Impact of medication therapy discontinuation on mortality after myocardial infarction
Impact of medication therapy discontinuation on mortality after myocardial infarction
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DOI：
10.1001/archinte.166.17.1842
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发表时间：
2006-09-25
影响因子：
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通讯作者：
Rumsfeld, John S.
中科院分区：
文献类型：
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作者：
Ho, P. Michael;Spertus, John A.;Rumsfeld, John S.
背景：不依从药物治疗是常见的，但决定因素和后果的定义很差。本研究的目的是确定患者和心肌梗死（MI）的治疗因素与药物治疗中止，并评估药物治疗中止后1个月MI对12个月mortality. Methods的影响：这是一个多中心的前瞻性队列的患者与MI登记的前瞻性登记评估心肌梗死：事件和恢复研究。结果是在MI住院后1个月时服用阿司匹林、β受体阻滞剂和他汀类药物的患者出院时服用所有3种药物以及12个月死亡率。在1521例接受所有3种药物治疗出院的患者中，184例停用所有3种药物，56例停用2种药物，272例停用1种药物，1009例在1个月时继续服用所有3种药物。在多变量分析中，未从高中毕业的患者（比值比[OR]，1.76; 95%置信区间[CI]，1.20 - 2.60）更有可能停止使用所有药物。女性（OR，1.77; 95% CI，1.34 - 2.34）中年龄增加对药物治疗中止的影响大于男性（OR，1.23; 95% CI，1.02 - 1.47）。在1个月时停止使用所有药物的患者的1年生存率较低（88.5% vs 97.7%;对数秩P
Background: Nonadherence to medications is common, but the determinants and consequences are poorly defined. The objectives of this study were to identify patient and myocardial infarction (MI) treatment factors associated with medication therapy discontinuation and to assess the impact of medication discontinuation 1 month after MI on 12-month mortality.Methods: This was a multicenter prospective cohort of patients with MI enrolled in the Prospective Registry Evaluating Myocardial Infarction: Event and Recovery study. The outcomes were use of aspirin, beta-blockers, and statins at 1 month after MI hospitalization among patients discharged with all 3 medications as well as 12-month mortality.Results: Of 1521 patients discharged with all 3 medications, 184 discontinued use of all 3 medications, 56 discontinued use of 2 medications, 272 discontinued use of 1 medication, and 1009 continued taking all 3 medications at 1 month. In multivariable analyses, patients not graduating from high school (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.20- 2.60) were more likely to discontinue use of all medications. The effect of increasing age on medication therapy discontinuation was greater for females (OR, 1.77; 95% CI, 1.34- 2.34) than males (OR, 1.23; 95% CI, 1.02- 1.47). Patients who discontinued use of all medications at 1 month had lower 1-year survival (88.5% vs 97.7%; log-rank P