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Medication non-adherence is associated with a broad range of adverse outcomes in patients with coronary artery disease


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Presented by:
P. Michael Ho, MD, PhD, David J. Magid, MD, MPH, Susan M. Shetterly, MS, Kari L. Olson, PharmD, BCPS, Thomas M. Maddox, MD, MSc, Pamela N. Peterson, MD, MSPH, Frederick A. Masoudi, MD, MSPH, John S. Rumsfeld, MD, PhD

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Medication non-adherence is associated with a broad range of adverse outcomes in patients with coronary artery disease

  1. 1. Medication Non-adherence Is Associated With A Broad Range Of Adverse Outcomes In Patients With Coronary Artery Disease <ul><li>P. Michael Ho, MD, PhD 1-3 , David J. Magid, MD, MPH 2,3 , Susan M. Shetterly, MS 3 , Kari L. Olson, PharmD, BCPS 3 , Thomas M. Maddox, MD, MSc 1-3 , Pamela N. Peterson, MD, MSPH 2-4 , Frederick A. Masoudi, MD, MSPH 2-4 </li></ul><ul><li>John S. Rumsfeld, MD, PhD 1-3 </li></ul><ul><li>Denver VA Medical Center </li></ul><ul><li>University of Colorado Health Sciences Center </li></ul><ul><li>Institute for Health Research, Kaiser Permanente of Colorado </li></ul><ul><li>Denver Health Medical Center </li></ul>
  2. 2. Disclosure Information DISCLOSURE INFORMATION: This work was supported by an American Heart Association Scientist Development Grant (0535086N)
  3. 3. Background and Objectives <ul><li>Efficacy of β-blockers, ACE-inhibitors, and statins demonstrated in clinical trials </li></ul><ul><li>Gap between benefits demonstrated in clinical trials and effectiveness of medications in clinical practice </li></ul><ul><li>Objective: To evaluate the association between non-adherence to β-blockers, ACE-inhibitors, and statin medications with a broad range of CV adverse outcomes </li></ul>
  4. 4. Methods <ul><li>Setting: Integrated, nonprofit managed care organization in the Denver, Colorado metropolitan area </li></ul><ul><li>Patients: 15,567 patients with coronary artery disease </li></ul><ul><li>Study design: Retrospective cohort study </li></ul><ul><ul><li>Median follow-up 4.1 years </li></ul></ul><ul><ul><li>Medication adherence: proportion of days covered for β -blockers, ACE-inhibitors, and statin medications </li></ul></ul><ul><ul><li>Non-adherence defined as PDC<0.80 </li></ul></ul><ul><li>Outcomes </li></ul><ul><ul><li>All-cause mortality </li></ul></ul><ul><ul><li>Cardiovascular mortality </li></ul></ul><ul><ul><li>Cardiovascular hospitalization for AMI or heart failure </li></ul></ul><ul><ul><li>Revascularization procedures including PCI or CABG </li></ul></ul>
  5. 5. Baseline 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 65 Age (mean)
  6. 6. Rates of non-adherence Non-adherent patients were younger and more likely to have COPD and depression n=10,021 n=13,596 n=11,865
  7. 7. Non-adherence to cardioprotective medications is associated with adverse outcomes 0.5 All-cause mortality n=1,889 CV mortality n=372 CV Hospitalization* n=2,008 Coronary Revascularization # n=2,117 B-blockers Statins ACE-inhibitors Hazards Ratio 1.0 2.0 *Hospitalization for AMI or heart failure #PCI or CABG
  8. 8. Non-adherence to H2 antagonists or proton pump inhibitors not associated with 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
  9. 9. Conclusions <ul><li>1 in 4 patients were non-adherent </li></ul><ul><li>Non-adherence to cardioprotective medications associated with higher risk of adverse outcomes </li></ul><ul><li>Non-adherence to GI medications not associated with adverse outcomes </li></ul><ul><ul><li>Suggest lower risk associated with adherence due to benefits of cardioprotective medications rather than ‘healthy adherer’ effect </li></ul></ul><ul><li>Expanding current quality of care measures to include the assessment of medication adherence may be an important quality metric </li></ul>