{"id":6329,"date":"2007-01-10T00:00:00","date_gmt":"2007-01-10T05:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/relationship-between-adherence-to-evidence-based-pharmacotherapy-and-long-term-mortality-after-acute-myocardial-infarction\/"},"modified":"2023-06-14T19:28:56","modified_gmt":"2023-06-14T23:28:56","slug":"relationship-between-adherence-to-evidence-based-pharmacotherapy-and-long-term-mortality-after-acute-myocardial-infarction","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/relationship-between-adherence-to-evidence-based-pharmacotherapy-and-long-term-mortality-after-acute-myocardial-infarction\/","title":{"rendered":"Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction"},"content":{"rendered":"<p><strong>Context<\/strong> &#x2014; The extent to which drug adherence may affect survival remains unclear, in part because mortality differences may be attributable to &quot;healthy adherer&quot; behavioral attributes more so than to pharmacological benefits.<\/p>\n<p><strong>Objective<\/strong> &#x2014; To explore the relationship between drug adherence and mortality in survivors of acute myocardial infarction (AMI).<\/p>\n<p><span class=\"bold\">Design, Setting, and Participants<\/span> &#x2014; Population-based, observational, longitudinal study of 31 455 elderly AMI survivors between 1999 and 2003 in Ontario. All patients filled a prescription for statins, beta-blockers, or calcium channel blockers, with the latter drug considered a control given the absence of clinical trial-proven survival benefits.<\/p>\n<p><strong>Main Outcome Measures<\/strong> &#x2014; Patient adherence was subdivided a priori into 3 categories&#8211;high (proportion of days covered, &gt; or =80%), intermediate (proportion of days covered, 40%-79%), and low (proportion of days covered, &lt;40%)&#8211;and compared with long-term mortality (median of 2.4 years of follow-up) using multivariable survival models (and propensity analyses) adjusted for sociodemographic factors, illness severity, comorbidities, and concomitant use of evidence-based therapies.<\/p>\n<p><strong>Results<\/strong> &#x2014; Among statin users, compared with their high-adherence counterparts, the risk of mortality was greatest for low adherers (deaths in 261\/1071 (24%) vs 2310\/14,345 (16%); adjusted hazard ratio, 1.25; 95% confidence interval, 1.09-1.42; P = .001) and was intermediary for intermediate adherers (deaths in 472\/2407 (20%); adjusted hazard ratio, 1.12; 95% confidence interval, 1.01-1.25; P = .03). A similar but less pronounced dose-response-type adherence-mortality association was observed for beta-blockers. Mortality was not associated with adherence to calcium channel blockers. Moreover, sensitivity analyses demonstrated no relationships between drug adherence and cancer-related admissions, outcomes for which biological plausibility do not exist.<\/p>\n<p><strong>Conclusion<\/strong> &#x2014; The long-term survival advantages associated with improved drug adherence after AMI appear to be class-specific, suggesting that adherence outcome benefits are mediated by drug effects and do not merely reflect an epiphenomenon of &quot;healthy adherer&quot; behavioral attributes.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Context &#x2014; The extent to which drug adherence may affect survival remains unclear, in part because mortality differences may be attributable to &quot;healthy adherer&quot; behavioral attributes more so than to pharmacological benefits. Objective &#x2014; To explore the relationship between drug adherence and mortality in survivors of acute myocardial infarction (AMI). Design, Setting, and Participants &#x2014; [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[40,56],"migration-helper-qa-sample-set":[],"class_list":["post-6329","journal_article","type-journal_article","status-publish","hentry","topic-cardiovascular-disease","topic-pharmacoepidemiology-and-drug-safety"],"acf":{"citation":"Rasmussen JN, Chong A, Alter DA. <em>JAMA<\/em>. 2007; 297(2):177-86.","source_url":"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=205042","ices_scientist":[1381],"site":[6733],"research_program":[6742],"news_release":[7538],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"F679FD13-ED39-4A08-A6C7-31AA7D723914","sitecore_item_name":"Relationship-between-adherence-to-evidence-based-pharmacotherapy-and-long-term-mortality","sitecore_field_values":"{\n  \"Title\": \"Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction\",\n  \"Short title\": \"Relationship between adherence to\",\n  \"Citation\": \"<p>Rasmussen JN, Chong A, Alter DA. <em>JAMA<\/em>. 2007; 297(2):177-86.<\/p>\",\n  \"Abstract\": \"<p><strong>Context<\/strong> &mdash; The extent to which drug adherence may affect survival remains unclear, in part because mortality differences may be attributable to \"healthy adherer\" behavioral attributes more so than to pharmacological benefits.