpatients With Stable Atherothrombotic Disease: Findings From the REACH Registry
Predictors of Long-term Adherence to Evidence-based Cardiovascular Disease Medications in Outpatients With Stable Atherothrombotic Disease: Findings From the REACH Registry
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DOI：
10.1002/clc.22217
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发表时间：
2013-12-01
影响因子：
2.7
通讯作者：
Bhatt, Deepak L.
中科院分区：
文献类型：
--
作者：
Rodriguez, Fatima;Cannon, Christopher P.;Bhatt, Deepak L.
Background尽管心血管疾病的治疗和结果的整体改善，药物治疗不依从性仍然是一个重要的障碍，以有效的二级预防动脉粥样硬化thrombotic diseases.HypothesisLong-term药物治疗依从性在门诊患者稳定的动脉粥样硬化thrombotic disease是受人口统计学和临床factors.MethodsWe检查的数据，从前瞻性国际减少动脉粥样硬化thrombosis的持续健康（REACH）注册。分析来源于25737例确诊动脉粥样硬化血栓性疾病的患者，在入组时和第4年时有完整的依从性数据。坚持被定义为患者的自我报告服用药物的基础上，I类美国心脏病学会/美国心脏协会的二级预防指南的定义，包括抗血小板药物，他汀类药物，抗高血压药物。ResultsAmong患者动脉粥样硬化血栓形成疾病，12500（48.6%）被认为是遵守指南推荐的药物。依从性患者更年轻，为白色，多血管病变较少。与白色患者相比，西班牙裔和东亚患者的依从性较低（比值比[OR]：0.72，95%置信区间[CI]：0.59-0.88; OR：0.67，95% CI：0.53-0.83）。与未发生这些事件的患者相比，在随访期间发生非致死性MI或接受冠状动脉血管成形术/支架植入术的患者更有可能依从（OR：1.73，95% CI：1.25-2.38; OR：2.15，95% CI：1.72-2.67）。另一方面，随访期间非致命性中风与依从性呈负相关（比值比：0.77，95%置信区间：结论通过对动脉粥样硬化血栓形成疾病门诊患者的大型国际登记研究，我们发现年龄、地区、种族和心血管事件的发生是二级预防长期指南依从性的预测因素，这表明某些患者群体可能受益于有针对性的干预措施，以提高依从性。
BackgroundDespite overall improvements in cardiovascular-disease therapies and outcomes, medication nonadherence remains an important barrier to effective secondary prevention of atherothrombotic disease.HypothesisLong-term medication adherence in outpatients with stable atherothrombotic disease is impacted by demographic and clinical factors.MethodsWe examined data from the prospective international Reduction of Atherothrombosis for Continued Health (REACH) Registry. Analyses were derived from 25737 patients with established atherothrombotic disease with complete adherence data at enrollment and at year 4. Adherence was defined as patients' self-report of taking medications based on class I American College of Cardiology/American Heart Association guidelines for secondary prevention as defined, including antiplatelet agents, statins, and antihypertensive medications.ResultsAmong patients with atherothrombotic disease, 12500 (48.6%) were deemed adherent to guideline-recommended medications. Adherent patients were younger, white, and had less polyvascular disease. Hispanic and East Asian patients were less likely to be adherent as compared with white patients (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.59-0.88; and OR: 0.67, 95% CI: 0.53-0.83, respectively). Patients who had a nonfatal MI or underwent coronary angioplasty/stenting during follow-up were more likely to be adherent compared with patients without these events (OR: 1.73, 95% CI: 1.25-2.38; and OR: 2.15, 95% CI: 1.72-2.67, respectively). On the other hand, nonfatal stroke during follow-up was inversely associated with adherence (OR: 0.77, 95% CI: 0.61-0.97).ConclusionsUsing a large international registry of outpatients with atherothrombotic disease, we found that age, region, race/ethnicity, and incident cardiovascular events were predictive of long-term guideline adherence for secondary prevention, suggesting that certain patient groups may benefit from targeted interventions to improve adherence.