title: Treatment adherence and risk of death after a myocardial infarction.
abstract: The relation of treatment adherence to mortality after a myocardial infarction was investigated among 2175 participants in the Beta Blocker Heart Attack Trial, which had data for measures of treatment adherence, clinical severity, and the psychological and social features that may influence post-infarction mortality. Overall, patients who did not adhere well to treatment regimen (ie, who took less than or equal to 75% of prescribed medication) were 2.6 times more likely than good adherers to die within a year of follow-up (95% confidence interval, 1.2, 5.6). Poor adherers had an increased risk of death whether they were on propranolol (OR = 3.1) or placebo (OR = 2.5). Furthermore, this increased risk of death for poor adherers was not accounted for by measures of the severity of myocardial infarction, sociodemographic features (eg, race, marital status, education), smoking, or psychological characteristics (high life-stress or social isolation).
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06510.
authors.forename: R I
authors.initials: RI
authors.lastname: Horwitz
authors.forename: C M
authors.initials: CM
authors.lastname: Viscoli
authors.forename: L
authors.initials: L
authors.lastname: Berkman
authors.forename: R M
authors.initials: RM
authors.lastname: Donaldson
authors.forename: S M
authors.initials: SM
authors.lastname: Horwitz
authors.forename: C J
authors.initials: CJ
authors.lastname: Murray
authors.forename: D F
authors.initials: DF
authors.lastname: Ransohoff
authors.forename: J
authors.initials: J
authors.lastname: Sindelar
mesh_terms: D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality* / Q000523:psychology; D010349:Patient Compliance; D011433:Propranolol / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological
chemical_list: D011433:Propranolol