Author + information
- Received April 21, 2017
- Revision received July 20, 2017
- Accepted July 23, 2017
- Published online September 18, 2017.
- Maarit J. Korhonen, LicSci(Pharm), PhDa,b,c,
- Jennifer G. Robinson, MPH, MDd,e,
- Izabela E. Annis, MSca,
- Ryan P. Hickson, PharmD, MPHa,
- J. Simon Bell, PhDb,c,
- Juha Hartikainen, PhD, MDf,g and
- Gang Fang, PharmD, MS, PhDa,∗ ()
- aDivision of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
- bNational Health and Medical Research Council Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide, South Australia, Australia
- cCentre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
- dDepartment of Epidemiology, College of Public Health, the University of Iowa, Iowa City, Iowa
- eDepartment of Internal Medicine, Carver College of Medicine, the University of Iowa, Iowa City, Iowa
- fHeart Center, Kuopio University Hospital, Kuopio, Finland
- gSchool of Medicine, University of Eastern Finland, Kuopio, Finland
- ↵∗Address for correspondence:
Dr. Gang Fang, Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, 2202 Kerr Hall, University of North Carolina, Chapel Hill, North Carolina 27599-7573.
Background Angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB), beta-blockers and statins are recommended after acute myocardial infarction (AMI). Patients may adhere to some, but not all, therapies.
Objectives The authors investigated the effect of tradeoffs in adherence to ACE inhibitors/ARBs, beta-blockers, and statins on survival among older people after AMI.
Methods The authors identified 90,869 Medicare beneficiaries ≥65 years of age who had prescriptions for ACE inhibitors/ARBs, beta-blockers, and statins, and survived ≥180 days after AMI hospitalization in 2008 to 2010. Adherence was measured by proportion of days covered (PDC) during 180 days following hospital discharge. Mortality follow-up extended up to 18 months after this period. The authors used Cox proportional hazards models to estimate hazard ratios of mortality for groups adherent to 2, 1, or none of the therapies versus group adherent to all 3 therapies.
Results Only 49% of the patients adhered (PDC ≥80%) to all 3 therapies. Compared with being adherent to all 3 therapies, multivariable-adjusted hazard ratios (95% confidence intervals [CIs]) for mortality were 1.12 (95% CI: 1.04 to 1.21) for being adherent to ACE inhibitors/ARBs and beta-blockers only, 0.98 (95% CI: 0.91 to 1.07) for ACEI/ARBs and statins only, 1.17 (95% CI: 1.10 to 1.25) beta-blockers and statins only, 1.19 (95% CI: 1.07 to 1.32) for ACE inhibitors/ARBs only, 1.32 (95% CI: 1.21 to 1.44) for beta-blockers only, 1.26 (95% CI: 1.15 to 1.38) statins only, and 1.65 (95% CI: 1.54 to 1.76) for being nonadherent (PDC <80%) to all 3 therapies.
Conclusions Patients adherent to ACE inhibitors/ARBs and statins only had similar mortality rates as those adherent to all 3 therapies, suggesting limited additional benefit for beta-blockers in patients who were adherent to statins and ACE inhibitors/ARBs. Nonadherence to ACE inhibitors/ARBs and/or statins was associated with higher mortality.
This study is supported in part by National Institute of Aging (NIA) grant 1R01AG046267-01A1 (Dr. Fang) and 1R21AG043668-01A1 (Dr. Fang). The findings and views in this paper are the authors, and do not represent the official opinions and views of the NIA. Dr. Korhonen was supported by the Australian National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Frailty and Healthy Ageing. Dr. Robinson has received institutional research grants from Amarin, Amgen, AstraZeneca, Eli Lilly, Esai, Esperion, GlaxoSmithKline, Merck, Pfizer, Regeneron/Sanofi, and Takeda; and is a consultant for Akcea/Ionis, Amgen, Dr. Reddy Laboratories, Eli Lilly, Esperion, Merck, Pfizer, and Regeneron/Sanofi. Dr. Hartikainen has received institutional research grants from Biosense Webster, Medtronic, St. Jude Medical, Boehringer Ingelheim, Merck Sharp and Dohme, Amgen, and AstraZeneca; and is a member of advisory boards for Biosense Webster, Medtronic, St. Jude Medical, Boehringer Ingelheim, Merck Sharp and Dohme, Amgen, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 21, 2017.
- Revision received July 20, 2017.
- Accepted July 23, 2017.
- 2017 American College of Cardiology Foundation
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