Background

Medication adherence to guideline-recommended therapy is important and associated with a lower rate of death and major adverse cardiovascular events (MACE) among patients with acute coronary syndrome (ACS).

Objective

This retrospective study aimed to evaluate medication adherence in four classes of guideline-recommended medicines (antiplatelets, ACEIs/ARBs, beta-blockers, and statins) among patients discharged with ACS and to assess the association between patients’ adherence to each medication and the occurrence of MACE including all causes of death, myocardial infarction, unstable angina, heart failure, stroke, atrial fibrillation or coronary revascularization.

Methods

The electronic medical records of patients with ACS admitted at a tertiary teaching hospital in northern Thailand between January 1, 2010 and December 31, 2015 were reviewed. Medication adherence was evaluated from a hospital database of prescription refills using the medication gap technique with ≥90% as a cut-off for full adherence and <90% as partial adherence.

Results

Of 256 patients, the mean age was 65.9 (±13.0) years. The median percentage of medication adherence in the dual antiplatelet group, ACEI/ARB group, beta-blocker group, and statin group were 94.7, 93.6, 93.1, and 93.1%, respectively. Sixty-two patients (24.2%) experienced MACE after a median follow-up of 1.5 years. Patients with ≥90% adherence of beta-blockers had a significantly lower risk of MACE than those with <90% adherence: HR = 0.47, 95% Cl, 0.26–0.87, p = 0.016, adjusted with potential confounders. No other significant associations were observed.

Conclusions

Medication adherence of each medication was above 90%. ACS patients with at least 90% adherence to beta-blockers had a lower risk of MACE than those having less than 90% adherence, but no other significant associations were found for other medications.

中文翻译：

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急性冠脉综合征患者服药依从性与心血管结局的关系

背景

药物依从指南——推荐的治疗很重要，并且与急性冠脉综合征 (ACS) 患者的死亡率和主要不良心血管事件 (MACE) 的发生率较低有关。

客观的

本回顾性研究旨在评估 ACS 出院患者对四类指南推荐药物（抗血小板、ACEIs/ARB、β 受体阻滞剂和他汀类药物）的药物依从性，并评估患者对每种药物的依从性与发生MACE 的所有原因包括死亡、心肌梗塞、不稳定心绞痛、心力衰竭、中风、心房颤动或冠状动脉血运重建。

方法

回顾了2010年1月1日至2015年12月31日期间在泰国北部一家三级教学医院收治的ACS患者的电子病历。药物依从性是从医院处方补充数据库中评估的，使用药物间隙技术，≥90% 作为完全依从性的临界值，<90% 作为部分依从性的临界值。

结果

在 256 名患者中，平均年龄为 65.9 (±13.0) 岁。双联抗血小板组、ACEI/ARB 组、β-受体阻滞剂组和他汀组的药物依从性中位数百分比分别为 94.7、93.6、93.1 和 93.1%。中位随访 1.5 年后，62 名患者 (24.2%) 经历了 MACE。β受体阻滞剂依从性≥90%的患者发生MACE的风险显着低于依从性<90%的患者：HR = 0.47, 95% Cl, 0.26–0.87, p = 0.016，根据潜在混杂因素进行调整。没有观察到其他显着关联。

结论

每种药物的服药依从性均在90%以上。与依从性低于 90% 的患者相比，β 受体阻滞剂依从性至少为 90% 的 ACS 患者发生 MACE 的风险较低，但未发现其他药物与其他显着关联。