Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease
<p>Abstract</p> <p>Background</p> <p>Patients with diabetes and ischemic heart disease (IHD) are at high risk for adverse cardiac outcomes. Clinical practice guidelines recommend multiple cardioprotective medications to reduce recurrent events. We evaluated the associat...
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| Format: | Article |
| Language: | English |
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BMC
2006-12-01
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| Series: | BMC Cardiovascular Disorders |
| Online Access: | http://www.biomedcentral.com/1471-2261/6/48 |
| _version_ | 1819027861594439680 |
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| author | Masoudi Frederick A Magid David J Ho P Michael McClure David L Rumsfeld John S |
| author_facet | Masoudi Frederick A Magid David J Ho P Michael McClure David L Rumsfeld John S |
| author_sort | Masoudi Frederick A |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Patients with diabetes and ischemic heart disease (IHD) are at high risk for adverse cardiac outcomes. Clinical practice guidelines recommend multiple cardioprotective medications to reduce recurrent events. We evaluated the association between cardioprotective medication adherence and mortality among patients with diabetes and IHD.</p> <p>Methods</p> <p>In a retrospective cohort study of 3,998 patients with diabetes and IHD, we evaluated use of ACE inhibitors or angiotensin receptor blockers, β-blockers, and statin medications. Receipt of cardioprotective medications was based on filled prescriptions. Medication adherence was calculated as the proportion of days covered (PDC) for filled prescriptions. The primary outcome of interest was all-cause mortality.</p> <p>Results</p> <p>The majority of patients (92.8%) received at least 1 cardioprotective medication. Patients receiving any medications had lower unadjusted mortality rates compared to patients not receiving any medications (7.9% vs. 11.5%; p = 0.03). In multivariable analysis, receipt of any cardioprotective medication remained associated with lower all-cause mortality (OR 0.65; 95% CI 0.43–0.99). Among patients receiving cardioprotective medications, the majority (80.3%) were adherent (PDC ≥ 0.80). Adherent patients had lower unadjusted mortality rates (6.7% vs. 12.1%; p < 0.01). In multivariable analysis, medication adherence remained associated with lower all-cause mortality (OR 0.52; 95% CI 0.39–0.69) compared to non-adherence. In contrast, there was no mortality difference between patients receiving cardioprotective medications who were non-adherent compared to patients not receiving any medications (OR 1.01; 95% CI 0.64–1.61).</p> <p>Conclusion</p> <p>In conclusion, medication adherence is associated with improved outcomes among patients with diabetes and IHD. Quality improvement interventions are needed to increase medication adherence in order for patients to maximize the benefit of cardioprotective medications.</p> |
| first_indexed | 2024-12-21T05:49:12Z |
| format | Article |
| id | doaj.art-f3a0f25df4a24c6dbe9e4d890801cda2 |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-12-21T05:49:12Z |
| publishDate | 2006-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-f3a0f25df4a24c6dbe9e4d890801cda22022-12-21T19:14:02ZengBMCBMC Cardiovascular Disorders1471-22612006-12-01614810.1186/1471-2261-6-48Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart diseaseMasoudi Frederick AMagid David JHo P MichaelMcClure David LRumsfeld John S<p>Abstract</p> <p>Background</p> <p>Patients with diabetes and ischemic heart disease (IHD) are at high risk for adverse cardiac outcomes. Clinical practice guidelines recommend multiple cardioprotective medications to reduce recurrent events. We evaluated the association between cardioprotective medication adherence and mortality among patients with diabetes and IHD.</p> <p>Methods</p> <p>In a retrospective cohort study of 3,998 patients with diabetes and IHD, we evaluated use of ACE inhibitors or angiotensin receptor blockers, β-blockers, and statin medications. Receipt of cardioprotective medications was based on filled prescriptions. Medication adherence was calculated as the proportion of days covered (PDC) for filled prescriptions. The primary outcome of interest was all-cause mortality.</p> <p>Results</p> <p>The majority of patients (92.8%) received at least 1 cardioprotective medication. Patients receiving any medications had lower unadjusted mortality rates compared to patients not receiving any medications (7.9% vs. 11.5%; p = 0.03). In multivariable analysis, receipt of any cardioprotective medication remained associated with lower all-cause mortality (OR 0.65; 95% CI 0.43–0.99). Among patients receiving cardioprotective medications, the majority (80.3%) were adherent (PDC ≥ 0.80). Adherent patients had lower unadjusted mortality rates (6.7% vs. 12.1%; p < 0.01). In multivariable analysis, medication adherence remained associated with lower all-cause mortality (OR 0.52; 95% CI 0.39–0.69) compared to non-adherence. In contrast, there was no mortality difference between patients receiving cardioprotective medications who were non-adherent compared to patients not receiving any medications (OR 1.01; 95% CI 0.64–1.61).</p> <p>Conclusion</p> <p>In conclusion, medication adherence is associated with improved outcomes among patients with diabetes and IHD. Quality improvement interventions are needed to increase medication adherence in order for patients to maximize the benefit of cardioprotective medications.</p>http://www.biomedcentral.com/1471-2261/6/48 |
| spellingShingle | Masoudi Frederick A Magid David J Ho P Michael McClure David L Rumsfeld John S Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease BMC Cardiovascular Disorders |
| title | Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease |
| title_full | Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease |
| title_fullStr | Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease |
| title_full_unstemmed | Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease |
| title_short | Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease |
| title_sort | adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease |
| url | http://www.biomedcentral.com/1471-2261/6/48 |
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