Risk factor management after myocardial infarction: reported adherence and outcomes.
BACKGROUND
Providing patients with documented discharge instructions is a performance measure of health care quality. It is not well known how often cardiac patients comply with the list of instructions or what their association is with health status outcomes after an acute myocardial infarction.


METHODS
Acute myocardial infarction patients (N = 2,498) were prospectively enrolled into a 19-center study and asked, at 1 month, if they had recalled receiving instructions at discharge on any of the 13 secondary prevention behaviors (eg, exercise, medications, diet, and smoking). Adherence, defined as the percentage of relevant activities patients reported adhering to at 1 month, was grouped into 4 categories: poor (0%-49%), partial (50%-74%), careful (75%-99%), and very careful (100%).


RESULTS
A total of 2,046 patients completed 1-month interviews and received instruction on at least 1 risk factor management (RFM) behavior. Very careful adherence at 1-month was reported most frequently with "taking medications as prescribed" (94%). In multivariable-adjusted models, patients who reported being poorly adherent were 58% more likely to report angina at 1 year as compared with those who very carefully followed RFM (relative risk 1.58, 95% CI 1.05-2.37). There was no independent association between RFM behavior and quality of life, physical functioning, rehospitalization, or mortality.


CONCLUSIONS
There is substantial variation in the types of RFM to which acute myocardial infarction patients adhere. In aggregate, stronger adherence was associated with less angina at 1 year. More research is needed to understand adherence patterns and its association with outcomes.
Decker
Carole
C
Mid America Heart Institute at Saint Luke's Hospital in Kansas City, MO 64111, USA. c1decker@saint-lukes.org
Ahmad
Homaa
H
Moreng
Kate Louise
KL
Maddox
Thomas M
TM
Reid
Kimberly J
KJ
Jones
Philip G
PG
Spertus
John A
JA
D000368:Aged; D005260:Female; D015438:Health Behavior; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010351:Patient Discharge; D012307:Risk Factors; D016896:Treatment Outcome