Association Between Medication Adherence and 1‐Year Major Cardiovascular Adverse Events After Acute Myocardial Infarction in China
Background Secondary prevention after acute myocardial infarction (AMI) requires long‐term guideline‐directed medical therapy. However, the level of medication adherence, factors associated with poor adherence, and extent to which good adherence can reduce adverse events after AMI in China remain un...
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| Format: | Article |
| Language: | English |
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Wiley
2019-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.011793 |
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| author | Pu Shang Gordon G. Liu Xin Zheng P. Michael Ho Shuang Hu Jing Li Zihan Jiang Xi Li Xueke Bai Yan Gao Chao Xing Yun Wang Sharon‐Lise Normand Harlan M. Krumholz |
| author_facet | Pu Shang Gordon G. Liu Xin Zheng P. Michael Ho Shuang Hu Jing Li Zihan Jiang Xi Li Xueke Bai Yan Gao Chao Xing Yun Wang Sharon‐Lise Normand Harlan M. Krumholz |
| author_sort | Pu Shang |
| collection | DOAJ |
| description | Background Secondary prevention after acute myocardial infarction (AMI) requires long‐term guideline‐directed medical therapy. However, the level of medication adherence, factors associated with poor adherence, and extent to which good adherence can reduce adverse events after AMI in China remain uncertain. Methods and Results In 2013 to 2014, 4001 AMI patients aged ≥18 years were discharged alive from 53 hospitals across China (mean age 60.5±11.7 years; 22.7% female). Good adherence was defined as taking medications (aspirin, β‐blockers, statins, clopidogrel, or angiotensin‐converting enzyme inhibitors/angiotensin‐receptor blockers) ≥90% of the time as prescribed. Cox models assessed the association between good adherence (a time‐varying covariate) and 1‐year cardiovascular events after AMI. The most common medications were aspirin (82.2%) and statins (80.5%). There were 243 patients who were not prescribed any medications during follow‐up; 1‐year event rates were higher for these patients (25.1%, 95% CI 19.7–30.6%) versus those taking ≥1 medications (6.6%, 95% CI 5.76–7.34%). The overall rate of good adherence was 52.9%. Good adherence was associated with lower risk of 1‐year events (adjusted hazard ratio 0.61, 95% CI 0.49–0.77). The most common reason for poor adherence was belief that one's condition had improved/no longer required medication. More comorbidities and lower education level were associated with poor adherence. Conclusions Good adherence reduced 1‐year cardiovascular event risk after AMI. About half of our cohort did not have good adherence. National efforts to improve AMI outcomes in China should focus on medication adherence and educating patients on the importance of cardiovascular medications for reducing risk of recurrent events. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01624909. |
| first_indexed | 2024-12-13T01:50:52Z |
| format | Article |
| id | doaj.art-666a23ef4ed1430aba66943b39849193 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T01:50:52Z |
| publishDate | 2019-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-666a23ef4ed1430aba66943b398491932022-12-22T00:03:31ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-05-018910.1161/JAHA.118.011793Association Between Medication Adherence and 1‐Year Major Cardiovascular Adverse Events After Acute Myocardial Infarction in ChinaPu Shang0Gordon G. Liu1Xin Zheng2P. Michael Ho3Shuang Hu4Jing Li5Zihan Jiang6Xi Li7Xueke Bai8Yan Gao9Chao Xing10Yun Wang11Sharon‐Lise Normand12Harlan M. Krumholz13School of International Pharmaceutical Business China Pharmaceutical University Nanjing ChinaSchool of International Pharmaceutical Business China Pharmaceutical University Nanjing ChinaNHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College National Center for Cardiovascular Diseases Beijing ChinaCardiology Section Rocky Mountain Regional VA Medical Center Aurora CONHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College National Center for Cardiovascular Diseases Beijing ChinaNHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College National Center for Cardiovascular Diseases Beijing ChinaHealth Care and International Medical Services Peking Union Medical College Hospital Beijing ChinaNHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College National Center for Cardiovascular Diseases Beijing ChinaNHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College National Center for Cardiovascular Diseases Beijing ChinaNHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College National Center for Cardiovascular Diseases Beijing ChinaNHC Key Laboratory of Clinical Research for Cardiovascular Medications National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College National Center for Cardiovascular Diseases Beijing ChinaDepartment of Biostatistics Harvard T.H. Chan School of Public Health Boston MADepartment of Biostatistics Harvard T.H. Chan School of Public Health Boston MACenter for Outcomes Research and Evaluation Yale‐New Haven Hospital New Haven CTBackground Secondary prevention after acute myocardial infarction (AMI) requires long‐term guideline‐directed medical therapy. However, the level of medication adherence, factors associated with poor adherence, and extent to which good adherence can reduce adverse events after AMI in China remain uncertain. Methods and Results In 2013 to 2014, 4001 AMI patients aged ≥18 years were discharged alive from 53 hospitals across China (mean age 60.5±11.7 years; 22.7% female). Good adherence was defined as taking medications (aspirin, β‐blockers, statins, clopidogrel, or angiotensin‐converting enzyme inhibitors/angiotensin‐receptor blockers) ≥90% of the time as prescribed. Cox models assessed the association between good adherence (a time‐varying covariate) and 1‐year cardiovascular events after AMI. The most common medications were aspirin (82.2%) and statins (80.5%). There were 243 patients who were not prescribed any medications during follow‐up; 1‐year event rates were higher for these patients (25.1%, 95% CI 19.7–30.6%) versus those taking ≥1 medications (6.6%, 95% CI 5.76–7.34%). The overall rate of good adherence was 52.9%. Good adherence was associated with lower risk of 1‐year events (adjusted hazard ratio 0.61, 95% CI 0.49–0.77). The most common reason for poor adherence was belief that one's condition had improved/no longer required medication. More comorbidities and lower education level were associated with poor adherence. Conclusions Good adherence reduced 1‐year cardiovascular event risk after AMI. About half of our cohort did not have good adherence. National efforts to improve AMI outcomes in China should focus on medication adherence and educating patients on the importance of cardiovascular medications for reducing risk of recurrent events. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01624909.https://www.ahajournals.org/doi/10.1161/JAHA.118.011793acute myocardial infarctioncardiovascular adverse eventsmedication adherencepatient‐reported outcomes |
| spellingShingle | Pu Shang Gordon G. Liu Xin Zheng P. Michael Ho Shuang Hu Jing Li Zihan Jiang Xi Li Xueke Bai Yan Gao Chao Xing Yun Wang Sharon‐Lise Normand Harlan M. Krumholz Association Between Medication Adherence and 1‐Year Major Cardiovascular Adverse Events After Acute Myocardial Infarction in China Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute myocardial infarction cardiovascular adverse events medication adherence patient‐reported outcomes |
| title | Association Between Medication Adherence and 1‐Year Major Cardiovascular Adverse Events After Acute Myocardial Infarction in China |
| title_full | Association Between Medication Adherence and 1‐Year Major Cardiovascular Adverse Events After Acute Myocardial Infarction in China |
| title_fullStr | Association Between Medication Adherence and 1‐Year Major Cardiovascular Adverse Events After Acute Myocardial Infarction in China |
| title_full_unstemmed | Association Between Medication Adherence and 1‐Year Major Cardiovascular Adverse Events After Acute Myocardial Infarction in China |
| title_short | Association Between Medication Adherence and 1‐Year Major Cardiovascular Adverse Events After Acute Myocardial Infarction in China |
| title_sort | association between medication adherence and 1 year major cardiovascular adverse events after acute myocardial infarction in china |
| topic | acute myocardial infarction cardiovascular adverse events medication adherence patient‐reported outcomes |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.011793 |
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