Clinical InvestigationCoronary Artery DiseaseMedication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease
Section snippets
Study setting
Kaiser Permanente of Colorado (KPCO) is an integrated nonprofit Managed Care Organization that provides medical services to more than 430 000 members in the Denver, CO, metropolitan area. A CAD registry was previously established in 1998.10 Patients are identified by an algorithm applied to KPCO automated databases consisting of hospitalization records and outpatient diagnoses. Once a potential patient is identified, the diagnosis of CAD is validated by chart review before inclusion in the
Results
Baseline characteristics of adherent and nonadherent patients for each class of medication are shown in Table I. Among patients dispensed β-blockers (n = 11 865), 28.8% of the patients were nonadherent, as defined by a PDC <0.80. For patients dispensed ACE inhibitors or angiotensin receptor blocker (ACE inhibitors) medications (n = 10 021), 21.6% of patients were nonadherent. For statin medications (n = 13 596), 26.0% of the patients were nonadherent. Across the 3 classes of medications,
Discussion
The objective of this study was to assess the association between medication nonadherence and a broad range of outcomes among patients with known CAD in the outpatient setting. Over a median follow-up of 4.1 years, we found that medication nonadherence to statins, ACE inhibitors, or β-blockers was common, with about 1 in 4 patients being nonadherent to their prescribed β-blockers, statins, and/or ACE inhibitors. Medication nonadherence was associated with significantly increased risk for
References (26)
- et al.
ACC/AHA clinical performance measures for adults with ST-elevation and non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures on ST-Elevation and Non–ST-Elevation Myocardial Infarction)
J Am Coll Cardiol
(2006) - et al.
A telecommunications system for monitoring and counseling patients with hypertension. Impact on medication adherence and blood pressure control
Am J Hypertens
(1996) - et al.
ACC/AHA 2002 guidelines update for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for the Management of Patients With Chronic Stable Angina)
(2002) Clinical performance measures: chronic stable coronary artery disease
- et al.
National and state trends in quality of care for acute myocardial infarction between 1994-1995 and 1998-1999: the Medicare health care quality improvement program
Arch Intern Med
(2003) - et al.
Nationwide trends in the prescription of beta-blockers and angiotensin-converting enzyme inhibitors after myocardial infarction in Denmark, 1995-2002
Scand Cardiovasc J
(2005) - et al.
Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease
BMC Cardiovasc Disord
(2006) - et al.
Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease
Circulation
(2006) - et al.
Long-term persistence in use of statin therapy in elderly patients
JAMA
(2002) - et al.
Long-term compliance with beta-blockers, angiotensin-converting enzyme inhibitors, and statins after acute myocardial infarction
Eur Heart J
(2006)
A meta-analysis of the association between adherence to drug therapy and mortality
BMJ
Clinical Pharmacy Cardiac Risk Service Study Group. Lipid management in patients with coronary artery disease by a clinical pharmacy service in a group model health maintenance organization
Arch Intern Med
Clinical Pharmacy Cardiac Risk Service: guidelines and practices in a population approach to managing patients with coronary artery disease
Am J Health Syst Pharm
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This work was supported by an award from the American Heart Association (0535086N). Dr Ho is supported by a VA Research and Development Career Development Award (05-026-2). Dr Peterson is supported by an award from the American Heart Association (0670017N).