Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Adherence Rates to Secondary Prevention Meds

Circulation; ePub 2018 Jan 31; Mathews, et al

Among US hospitals, post-discharge use of secondary prevention medications varies significantly and are inversely associated with 2-year outcomes, a recent study found. Researchers identified 19,704 Medicare patients discharged after acute myocardial infarction (MI) from 347 US hospitals from January 2, 2007, to October 1, 2010. Medication adherence was defined as proportion of days covered (PDC) >80% within 90 days post-discharge. Among the findings:

  • By 90 days post-MI, overall rates of adherence to medications prescribed at discharge were 68% for beta-blockers, 63% for statins, 64% for angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), and 72% for thienopyridines.
  • Adherence up to 90 days varied significantly among hospitals.
  • Hospitals with the highest adherence, compared to those with low adherence rates, had lower unadjusted and adjusted 2-year major adverse cardiovascular events (MACE) risk, 27% vs 35% (HR, 0.88).
  • High adherence hospitals also had lower adjusted rates of death or readmission (HR, 0.90).

Citation:

Mathews R, Wang W, Kaltenbach LA, et al. Hospital variation in adherence rates to secondary prevention medications and the implications of quality. [Published online ahead of print January 31, 2018]. Circulation. doi:10.1161/CIRCULATIONAHA.117.029160.

Commentary:

Evidence-based therapies including beta-blockers, statins, and antiplatelet agents improve outcomes after acute myocardial infarction (MI). Most clinicians and hospitals have done a good job at making sure that eligible patients receive these therapies during hospitalization and as a part of their discharge medications. Less attention has been devoted to compliance after hospital discharge. This study shows that adherence is not very good, with most patients only taking two-thirds of prescribed doses of medications. It also shows that adherence to simple medications—beta-blockers, statins and antiplatelet agents—in the 2 years after an MI makes a difference in outcomes for those patients who take their medicines. — Neil Skolnik, MD

This Week's Must Reads

Is Obesity Associated With Adverse CV Outcomes?, JAMA Netw Open; 2018 Nov 16; Riaz, et al

BMI & Risk of Postpregnancy T2D in Women with HDP , Diabetes Care; ePub 2018 Nov 19; Timpka, et al

Diabetes Outcomes in Patients by PCPs, NPs, or PAs, Ann Intern Med; ePub 2018 Nov 20; Jackson, et al

Traumatic Exposures & Health Issues in Older Women, JAMA Intern Med; ePub 2018 Nov 19; Gibson, et al

Risk of Opioid Overdose Hospitalizations , J Am Board Fam Med; 2018 Nov-Dec; Peters, et al

Must Reads in Cardiology

Is Obesity Associated With Adverse CV Outcomes?, JAMA Netw Open; 2018 Nov 16; Riaz, et al

Cholesterol Guidelines Stress Lifetime Approach, Circulation; ePub 2018 Nov 10; Grundy, et al

Does Vitamin D Reduce Cancer & CVD Risk?, N Engl J Med; ePub 2018 Nov 10; Manson, et al

Elevated BP in Young Adults & Subsequent CVD Risk, JAMA; 2018 Nov 6; Yano, Reis, et al

Health Literacy and 1-Year Mortality in CVD, Mayo Clin Proc; ePub 2018 Nov 7; Mayberry, et al