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

Year 2019, Volume: 10 Issue: 3, 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

References

• 1.Smith Jr SC, Benjamin EJ, BonowRO et al. AHA/ACCF secondarypreventionand risk reduction therapy for patients with coronary and other atherosclerotic vasculard isease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol 2011; 58: 2432-46
• 2.Butler J, Arbogast PG, BeLue R et al. Outpatient adherence to beta-blocker therapy after acute myocardial infarction. J Am Coll Cardiol 2002; 40:1589-95.
• 3.Mitra S, Findley K, Frohnapple D, Mehta JL.Trends in long‐term management of survivors of acutemyocardial infarction by cardiologists in a government university‐affiliated teaching hospital. Clin Cardiol 2002; 25: 16-18.
• 4.Simpson E, Beck C, Richard H, Eisenberg MJ, Pilote L. Drug prescriptions after acute myocardial infarction: dosage, compliance, and persistence. Am Heart J 2003; 145: 438-44.
• 5.Wei L, Flynn R, Murray GD, MacDonald TM. Use and adherence to beta‐blockers for secondary prevention of myocardial infarction: who is not getting the treatment? Pharmacoepidemiol Drug Saf 2004; 13: 761-66.
• 6.Grégoire JP, Moisan J, Guibert Ret al. Determinants of discontinuation of newcourses of antihypertensive medications. J Clin Epidemiol 2002; 55: 728-35.
• 7.Newby LK, LaPointe NM, Chen AY et al. Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease. Circulation 2006; 113: 203-12.
• 8. McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: TheTask Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the EuropeanSociety of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33: 1787-847.
• 9.Akgün G, Onat A, Enar R, Alp N. Türkiye’de koroner kalp hastalığı tedavi kalıpları çalışması. Turk Kardiyol Dern Ars 2000; 28: 274-81
• 10.Hanratty B, Lawlor DA, Robinson MB, Sapsford RJ, Greenwood D, Hall A. Sex differences in risk factors, treatment and mortality after acute myocardial infarction: an observational study. J Epidemiol Community Health 2000; 54: 912-16.
• 11.Tokgözoğlu L, KayaE. B, Erol Ç,ErgeneO. EUROASPIRE III: Türkiye ile Avrupa’nın karşılaştırılması.Turk Kardiyol Dern Ars 2010; 38: 164-72
• 12.Şimşek H. Demiral Y, Aslan Ö, Toğrul BÜ. Bir Üniversite Hastanesinde Koroner Kalp Hastalarına Uygulanan Tedavi Oranları. DEÜ Tıp Fakültesi Dergisi 2012; 2: 111-17
• 13.Akincigil A, Bowblis JR, Levin C, Jan S, Patel M, Crystal S. Long-term adherence to evidence based secondary prevention therapies after acute myocardial infarction. J Gen Intern Med 2008; 23:115–21.
• 14.Tuppin P,Neumann A,Danchin N et al. Evidence-based pharmacotherapy after myocardial infarction in France: adherence-associated factors and relationship with 30-month mortality and rehospitalization. Arch Cardiovasc Dis 2010; 103: 363-75