Early Medication Nonadherence After Acute Myocardial Infarction: Insights into Actionable Opportunities From the TReatment with ADP receptor iNhibitorS: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS) Study.


Journal Article

Nonadherence to prescribed evidence-based medications after acute myocardial infarction (MI) can contribute to worse outcomes and higher costs. We sought to better understand the modifiable factors contributing to early nonadherence of evidence-based medications after acute MI.We assessed 7425 acute MI patients treated with percutaneous coronary intervention at 216 US hospitals participating in TReatment with ADP receptor iNhibitorS: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS) between April 2010 and May 2012. Using the validated Morisky instrument to assess cardiovascular medication adherence at 6 weeks post MI, we stratified patients into self-reported high (score, 8), moderate (score, 6-7), and low (score, <6) adherence groups. Moderate and low adherence was reported in 25% and 4% of patients, respectively. One third of low adherence patients described missing doses of antiplatelet therapy at least twice a week after percutaneous coronary intervention. Signs of depression and patient-reported financial hardship because of medication expenses were independently associated with a higher likelihood of medication nonadherence. Patients were more likely to be adherent at 6 weeks if they had follow-up appointments made before discharge and had a provider explain potential side effects of their medications. Lower medication adherence may be associated with a higher risk of 3-month death/readmission (adjusted hazard ratio, 1.35; 95% confidence interval, 0.98-1.87) although this did not reach statistical significance.Even early after MI, a substantial proportion of patients report suboptimal adherence to prescribed medications. Tailored patient education and pre discharge planning may represent actionable opportunities to optimize patient adherence and clinical outcomes.URL: http://www.clinicaltrials.gov. Unique identifier: NCT01088503.

Full Text

Duke Authors

Cited Authors

  • Mathews, R; Peterson, ED; Honeycutt, E; Chin, CT; Effron, MB; Zettler, M; Fonarow, GC; Henry, TD; Wang, TY

Published Date

  • July 2015

Published In

Volume / Issue

  • 8 / 4

Start / End Page

  • 347 - 356

PubMed ID

  • 26038524

Pubmed Central ID

  • 26038524

Electronic International Standard Serial Number (EISSN)

  • 1941-7705

International Standard Serial Number (ISSN)

  • 1941-7713

Digital Object Identifier (DOI)

  • 10.1161/CIRCOUTCOMES.114.001223


  • eng