Prior Cardiovascular Treatments-A Key Characteristic in Determining Medication Adherence After an Acute Myocardial Infarction

Anna Campain; Carinna Hockham; Louisa Sukkar; Kris Rogers; Clara K Chow; Thomas Lung; Min Jun; Carol Pollock; Alan Cass; David Sullivan; Elizabeth Comino; David Peiris; Meg Jardine

doi:10.3389/fphar.2022.834898

Prior Cardiovascular Treatments-A Key Characteristic in Determining Medication Adherence After an Acute Myocardial Infarction

Front Pharmacol. 2022 Mar 7:13:834898. doi: 10.3389/fphar.2022.834898. eCollection 2022.

Authors

Anna Campain^{1

2}, Carinna Hockham³, Louisa Sukkar^{1

4}, Kris Rogers^{1

2

5}, Clara K Chow^{1

6

7}, Thomas Lung^{1

2

4}, Min Jun^{1

2}, Carol Pollock^{8

9}, Alan Cass¹⁰, David Sullivan^{11

12

13}, Elizabeth Comino², David Peiris^{1

2}, Meg Jardine^{4

14

15}

Affiliations

¹ The George Institute for Global Heath, UNSW, Sydney, NSW, Australia.
² Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
³ School of Public Health, Imperial College London, The George Institute for Global Health, London, United Kingdom.
⁴ Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁵ Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.
⁶ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
⁷ Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
⁸ Renal Division, Kolling Institute for Medical Research, Sydney, NSW, Australia.
⁹ University of Sydney, Sydney, NSW, Australia.
¹⁰ Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
¹¹ Department of Chemical Pathology Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
¹² NSW Health Pathology, Newcastle, NSW, Australia.
¹³ Central Clinical School, University of Sydney, Camperdown, NSW, Australia.
¹⁴ NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.
¹⁵ Concord Repatriation General Hospital, Sydney, NSW, Australia.

Abstract

Objective: To investigate long-term adherence to guideline-recommended cardioprotective medications following hospitalization for an acute myocardial infarction (AMI), and identify characteristics associated with adherence. Methods: An Australian population-based cohort study was used to identify participants who had their first AMI between 2006 and 2014 and were alive after 12 months. Linked routinely collected hospital, and prescription medication claims data was used to study adherence over time. Predictors and rates of adherence to both lipid-lowering medication and renin-angiotensin system blockade at 12 months post-AMI was assessed. Results: 14,200 people (mean age 69.9 years, 38.7% female) were included in our analysis. At 12 months post-AMI, 29.5% (95% CI: 28.8-30.3%) of people were adherent to both classes of medication. Individuals receiving treatment with both lipid-lowering medication and renin-angiotensin system blockade during the 6 months prior to their AMI were over 9 times more likely to be adherent to both medications at 12 months post-AMI (66.2% 95% CI: 64.8-67.5%) compared to those with no prior medication use (treatment naïve) (7.1%, 95% CI: 6.4-7.9%). Prior cardiovascular treatment was the strongest predictor of long-term adherence even after adjusting for age, sex, education and income. Conclusions: Despite efforts to improve long-term medication adherence in patients who have experienced an acute coronary event, considerable gaps remain. Of particular concern are people who are commencing guideline-recommended cardioprotective medication at the time of their AMI. The relationship between prior cardiovascular treatments and post AMI adherence offers insight into the support needs for the patient. Health care intervention strategies, strengthened by enabling policies, are needed to provide support to patients through the initial months following their AMI.

Keywords: AMI; acute myocardial infarction; big data; cardioprotective medications; linked data; medication adherence; routinely collected data.