title: Assessing the Impact of Medication Adherence on Long-Term Cardiovascular Outcomes.
abstract: Although guideline-recommended therapies reduce major adverse cardiovascular events (MACE) in patients after myocardial infarction (MI) or those with atherosclerotic disease (ATH), adherence is poor.
  
  
  
  The goal of this study was to determine the association between medication adherence levels and long-term MACE in these patients.
  
  
  
  We queried the claims database of a large health insurer for patients hospitalized for MI or with ATH. The primary outcome measure was a composite of all-cause death, MI, stroke, or coronary revascularization. Using proportion of days covered for statins and angiotensin-converting enzyme inhibitors, patients were stratified as fully adherent (≥80%), partially adherent (≥40% to ≤79%), or nonadherent (<40%). Per-patient annual direct medical (ADM) costs were estimated by using unit costs from 2 national files.
  
  
  
  Data were analyzed for 4,015 post-MI patients and 12,976 patients with ATH. In the post-MI cohort, the fully adherent group had a significantly lower rate of MACE than the nonadherent (18.9% vs. 26.3%; hazard ratio [HR]: 0.73; p = 0.0004) and partially adherent (18.9% vs. 24.7%; HR: 0.81; p = 0.02) groups at 2 years. The fully adherent group had reduced per-patient ADM costs for MI hospitalizations of $369 and $440 compared with the partially adherent and nonadherent groups, respectively. In the ATH cohort, the fully adherent group had a significantly lower rate of MACE than the nonadherent (8.42% vs. 17.17%; HR: 0.56; p < 0.0001) and the partially adherent (8.42% vs. 12.18%; HR: 0.76; p < 0.0001) groups at 2 years. The fully adherent group had reduced per-patient ADM costs for MI hospitalizations of $371 and $907 compared with the partially adherent and nonadherent groups.
  
  
  
  Full adherence to guideline-recommended therapies was associated with a lower rate of MACE and cost savings, with a threshold effect at >80% adherence in the post-MI population; at least a 40% level of long-term adherence needs to be maintained to continue to accrue benefit. Novel approaches to improve adherence may significantly reduce cardiovascular events.
authors.affiliation: Icahn School of Medicine at Mount Sinai School, New York, New York.
authors.forename: Sameer
authors.initials: S
authors.lastname: Bansilal
authors.affiliation: Icahn School of Medicine at Mount Sinai School, New York, New York; National Centre for Cardiovascular Research, Madrid, Spain; Hospital Universitario Monteprincipe, Grupo HM, Madrid, Spain.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Castellano
authors.affiliation: Icahn School of Medicine at Mount Sinai School, New York, New York; Ferrer, Barcelona, Spain.
authors.forename: Ester
authors.initials: E
authors.lastname: Garrido
authors.affiliation: Aetna Inc., Hartford, Connecticut.
authors.forename: Henry G
authors.initials: HG
authors.lastname: Wei
authors.affiliation: Aetna Inc., Hartford, Connecticut.
authors.forename: Allison
authors.initials: A
authors.lastname: Freeman
authors.affiliation: Aetna Inc., Hartford, Connecticut.
authors.forename: Claire
authors.initials: C
authors.lastname: Spettell
authors.affiliation: Ferrer, Barcelona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Garcia-Alonso
authors.affiliation: Ferrer, Barcelona, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Lizano
authors.affiliation: Icahn School of Medicine at Mount Sinai School, New York, New York.
authors.forename: Renee J G
authors.initials: RJ
authors.lastname: Arnold
authors.affiliation: Aetna Inc., Hartford, Connecticut.
authors.forename: Jay
authors.initials: J
authors.lastname: Rajda
authors.affiliation: Aetna Inc., Hartford, Connecticut.
authors.forename: Gregory
authors.initials: G
authors.lastname: Steinberg
authors.affiliation: Icahn School of Medicine at Mount Sinai School, New York, New York; National Centre for Cardiovascular Research, Madrid, Spain. Electronic address: valentin.fuster@mountsinai.org.
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000191:economics; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods*; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016903:Drug Monitoring
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: atherosclerosis; myocardial infarction; secondary prevention