Association of medical noncompliance and long-term adverse outcomes, after myocardial infarction in a minority and uninsured population.
The association of noncompliance with evidence-based medical therapies after myocardial infarction (MI) on long-term outcomes is not well recognized in minority and uninsured populations. Consecutive MI patients at a large urban hospital were followed for compliance with evidence-based medications (aspirin, clopidogrel, statins, beta blockers, and angiotensin converting enzyme inhibitors [ACEIs]/angiotensin receptor blockers [ARBs]). Noncompliance was defined as proportion of days covered < or =80%. The outcome was combined mortality and MI. Kaplan-Meier analyses were used to explore the impact of noncompliance > or =4 medications. Of the 509 patients (86% minorities, 77% uninsured, and 54% diabetics), 132 (25.9%) presented with ST segment elevation with myocardial infarction (STEMI) and 377 (74.1%) with a non-ST segment elevation with myocardial infarction (NSTEMI), revascularization was performed in 297 (58.4%) patients, 72 (14.2%) patients died, 22 (4.3%) patients had an MI, and 91 (17.9%) patients had either event at a median follow-up of 2 (0.5-2.9) years. Noncompliance > or = 4 medications was significantly associated with adverse survival compared with compliant patients (29.7% vs 78.9%). After adjusting for traditional risk factors, The Global Registry of Acute Coronary Events risk score for predicting death during 6 months post-discharge, revascularization, left ventricular (LV) function, coronary artery disease (CAD) severity, and punctual clinic visits, noncompliance with > or = 4 evidence-based medications was an independent factor associated with death or MI (hazard ratio [HR], 2.83; 95% confidence interval [CI]=1.60-5.01) in this minority and uninsured population.
Amin
Amit P
AP
Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County (Cook County Hospital), Chicago, IL 60612, USA. amit_p_amin@yahoo.com
Mukhopadhyay
Ekanka
E
Nathan
Sandeep
S
Napan
Sirikarn
S
Kelly
Russell F
RF
D002317:Cardiovascular Agents / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006801:Humans; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008913:Minority Groups / Q000706:statistics & numerical data*; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D010349:Patient Compliance; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors
D002317:Cardiovascular Agents