Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease

P. Michael Ho, David J. Magid, Susan M. Shetterly, Kari L. Olson, Thomas M. Maddox, Pamela N. Peterson, Frederick A. Masoudi, John S. Rumsfeld

Research output: Contribution to journalArticle

388 Scopus citations

Abstract

Background: Little is known about the effect of nonadherence among patients with coronary artery disease (CAD) on a broad spectrum of outcomes including cardiovascular mortality, cardiovascular hospitalizations, and revascularization procedures. Methods: This was a retrospective cohort study of 15 767 patients with CAD. Medication adherence was calculated as proportion of days covered for filled prescriptions of β-blockers, angiotensin-converting enzyme (ACE) inhibitors, and statin medications. Multivariable Cox regression assessed the association between medication nonadherence as a time-varying covariate and a broad range of outcomes, adjusting for demographics and clinical characteristics. Median follow-up was 4.1 years. Results: Rates of medication nonadherence were 28.8% for β-blockers, 21.6% for ACE inhibitors, and 26.0% for statins. In unadjusted analysis, nonadherence to each class of medication was associated with higher all-cause and cardiovascular mortality. In multivariable analysis, nonadherence remained significantly associated with increased all-cause mortality risk for β-blockers (hazard ratio [HR] 1.50, 95% CI 1.33-1.71), ACE inhibitors (HR 1.74, 95% CI 1.52-1.98), and statins (HR 1.85, 95% CI 1.63-2.09). In addition, nonadherence remained significantly associated with higher risk of cardiovascular mortality for β-blockers (HR 1.53, 95% CI 1.16-2.01), ACE inhibitors (HR 1.66, 95% CI 1.26-2.20), and statins (HR 1.62, 95% CI 1.124-2.13). The findings of increased risk associated with nonadherence were consistent for cardiovascular hospitalization and revascularization procedures. Conclusions: Nonadherence to cardioprotective medications is common in clinical practice and associated with a broad range of adverse outcomes. These findings suggest that medication nonadherence should be a target for quality improvement interventions to maximize the outcomes of patients with CAD.

Original languageEnglish
Pages (from-to)772-779
Number of pages8
JournalAmerican heart journal
Volume155
Issue number4
DOIs
StatePublished - Apr 1 2008
Externally publishedYes

Fingerprint Dive into the research topics of 'Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease'. Together they form a unique fingerprint.

  • Cite this

    Ho, P. M., Magid, D. J., Shetterly, S. M., Olson, K. L., Maddox, T. M., Peterson, P. N., Masoudi, F. A., & Rumsfeld, J. S. (2008). Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease. American heart journal, 155(4), 772-779. https://doi.org/10.1016/j.ahj.2007.12.011