Medication nonadherence and adverse outcomes in CAD patients

Clinical trials have demonstrated the efficacy of beta blockers, angiotensin converting enzyme (ACE) inhibitors, and statins for the secondary prevention of coronary artery disease (CAD). ₁ The American College of Cardiology/American Heart Association clinical practice guidelines have adopted these medications as class I recommendations for CAD patients to reduce recurrent cardiovascular events. ¹ Although there have been improvements in the prescription rates of secondary prevention medications for CAD patients, a gap persists between the benefits demonstrated with these medications in clinical trials and the effectiveness observed in clinical practice. ^2,3 One potential explanation for this discrepancy is suboptimal adherence to secondary prevention medications in practice compared with clinical trials, where adherence is often closely monitored. ^4-ε The objective of our study was to assess the association between medication adherence and a broad range of outcomes among patients with known CAD treated in a large managed care organization. Specifically, we evaluated the association between nonadherence to beta blockers, ACE inhibitors, and statins with outcomes of all-cause and cardiovascular mortality, hospitalization for acute myocardial infarction (MI) or heart failure, and need for coronary revascularization, including percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery.