Age and persistent use of cardiovascular medication after acute coronary syndrome: results from medication applied and sustained over time.

Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.22). 09/2009; 57(11):1990-6. DOI: 10.1111/j.1532-5415.2009.02483.x
Source: PubMed

ABSTRACT To describe the persistent use of evidence-based cardiovascular medications (EBCMs) 3 months after discharge from an acute coronary syndrome (ACS) event and patient-reported reasons for nonpersistence across age groups.
Medication Applied and Sustained Over Time (MAINTAIN) is a longitudinal follow-up cohort study of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation quality improvement initiative and Acute Coronary Treatment and Intervention Outcomes Network registry.
Forty-one acute care hospitals in the United States from January 2006 to September 2007.
One thousand fifty-four patients with a median age of 60 (interquartile range 52-71), including 27% aged 70 and older, admitted with an ACS.
Three-month posthospital discharge telephone follow-up with EBCMs reviewed and reconciled. Patients who reported nonpersistence were surveyed regarding reasons for EBCM discontinuation.
At 3-month follow-up, overall persistence was 71.2%. There was a significant trend toward lower overall persistence with prescribed EBCMs in older adults than in the other age groups (74.9% for <60, 71.0% for 60-69, 64.5% for > or =70; P=.02). Overall, 112 (10.6%) patients discontinued EBCMs with provider advice, and 178 (16.9%) self-discontinued. Provider discontinuation increased across age groups (9.1%, 10.4%, and 13.6%, respectively). A similar trend was observed for EBCM self-discontinuation (15.2%, 17.0%, and 19.9%, respectively). Reasons for self-discontinuation included adverse effects, cost, and perception that the medication was not needed.
Older patients are less likely to be persistent with EBCMs after an ACS event at 3-month follow-up. Understanding patient-reported reasons for discontinuation can influence intervention strategies to improve long-term adherence to EBCMs.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Few studies have evaluated age-related predictors associated with the underuse of medications in patients with coronary heart disease (CHD). The objective of this study was to identify age-related differences in the factors associated with the underuse of recommended medications in patients diagnosed with acute coronary syndrome (ACS).
    BMC Cardiovascular Disorders 09/2014; 14(1):127. · 1.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Rationale, aims and objectives Poor medication adherence is a major global public health challenge. A valid, reliable, cost-effective tool for measuring medication adherence would lead to a better understanding of non-adherence and lay the groundwork for interventions aimed at facilitating adherence to therapies. The aim of this study was to translate and evaluate the psychometric properties of the Chinese version of the 8-item Morisky medication adherence scale (C-MMAS-8) in Chinese myocardial infarction (MI) patients.Methods Psychometric testing of the C-MMAS-8 was conducted using a convenience sample of 176 MI patients recruited from four major hospitals in Guangzhou in southern China. Socio-demographic data, C-MMAS-8 and three subscales of the revised illness perception questionnaire (treatment control, personal control and illness coherence subscales) were administered to the MI patients. Thirty MI patients participated in a 4-week retest.Results The C-MMAS-8 demonstrated good internal consistency (Cronbach's α = 0.77) and test–retest reliability (r = 0.88, P < 0.001). Significant correlations with treatment control subscale (r = 0.32, P < 0.01), personal control subscale (r = 0.47, P < 0.01), and illness coherence subscale (r = 0.44, P < 0.01) of the revised illness perception questionnaire demonstrated good construct validity.Conclusions The psychometric properties of the C-MMAS-8 are satisfactory.
    Journal of Evaluation in Clinical Practice 06/2014; · 1.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The recommended pharmacotherapy for secondary prevention of acute coronary syndrome (ACS) is long-term treatment with a combination of four therapeutic classes: beta-blockers, antiplatelet agents (including aspirin), statins or other lipid-lowering agents, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The aim of this study was to describe use and persistence of the recommended drug combination after the first occurrence of ACS in France. This was a database cohort study of patients with first registration for ACS between 2004 and 2007 in a representative sample of the French healthcare insurance database (Echantillon Généraliste de Bénéficiaires, EGB). The drugs of interest were those recommended. Persistence was assessed for patients dispensed three or all four drug classes within 2 months following ACS. Discontinuation was defined by a gap of more than 6 weeks between two dispensations. The follow-up period was 24 months after ACS occurrence. Of 2,057 patients with incident ACS, 872 (42.4 %) had at least one dispensation of each of the four recommended drug classes, and 684 (33.3 %) had three of the four classes. Persistence to treatment at 24 months was 57.4 % (95 % CI [54.0-60.6]) for patients with four classes, and 55.5 % (95 % CI [51.6-59.1]) with three classes. Discontinuation of initial combination was higher in patients aged ≥ 65 years at ACS occurrence, those with associated ongoing chronic disease, and in those who did not suffer myocardial infarction. Post-ACS secondary prevention in France is not optimal, especially in patients who did not have myocardial infarction.
    European Journal of Clinical Pharmacology 11/2013; 70(4). · 2.70 Impact Factor