Age and persistent use of cardiovascular medication after acute coronary syndrome: results from medication applied and sustained over time.
OBJECTIVES: To describe the persistent use of evidence-based cardiovascular medications (EBCMs) 3 months after discharge from an acute coronary syndrome (ACS) event and patient-reported reasons for nonpersistence across age groups. DESIGN: Medication Applied and Sustained Over Time (MAINTAIN) is a longitudinal follow-up cohort study of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation quality improvement initiative and Acute Coronary Treatment and Intervention Outcomes Network registry. SETTING: Forty-one acute care hospitals in the United States from January 2006 to September 2007. PARTICIPANTS: One thousand fifty-four patients with a median age of 60 (interquartile range 52-71), including 27% aged 70 and older, admitted with an ACS. MEASUREMENTS: Three-month posthospital discharge telephone follow-up with EBCMs reviewed and reconciled. Patients who reported nonpersistence were surveyed regarding reasons for EBCM discontinuation. RESULTS: At 3-month follow-up, overall persistence was 71.2%. There was a significant trend toward lower overall persistence with prescribed EBCMs in older adults than in the other age groups (74.9% for <60, 71.0% for 60-69, 64.5% for > or =70; P=.02). Overall, 112 (10.6%) patients discontinued EBCMs with provider advice, and 178 (16.9%) self-discontinued. Provider discontinuation increased across age groups (9.1%, 10.4%, and 13.6%, respectively). A similar trend was observed for EBCM self-discontinuation (15.2%, 17.0%, and 19.9%, respectively). Reasons for self-discontinuation included adverse effects, cost, and perception that the medication was not needed. CONCLUSION: Older patients are less likely to be persistent with EBCMs after an ACS event at 3-month follow-up. Understanding patient-reported reasons for discontinuation can influence intervention strategies to improve long-term adherence to EBCMs.
Ali, RC; Melloni, C; Ou, F-S; Schmader, K; Ohman, EM; Roe, MT; Peterson, ED; Alexander, KP
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