Medication adherence after myocardial infarction: A single center retrospective cohort study

Year 2019, , 329 - 334, 30.09.2019

Ufuk Tan Bayram Kürşat Akbuğa , Mustafa Karanfil Mehmet Akif Düzenli

https://doi.org/10.18663/tjcl.557476

Abstract

Aim: The study is designed to compare the discharge prescriptions
of ST-elevated (STEMI) and non ST-elevated (NSTEMI) myocardial infarction
patients and the medications used end of first year and also to investigate the
relationship between MI type, gender, age groups and drug adherence.
Material and Methods: In retrospect, data from 413 patients were collected
via epicrisis and phone visits. Discharge and the outpatient medications end of
one year were compared.
Results: Of the 413 patients included in the study, 312 (%75)
were male. MI type distribution was NSTEMI with a ratio of 38.5% (n = 159) and
STEMI with a ratio of 61.5% (n = 254). Only 2 (0.5%) patients did not receive
acetylsalicylic acid (ASA) at discharge. The rate of beta-blocker, statin,
clopidogrel users were %94.4, %97.1 and %97.8, respectively. The rate of
patients who used five drugs (ASA, beta blocker, ACEI/ARB, statin, clopidogrel)
at discharge was 78.7% (n = 325). At the end of first year, the rate of ASA,
statin, beta blocker, angiotensin converting enzyme inhibitors/aldosterone
receptor blocker(ACEI/ARB) and clopidogrel users dropped down to 88.1% (n =
364), 66% (n = 273), 80.9% (n = 334), 69.7% (n = 288) and 81.3% (n = 336),
respectively(p<0.05 for all parameters). After one year, the number of
patients using five drugs dropped to %45(p<0.05). Beta-blocker target dose
was achieved in 68(16.5%) patients and ACEI / ARB target dose was achieved in
74(17.9%) patients. Patients with renal failure were not able to reach the
target doses of ACEI/ARB at the end of first year (p: 0,033). And also renal
failure is considered as an impediment to proper drug use at discharge and end
of the first year (p <0.01 and p<0.01 respectively).
Conclusion: It was determined that treatment compliance was
impaired at the end of one year in a significant proportion of patients with
acute coronary syndrome. One year later, compliance with treatment was higher
in females than in males and was inversely related to age and renal failure. It
is observed that follow-up training programs are needed to succeed in drug
adherence.

Keywords

Acute coronary syndrome, Therapeutic adherence, Maximal tolerated dose

Miyokard infarktüsü sonrası ilaç uyumu: Tek merkezli retrospektif kohort çalışması

Abstract

Amaç: Çalışma, ST yükselmeli
(STEMI) ve ST yükselmesiz (NSTEMI) miyokard infarktüslü hastaların taburculuk
reçetelerini ve birinci yıl sonundaki kullanılan ilaçlarını karşılaştırmak ve
ayrıca bunların MI tipi ilecinsiyet, yaş arasındaki ilişkisini araştırmak için
tasarlanmıştır.

Gereç ve Yöntemler:
Retrospektif olarak 413 hastanın verilerepikriz ve telefon ziyaretleri yoluyla
toplandı. Taburculuk ve bir yıl sonunda kullanılan ilaçları karşılaştırıldı.

Bulgular: Çalışmaya dahil
edilen 413 hastanın 312'si (% 75) erkekti. MI tipi dağılımı% 38.5 (n =
159)  NSTEMI, % 61.5 (n = 254) STEMI’idi.
Sadece 2 (% 0.5) hasta taburcu olduklarında asetilsalisilik asit (ASA) almadı.
Beta-bloker, statin, klopidogrel kullanıcılarının oranı sırasıyla% 94.4,% 97.1
ve% 97.8’di. Taburculukta beşli ilaç (ASA, beta bloker, ADEİ / ARB, statin,
klopidogrel) kullanan hastaların oranı% 78.7’di (n = 325). İlk yılın sonunda,
ASA, statin, beta bloker, anjiyotensin dönüştürücü enzim inhibitörleri /
aldosteron reseptör bloker (ADEİ / ARB) ve klopidogrel kullananların oranı
sırasıyla; % 88.1'e (n = 364), % 66'ya (n = 273), % 80.9’a (n = 334),% 69.7’ye
(n = 288) ve% 81.3’e düştü (n = 336) (tüm parametreler için p <0.05). Bir
yıl sonra, beşli ilaç kullanan hasta sayısı% 45'e düştü (p <0.05). 68
hastada (% 16.5) beta blokör hedef dozu, 74 hastada (% 17.9) ADEİ/ ARB hedef
dozu sağlandı. Böbrek yetmezliği olan hastalar birinci yıl sonunda  ADEI / ARB hedef dozlarına ulaşamadı (p:
0,033). Ayrıca böbrek yetmezliğinintaburculuk sırasında ve ilk yılın sonunda
uygun ilaç kullanımına engel olduğu gözlendi.(sırasıyla p <0.01 ve p
<0.01).

Sonuç: Akut koroner sendromlu
hastaların önemli bir bölümünde tedavi uyumu bir yıl sonunda bozulmuş bulundu.
Bir yıl sonra, tedaviye uyum kadınlarda erkeklere göre daha yüksekti, yaş ve
böbrek yetmezliği ile ters orantılıydı. İlacın uyumunda başarılı olmak için
takip eğitim programlarına ihtiyaç duyulduğu gözlendi.

Keywords

Akut koroner sendrom, Terapötik uyum, maksimum tolere edilen doz

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