title: Persistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study.
abstract: BACKGROUND
  Persistent use of secondary prevention therapies after acute myocardial infarction (MI) is critical to optimizing long-term outcomes.
  
  
  METHODS
  Medication persistence was assessed among 7,955 MI patients in 216 hospitals participating in the Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome study from 2010 to 2012. Persistence was defined as continuation of aspirin, adenosine diphosphate receptor inhibitors, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins from discharge to 6 months post-MI. Multivariable logistic regression modeling was used to determine factors associated with nonpersistence, defined as <80% persistence with all medication classes.
  
  
  RESULTS
  Overall, 31% of MI patients stopped taking a least 1 medication by 6 months. The most common reasons cited for medications discontinuation were side effects and physician instruction (57%), whereas financial concerns were cited in 8% overall. After multivariable modeling, black race (odds ratio 1.36, 95% CI 1.15-1.62), older age (odds ratio 1.07, 95% CI 1.02-1.12), atrial fibrillation (odds ratio 1.67, 95% CI 1.33-2.09), dialysis (odds ratio 1.79, 95% CI 1.15-2.78), and depression (odds ratio 1.22, 95% CI 1.02-1.45) were associated with lower likelihood of persistence. Private insurance (odds ratio 0.85, 95% 0.76-0.95), prescription cost assistance (odds ratio 0.63, 95% CI 0.54-0.75), and outpatient follow-up arranged before discharge (odds ratio 0.89, 95% CI 0.80-0.99) were associated with higher persistence.
  
  
  CONCLUSIONS
  Nearly one-third of MI patients are no longer persistent with their prescribed medications by 6 months. Patients at high risk for nonpersistence may be identified by clinical and sociodemographic features. These observations underscore key opportunities to optimize longitudinal use of secondary prevention therapies.
authors.affiliation: Duke Clinical Research Institute, Durham, NC. Electronic address: robin.mathews@duke.edu.
authors.forename: Robin
authors.initials: R
authors.lastname: Mathews
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Emily
authors.initials: E
authors.lastname: Honeycutt
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
authors.affiliation: Lilly, USA, LLC, Indianapolis, IN.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Zettler
authors.affiliation: Mercy Heart Vascular Institute, Sacramento, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Chang
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D017533:Marital Status; D017057:Medically Uninsured / Q000706:statistics & numerical data; D055118:Medication Adherence / Q000208:ethnology / Q000523:psychology; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use; D012307:Risk Factors; D055502:Secondary Prevention; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data; D016903:Drug Monitoring
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D001241:Aspirin