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).


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.


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

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