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Medication Non-adherence Is Associated With A Broad Range Of Adverse Outcomes In Patients With
Coronary Artery Disease
P. Michael Ho, MD, PhDP. Michael Ho, MD, PhD1-31-3, David J. Magid, MD, MPH, David J. Magid, MD, MPH2,32,3, Susan M. Shetterly, MS, Susan M. Shetterly, MS33, , Kari L. Olson, PharmD, BCPSKari L. Olson, PharmD, BCPS33, Thomas M. Maddox, MD, MSc, Thomas M. Maddox, MD, MSc1-31-3, Pamela N. , Pamela N.
Peterson, MD, MSPHPeterson, MD, MSPH2-42-4, Frederick A. Masoudi, MD, MSPH, Frederick A. Masoudi, MD, MSPH2-42-4
John S. Rumsfeld, MD, PhDJohn S. Rumsfeld, MD, PhD1-31-3
6.6. Denver VA Medical CenterDenver VA Medical Center7.7. University of Colorado Health Sciences CenterUniversity of Colorado Health Sciences Center8.8. Institute for Health Research, Kaiser Permanente of ColoradoInstitute for Health Research, Kaiser Permanente of Colorado9.9. Denver Health Medical CenterDenver Health Medical Center
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Disclosure Information
DISCLOSURE INFORMATION: This work was supported by an American Heart Association Scientist Development Grant (0535086N)
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Background and ObjectivesBackground and Objectives
Efficacy of β-blockers, ACE-inhibitors, and Efficacy of β-blockers, ACE-inhibitors, and statins demonstrated in clinical trialsstatins demonstrated in clinical trials
Gap between benefits demonstrated in clinical Gap between benefits demonstrated in clinical trials and effectiveness of medications in clinical trials and effectiveness of medications in clinical practicepractice
Objective: To evaluate the association between Objective: To evaluate the association between non-adherence to β-blockers, ACE-inhibitors, non-adherence to β-blockers, ACE-inhibitors, and statin medications with a broad range of CV and statin medications with a broad range of CV adverse outcomes adverse outcomes
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MethodsMethods Setting: Integrated, nonprofit managed care organization Setting: Integrated, nonprofit managed care organization
in the Denver, Colorado metropolitan areain the Denver, Colorado metropolitan area Patients: 15,567 patients with coronary artery disease Patients: 15,567 patients with coronary artery disease Study design: Retrospective cohort studyStudy design: Retrospective cohort study
Median follow-up 4.1 yearsMedian follow-up 4.1 years Medication adherence: proportion of days covered for Medication adherence: proportion of days covered for
ββ-blockers, ACE-inhibitors, and statin medications-blockers, ACE-inhibitors, and statin medications Non-adherence defined as PDC<0.80Non-adherence defined as PDC<0.80
OutcomesOutcomes All-cause mortalityAll-cause mortality Cardiovascular mortalityCardiovascular mortality Cardiovascular hospitalization for AMI or heart failureCardiovascular hospitalization for AMI or heart failure Revascularization procedures including PCI or CABGRevascularization procedures including PCI or CABG
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Baseline characteristicsBaseline characteristics
28-36%Depression
35-45%Diabetes
95%Hyperlipidemia
90%Hypertension
25%Cerebrovascular disease
28%Chronic obstructive pulmonary disease
33-48%Heart failure
42-49%Prior MI
50%Prior PCI
45-50%Prior CABG
20%Current smoker
30%Female gender
65Age (mean)
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Rates of non-adherenceRates of non-adherence
0
5
10
15
20
25
30P
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AC
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Sta
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s
B-
blo
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ers
Non-adherent patients were younger and more likely to have COPD and depression
n=10,021
n=13,596n=11,865
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Non-adherence to cardioprotective Non-adherence to cardioprotective medications is associated with adverse medications is associated with adverse
outcomesoutcomes
0.5
All-cause mortalityn=1,889
CV mortalityn=372
CV Hospitalization*n=2,008
Coronary Revascularization#
n=2,117
B-blockersStatinsACE-inhibitors
Hazards Ratio1.0 2.0
*Hospitalization for AMI or heart failure#PCI or CABG
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Non-adherence to H2 antagonists or Non-adherence to H2 antagonists or proton pump inhibitors not associated proton pump inhibitors not associated
with adverse outcomeswith adverse outcomes
1.14 (0.97-1.33)All-cause mortality
1.10 (0.78-1.57)CV mortality
1.02 (0.87-1.18)CV hospitalization
1.07 (0.92-1.23)Coronary revascularization
Hazard ratio (95% confidence interval)
Outcome
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ConclusionsConclusions
1 in 4 patients were non-adherent 1 in 4 patients were non-adherent Non-adherence to cardioprotective medications Non-adherence to cardioprotective medications
associated with higher risk of adverse outcomes associated with higher risk of adverse outcomes Non-adherence to GI medications not Non-adherence to GI medications not
associated with adverse outcomesassociated with adverse outcomes Suggest lower risk associated with adherence due to Suggest lower risk associated with adherence due to
benefits of cardioprotective medications rather than benefits of cardioprotective medications rather than ‘healthy adherer’ effect‘healthy adherer’ effect
Expanding current quality of care measures to Expanding current quality of care measures to include the assessment of medication include the assessment of medication adherence may be an important quality metricadherence may be an important quality metric