Age and persistent use of cardiovascular medication after acute coronary syndrome: results from medication applied and sustained over time.
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.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.Forty-one acute care hospitals in the United States from January 2006 to September 2007.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.Three-month posthospital discharge telephone follow-up with EBCMs reviewed and reconciled. Patients who reported nonpersistence were surveyed regarding reasons for EBCM discontinuation.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.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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