Author + information
- Received February 11, 2016
- Revision received May 2, 2016
- Accepted June 9, 2016
- Published online August 23, 2016.
- Sameer Bansilal, MD, MSa,
- Jose Maria Castellano, MD, PhDa,b,c,
- Ester Garrido, MPHa,d,
- Henry G. Wei, MDe,
- Allison Freeman, MSe,
- Claire Spettell, PhDe,
- Fernando Garcia-Alonso, MD, PhDd,
- Irene Lizano, PhDd,
- Renee J.G. Arnold, PharmDa,
- Jay Rajda, MD, MBAe,
- Gregory Steinberg, MBChBe and
- Valentin Fuster, MD, PhDa,b,∗ ()
- aIcahn School of Medicine at Mount Sinai School, New York, New York
- bNational Centre for Cardiovascular Research, Madrid, Spain
- cHospital Universitario Monteprincipe, Grupo HM, Madrid, Spain
- dFerrer, Barcelona, Spain
- eAetna Inc., Hartford, Connecticut
- ↵∗Reprint requests and correspondence:
Dr. Valentin Fuster, Cardiovascular Institute, Mount Sinai Heart, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
Background Although guideline-recommended therapies reduce major adverse cardiovascular events (MACE) in patients after myocardial infarction (MI) or those with atherosclerotic disease (ATH), adherence is poor.
Objectives The goal of this study was to determine the association between medication adherence levels and long-term MACE in these patients.
Methods We queried the claims database of a large health insurer for patients hospitalized for MI or with ATH. The primary outcome measure was a composite of all-cause death, MI, stroke, or coronary revascularization. Using proportion of days covered for statins and angiotensin-converting enzyme inhibitors, patients were stratified as fully adherent (≥80%), partially adherent (≥40% to ≤79%), or nonadherent (<40%). Per-patient annual direct medical (ADM) costs were estimated by using unit costs from 2 national files.
Results Data were analyzed for 4,015 post-MI patients and 12,976 patients with ATH. In the post-MI cohort, the fully adherent group had a significantly lower rate of MACE than the nonadherent (18.9% vs. 26.3%; hazard ratio [HR]: 0.73; p = 0.0004) and partially adherent (18.9% vs. 24.7%; HR: 0.81; p = 0.02) groups at 2 years. The fully adherent group had reduced per-patient ADM costs for MI hospitalizations of $369 and $440 compared with the partially adherent and nonadherent groups, respectively. In the ATH cohort, the fully adherent group had a significantly lower rate of MACE than the nonadherent (8.42% vs. 17.17%; HR: 0.56; p < 0.0001) and the partially adherent (8.42% vs. 12.18%; HR: 0.76; p < 0.0001) groups at 2 years. The fully adherent group had reduced per-patient ADM costs for MI hospitalizations of $371 and $907 compared with the partially adherent and nonadherent groups.
Conclusions Full adherence to guideline-recommended therapies was associated with a lower rate of MACE and cost savings, with a threshold effect at >80% adherence in the post-MI population; at least a 40% level of long-term adherence needs to be maintained to continue to accrue benefit. Novel approaches to improve adherence may significantly reduce cardiovascular events.
Ms. Garrido, Dr. Alonso, and Dr. Lizano are employees of Ferrer. Dr. Rajda, Ms. Freeman, and Dr. Spettell are employees of Aetna Inc. Drs. Wei and Steinberg were employees of Aetna Inc. at the time this research was performed.
- Received February 11, 2016.
- Revision received May 2, 2016.
- Accepted June 9, 2016.
- American College of Cardiology Foundation