The American Journal of Medicine
Volume 122, Issue 10 , Pages 961.e7-961.e13, October 2009

Long-term Medication Adherence after Myocardial Infarction: Experience of a Community

  • Nilay D. Shah, PhD

      Affiliations

    • Division of Health Care Policy and Research, Mayo Clinic College of Medicine, Rochester, Minn
    • Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, Minn
    • Corresponding Author InformationRequests for reprints should be addressed to Nilay D. Shah, Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
    • ,
  • Shannon M. Dunlay, MD

      Affiliations

    • Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minn
    • ,
  • Henry H. Ting, MD

      Affiliations

    • Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, Minn
    • Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minn
    • ,
  • Victor M. Montori, MD

      Affiliations

    • Knowledge and Encounter Research Unit, Mayo Clinic College of Medicine, Rochester, Minn
    • Division of Endocrinology Diabetes Metabolism and Nutrition, Mayo Clinic College of Medicine, Rochester, Minn
    • ,
  • Randal J. Thomas, MD

      Affiliations

    • Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minn
    • ,
  • Amy E. Wagie, BS

      Affiliations

    • Division of Health Care Policy and Research, Mayo Clinic College of Medicine, Rochester, Minn
    • ,
  • Véronique L. Roger, MD

      Affiliations

    • Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minn
    • Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minn

published online 29 June 2009.

Abstract 

Background

Adherence to evidence-based medications after myocardial infarction is associated with improved outcomes. However, long-term data on factors affecting medication adherence after myocardial infarction are lacking.

Methods

Olmsted County residents hospitalized with myocardial infarction from 1997-2006 were identified. Adherence to HMG-CoA reductase inhibitors (statins), beta blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers, were examined. Cox proportional hazard regression was used to determine the factors associated with medication adherence over time.

Results

Among 292 subjects with incident myocardial infarction (63% men, mean age 65 years), patients were followed for an average of 52±31 months. Adherence to guideline-recommended medications decreased over time, with 3-year medication continuation rates of 44%, 48%, and 43% for statins, beta-blockers, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, respectively. Enrollment in a cardiac rehabilitation program was associated with an improved likelihood of continuing medications, with adjusted hazard ratio (95% confidence interval) for discontinuation of statins and beta-blockers among cardiac rehabilitation participants of 0.66 (0.45-0.92) and 0.70 (0.49-0.98), respectively. Smoking at the time of myocardial infarction was associated with a decreased likelihood of continuing medications, although results did not reach statistical significance. There were no observed associations between demographic characteristics, clinical characteristics of the myocardial infarction, and medication adherence.

Conclusions

After myocardial infarction, a large proportion of patients discontinue use of medications over time. Enrollment in cardiac rehabilitation after myocardial infarction is associated with improved medication adherence.

Keywords: Adherence, Cardiac rehabilitation, Drugs, Myocardial infarction

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 Funding: Mayo Foundation for Education and Research, National Institute of Health, (ROI HL59205), Rochester Epidemiology Project Grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (ROI AR30582).

 Conflict of Interest: None.

 Authorship: NDS had access to data throughout the study and takes responsibility for the analysis. All other authors played important roles in conceptualization, data interpretation, writing, and critical revisions for this manuscript.

PII: S0002-9343(09)00281-2

doi:10.1016/j.amjmed.2008.12.021

The American Journal of Medicine
Volume 122, Issue 10 , Pages 961.e7-961.e13, October 2009

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