Author + information
- Fatima Rodriguez,
- Deepak Bhatt,
- Philippe Steg,
- Dharam Kumbhani,
- Amarachi Umez-Eronini,
- Elaine Hoffman and
- Christopher Cannon
Despite overall improvements in cardiovascular disease therapies and outcomes, lack of medication adherence remains an important barrier to the effective secondary prevention of atherothrombotic disease.
We examined data from the prospective international Reduction of Atherothrombosis for Continued Health (REACH) Registry. Analyses were derived from 25,737 patients with established atherothrombotic disease who had adherence data at enrollment and at year 4. Adherence was defined as patients’ self-report of taking medications based on Class I ACC/AHA guidelines for secondary prevention as defined as use of all three classes of drugs: antiplatelet agents, statins and anti-hypertensive medications. Covariates included were demographics, region, risk factors, prior vascular disease and incident non-fatal events.
Among patients with atherothrombotic disease, 12,500 (48.6%) received all 3 classes of medications and were deemed complete guideline-adherent. These patients were more likely to be younger, have less polyvascular disease, be of white race and report full-time employment. On multivariate analyses, Hispanic and East Asian patients were less likely to be adherent as compared to Caucasians (Odds Ratios [OR]=0.72 95% CI 0.59-0.88; OR=0.68; 95% CI 0.54-0.85, respectively). Patients who underwent coronary angioplasty or stenting during follow-up were more likely to be adherent (OR=2.31; 95% CI 1.86-2.85), as were patients who had a non-fatal MI during follow-up (OR=1.62; 95% CI 1.20-2.20). On the other hand, non-fatal stroke during follow-up was inversely associated with adherence (OR=0.81; 95% CI 0.71-0.93). Region, smoking status and polyvascular disease were also predictive of adherence.
Using a large, international registry of stable outpatients with atherothrombotic disease, we found that age, region, race/ethnicity and incident cardiovascular events were predictive of long-term complete guideline adherence for secondary prevention. These findings suggest that certain patient groups such as older adults, racial/ethnic minorities, and stroke patients may benefit from targeted interventions to improve adherence.
West, Room 3006
Sunday, March 10, 2013, 9:00 a.m.-9:15 a.m.
Session Title: Advancing the Cutting Edge of Cardiovascular Care: Recent Accomplishments and Future Goals
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 920-7
- 2013 American College of Cardiology Foundation