Association of medical noncompliance and long-term adverse outcomes, after myocardial infarction in a minority and uninsured population
| Autor: | Amit P. Amin, Sirikarn Napan, Ekanka Mukhopadhyay, Sandeep Nathan, Russell F. Kelly |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
Acute coronary syndrome Time Factors medicine.medical_treatment Population Myocardial Infarction Coronary artery disease Recurrence Physiology (medical) Internal medicine medicine Humans cardiovascular diseases Myocardial infarction education Minority Groups Retrospective Studies Medically Uninsured education.field_of_study Evidence-Based Medicine Framingham Risk Score business.industry Biochemistry (medical) Hazard ratio Public Health Environmental and Occupational Health Percutaneous coronary intervention Cardiovascular Agents General Medicine Prognosis Clopidogrel medicine.disease Cardiology Patient Compliance business medicine.drug |
| Zdroj: | Translational Research. 154:78-89 |
| ISSN: | 1931-5244 |
| DOI: | 10.1016/j.trsl.2009.05.004 |
| Popis: | The association of noncompliance with evidence-based medical therapies after myocardial infarction (MI) on long-term outcomes is not well recognized in minority and uninsured populations. Consecutive MI patients at a large urban hospital were followed for compliance with evidence-based medications (aspirin, clopidogrel, statins, beta blockers, and angiotensin converting enzyme inhibitors [ACEIs]/angiotensin receptor blockers [ARBs]). Noncompliance was defined as proportion of days coveredor =80%. The outcome was combined mortality and MI. Kaplan-Meier analyses were used to explore the impact of noncomplianceor =4 medications. Of the 509 patients (86% minorities, 77% uninsured, and 54% diabetics), 132 (25.9%) presented with ST segment elevation with myocardial infarction (STEMI) and 377 (74.1%) with a non-ST segment elevation with myocardial infarction (NSTEMI), revascularization was performed in 297 (58.4%) patients, 72 (14.2%) patients died, 22 (4.3%) patients had an MI, and 91 (17.9%) patients had either event at a median follow-up of 2 (0.5-2.9) years. Noncomplianceor = 4 medications was significantly associated with adverse survival compared with compliant patients (29.7% vs 78.9%). After adjusting for traditional risk factors, The Global Registry of Acute Coronary Events risk score for predicting death during 6 months post-discharge, revascularization, left ventricular (LV) function, coronary artery disease (CAD) severity, and punctual clinic visits, noncompliance withor = 4 evidence-based medications was an independent factor associated with death or MI (hazard ratio [HR], 2.83; 95% confidence interval [CI]=1.60-5.01) in this minority and uninsured population. |
| Databáze: | OpenAIRE |
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