Poor medication adherence tied to CV events, all-cause death in CAD
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Data from a meta-analysis show that a 20% improvement in CV medication adherence could reduce risk for any CV event by 8% and risk for all-cause mortality by 12% among patients with CAD, researchers reported.
“Medication adherence has been defined as the extent to which a patient takes medications as prescribed by their health care providers,” Kui Hong, MD, PhD, of the department of cardiovascular medicine at the Second Affiliated Hospital of Nanchang University in Jiangxi, China, and colleagues wrote in Clinical Cardiology. “In clinical practice, medication nonadherence is one of the main factors that reduce[s] the effectiveness of drug therapies. However, a previous study reported that almost 40% of the patients who initiated the use of ACE inhibitors/angiotensin II receptor blockers, beta‐blockers or statins following hospitalization for MI became nonadherent during the first treatment year. Moreover, many patients seemed to do so already during the first 6 months. Therefore, better adherence to cardiovascular treatment should be highlighted in clinical secondary prevention in patients with CAD.”
Hong and colleagues analyzed data from 18 prospective studies with 402,201 participants reporting on associations between CV medication adherence and any CV events and/or all‐cause mortality in adults with CAD. Studies were published between 2002 and 2022; sample sizes varied from 865 to 101,011 participants; mean age ranged from 62 to 77 years.
Benefits of CV medication adherence
Researchers observed an inverse linear association between CV medication adherence and CV events (P for nonlinearity = .68) and mortality (P for nonlinearity = .82). An improvement of 20% in CV medication adherence was associated with a 12% lower risk for all-cause death, with an RR of 0.88 (95% CI, 0.82-0.97; P < .001), with low evidence of heterogeneity. A 20% improvement in adherence was also associated with an 8% lower risk for any CV events, with an RR of 0.92 (95% CI, 0.87-0.98; P = .02).
In subgroup analysis, the same benefit was observed with adherence to statins (RR = 0.9 for CV events; RR = 0.85 for mortality), ACE inhibitors or angiotensin II receptor blockers (RR = 0.9 for mortality), and antiplatelet agents (RR = 0.89 for mortality). There was no association between adherence to beta‐blockers and CV events or death.
The estimated absolute differences per 1 million individuals per year for mortality associated with 20% improvement were 175 cases with statins, 129 cases with antiplatelet therapies and 117 cases with ACE inhibitors or angiotensin II receptor blockers.
“This benefit was not observed [with] good beta‐blocker adherence,” the researchers wrote. “This reason might be the majority of the included sample were patients with post‐MI. Recently, several studies reported that beta‐blocker[s] might have no benefit on post‐AMI patients without heart failure or ventricular dysfunction.”
‘A target for quality improvement’
The researchers noted that most research included in the meta‐analysis was focused on statins, limiting some subgroup analyses for beta‐blockers, antiplatelet therapies and ACE inhibitors or angiotensin II receptor blockers. Additionally, researchers could not estimate what proportion of the risk for CV events and/or all‐cause death that has been attributed to poor adherence is in fact explained by the prescription of suboptimal medication doses.
“Poor adherence is dose‐dependently associated with significantly increased risk of cardiovascular events and all‐cause mortality in patients with CAD,” the researchers wrote. “Cardiovascular medication adherence should be a target for quality improvement interventions to maximize the outcomes of secondary prevention of CAD.”
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