<\/p>n<p><strong>Objective<\/strong> &mdash; To explore the relationship between drug adherence and mortality in survivors of acute myocardial infarction (AMI).<\/p>n<p><span class=\"bold\">Design, Setting, and Participants<\/span> &mdash; Population-based, observational, longitudinal study of 31 455 elderly AMI survivors between 1999 and 2003 in Ontario. All patients filled a prescription for statins, beta-blockers, or calcium channel blockers, with the latter drug considered a control given the absence of clinical trial-proven survival benefits.<\/p>n<p><strong>Main Outcome Measures<\/strong> &mdash; Patient adherence was subdivided a priori into 3 categories--high (proportion of days covered, &gt; or =80%), intermediate (proportion of days covered, 40%-79%), and low (proportion of days covered, &lt;40%)--and compared with long-term mortality (median of 2.4 years of follow-up) using multivariable survival models (and propensity analyses) adjusted for sociodemographic factors, illness severity, comorbidities, and concomitant use of evidence-based therapies.<\/p>n<p><strong>Results<\/strong> &mdash; Among statin users, compared with their high-adherence counterparts, the risk of mortality was greatest for low adherers (deaths in 261\/1071 (24%) vs 2310\/14,345 (16%); adjusted hazard ratio, 1.25; 95% confidence interval, 1.09-1.42; P = .001) and was intermediary for intermediate adherers (deaths in 472\/2407 (20%); adjusted hazard ratio, 1.12; 95% confidence interval, 1.01-1.25; P = .03). A similar but less pronounced dose-response-type adherence-mortality association was observed for beta-blockers. Mortality was not associated with adherence to calcium channel blockers. Moreover, sensitivity analyses demonstrated no relationships between drug adherence and cancer-related admissions, outcomes for which biological plausibility do not exist.<\/p>n<p><strong>Conclusion<\/strong> &mdash; The long-term survival advantages associated with improved drug adherence after AMI appear to be class-specific, suggesting that adherence outcome benefits are mediated by drug effects and do not merely reflect an epiphenomenon of \"healthy adherer\" behavioral attributes.<\/p>n<p><a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=205042\" title=\"External link opens\">View full text<\/a><\/p>\",\n  \"Keywords\": \"{5718D5DE-813C-4BEF-B244-C1252842E4D5}|{B711DE54-5056-420D-AA0E-1349F1D88049}|{92E2791D-5DAB-4244-8A85-434D524D9A12}\",\n  \"Related Products\": \"<h2>News Release<\/h2>rn<h3><a href=\"~\/link.aspx?_id=10952CD5B8B4420F8844A66CA37C2307&amp;_z=z\">Heart attack survivors who take medications regularly have better mortality rates<\/a><\/h3>\",\n  \"Research Programs\": \"{BEC72DE0-BA8C-42B8-ACE5-EE29FFB2CB3B}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{5178A761-5208-4E70-ABF8-146FCEB83294}\",\n  \"Posted Date\": \"20070110T000000\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2007\/January\/Relationship-between-adherence-to-evidence-based-pharmacotherapy-and-long-term-mortality"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction<\/title>\n<meta name=\"description\" content=\"Context &#x2014; The extent to which drug adherence may affect survival remains unclear, in part because mortality differences may be attributable to\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/relationship-between-adherence-to-evidence-based-pharmacotherapy-and-long-term-mortality-after-acute-myocardial-infarction\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICES | Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction\" \/>\n<meta property=\"og:description\" content=\"Context &#x2014; The extent to which drug adherence may affect survival remains unclear, in part because mortality differences may be attributable to\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/relationship-between-adherence-to-evidence-based-pharmacotherapy-and-long-term-mortality-after-acute-myocardial-infarction\/\" \/>\n<meta property=\"og:site_name\" content=\"ICES\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/ICESOntario\/\" \/>\n<meta property=\"article:modified_time\" content=\"2023-06-14T23:28:56+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2024\/11\/ic-es-data-discovery-better-health-logo.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"675\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/relationship-between-adherence-to-evidence-based-pharmacotherapy-and-long-term-mortality-after-acute-myocardial-infarction\\\/\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/relationship-between-adherence-to-evidence-based-pharmacotherapy-and-long-term-mortality-after-acute-myocardial-infarction\\\/\",\"name\":\"ICES | Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#website\"},\"datePublished\":\"2007-01-10T05:00:00+00:00\",\"dateModified\":\"2023-06-14T23:28:56+00:00\",\"description\":\"Context &#x2014; 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