Persistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study.
Persistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study.
复制标题
DOI：
10.1016/j.ahj.2015.03.019
复制
发表时间：
2015-07
影响因子：
4.8
通讯作者：
TRANSLATE-ACS Study Investigators
中科院分区：
文献类型：
--
作者：
Mathews R;Wang TY;Honeycutt E;Henry TD;Zettler M;Chang M;Fonarow GC;Peterson ED;TRANSLATE-ACS Study Investigators
急性心肌梗死(MI)后持续使用二级预防治疗是优化长期结果的关键。2010年至2012年，对216家医院的7955名心肌梗塞患者进行了药物持久性评估，这些患者参与了这项名为Translate-ACS的研究。持续性被定义为从出院到MI后6个月持续服用阿司匹林、二磷酸腺苷受体抑制剂(ADPRi)、β-受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)和他汀类药物。多变量Logistic回归模型被用来确定与非持久性相关的因素，定义为所有药物类别的80%持久性。总体而言，31%的MI患者在6个月后停止服用至少一种药物。停止服药的最常见原因是副作用和医生指导(57%)，而8%的人提到了经济方面的担忧。经多因素建模后，黑人(优势比[OR]1.36；95%可信区间[CI]1.15~1.62)、高龄(OR 1.07；95%CI 1.02~1.12)、房颤(OR 1.67，95%CI 1.33~2.09)、透析(OR 1.79；95%CI 1.15~2.78)和抑郁(OR 1.22；95%CI 1.02~1.45)与较低的持久性相关。私人保险(OR 0.85，95%0.76-0.95)、处方费用补助(OR 0.63；95%CI 0.54-0.75)和出院前安排的门诊随访(OR 0.89。95%CI(0.80~0.99)与较高的持久性相关。近三分之一的心肌梗塞患者在6个月后不再坚持服用处方药。高危非持续性的患者可以通过临床和社会人口学特征来确定。这些观察结果强调了优化二级预防疗法纵向使用的关键机会。
Persistent use of secondary prevention therapies after acute myocardial infarction (MI) is critical to optimizing long-term outcomes. Medication persistence was assessed among 7,955 MI patients in 216 hospitals participating in the TRANSLATE-ACS study from 2010 to 2012. Persistence was defined as continuation of aspirin, adenosine diphosphate receptor inhibitors (ADPRi), beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), and statins from discharge to 6 months post-MI. Multivariable logistic regression modeling was used to determine factors associated with non-persistence, defined as <80% persistence with all medication classes. Overall, 31% of MI patients stopped taking a least one medication by 6 months. The most common reasons cited for medications discontinuation were side effects and physician instruction (57%), while financial concerns were cited in 8% overall. After multivariable modeling, black race (odds ratio [OR] 1.36; 95% confidence interval [CI] 1.15–1.62), older age (OR 1.07; 95% CI 1.02–1.12), atrial fibrillation (OR 1.67, 95% CI 1.33–2.09), dialysis (OR 1.79; 95% CI 1.15–2.78), and depression (OR 1.22; 95% CI 1.02–1.45) were associated with lower likelihood of persistence. Private insurance (OR 0.85, 95% 0.76–0.95), prescription cost assistance (OR 0.63; 95% CI 0.54–0.75), and outpatient follow-up arranged prior to discharge (OR 0.89. 95% CI 0.80–0.99) were associated with higher persistence. Nearly one-third of MI patients are no longer persistent with their prescribed medications by 6 months. Patients at high risk of non-persistence may be identified by clinical and sociodemographic features. These observations underscore key opportunities to optimize longitudinal use of secondary prevention therapies.