Clinical InvestigationOutcomes, Health Policy, and Managed CareUntangling the relationship between medication adherence and post–myocardial infarction outcomes: Medication adherence and clinical outcomes
Section snippets
Methods
The study population was derived from MI FREEE—a randomized policy study evaluating the impact of copayments for β-blocker, statin, angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB) prescribed to patients discharged from hospital after MI. Full details of the trial have previously been published.9 To evaluate the impact of adherence on clinical outcomes, we restricted the cohort to patients who had filled a prescription for at least one of the study
Results
The proportion of patients in the full and usual coverage groups who were fully and nonadherent to the study medications is presented in online Appendix A (top panel). Table I shows the baseline characteristics of all patients randomized to the full and usual coverage arms, stratified by study medication and achieved adherence. Age, gender, comorbidity scores, and copayment were similar across groups. Nonadherent patients in the full coverage cohort were slightly less likely to have used
Discussion
The broad use of secondary prevention medications in patients after MI has made substantial contributions to reductions in cardiovascular mortality.18 However, the benefits of these therapies19 are limited by patient adherence to treatment.20., 21. Although the role of consistent long-term medication use is appreciated by clinicians and policymakers, its actual impact on clinical outcomes and the level of drug use required to derive benefit have required further clarification. We evaluated the
Acknowledgements
This work was supported by unrestricted research grants from Aetna and CVS Caremark to Brigham and Women's Hospital. Troyen Brennan and Olga Matlin are employees of CVS Caremark. Lonny Reisman and Michele Toscano are employees of Aetna.
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