title: Predictors of long-term adherence to evidence-based cardiovascular disease medications in outpatients with stable atherothrombotic disease: findings from the REACH Registry.
abstract: BACKGROUND
  Despite overall improvements in cardiovascular-disease therapies and outcomes, medication nonadherence remains an important barrier to effective secondary prevention of atherothrombotic disease.
  
  
  OBJECTIVE
  Long-term medication adherence in outpatients with stable atherothrombotic disease is impacted by demographic and clinical factors.
  
  
  METHODS
  We examined data from the prospective international Reduction of Atherothrombosis for Continued Health (REACH) Registry. Analyses were derived from 25 737 patients with established atherothrombotic disease with complete adherence data at enrollment and at year 4. Adherence was defined as patients' self-report of taking medications based on class I American College of Cardiology/American Heart Association guidelines for secondary prevention as defined, including antiplatelet agents, statins, and antihypertensive medications.
  
  
  RESULTS
  Among patients with atherothrombotic disease, 12 500 (48.6%) were deemed adherent to guideline-recommended medications. Adherent patients were younger, white, and had less polyvascular disease. Hispanic and East Asian patients were less likely to be adherent as compared with white patients (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.59-0.88; and OR: 0.67, 95% CI: 0.53-0.83, respectively). Patients who had a nonfatal MI or underwent coronary angioplasty/stenting during follow-up were more likely to be adherent compared with patients without these events (OR: 1.73, 95% CI: 1.25-2.38; and OR: 2.15, 95% CI: 1.72-2.67, respectively). On the other hand, nonfatal stroke during follow-up was inversely associated with adherence (OR: 0.77, 95% CI: 0.61-0.97).
  
  
  CONCLUSIONS
  Using a large international registry of outpatients with atherothrombotic disease, we found that age, region, race/ethnicity, and incident cardiovascular events were predictive of long-term guideline adherence for secondary prevention, suggesting that certain patient groups may benefit from targeted interventions to improve adherence.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Fátima
authors.initials: F
authors.lastname: Rodriguez
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
authors.forename: Shinya
authors.initials: S
authors.lastname: Goto
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: Amarachi A
authors.initials: AA
authors.lastname: Umez-Eronini
authors.forename: Elaine
authors.initials: E
authors.lastname: Hoffman
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000592:standards; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D016009:Chi-Square Distribution; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000208:ethnology; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D044469:Racial Groups; D012042:Registries; D012111:Residence Characteristics; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods* / Q000592:standards; D057566:Self Report; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents