Key result
Adherence to secondary prevention drugs post-ACS is linked to ~20% lower major cardiovascular events and mortality.
Why the study?
Secondary prevention pharmacotherapy reduces cardiovascular events after ACS, but poor adherence has been widely observed, prompting evaluation of its clinical impact in primary care.
Does adherence to pharmacological therapy for secondary prevention reduce the risk of MACE and all-cause mortality in patients after a first episode of ACS?
Cohort (n=7,152)
Does adherence to pharmacological therapy for secondary prevention reduce the risk of MACE and all-cause mortality in patients after a first episode of ACS?
Adherence to secondary prevention medications after a first ACS is associated with a significantly reduced risk of MACE and all-cause mortality.
Answers are grounded in this paper and cite their sources.
Supports adherence post-ACS; hypothesis-generating and should not yet change practice.
PURPOSE: Adherence to pharmacological therapy for secondary prevention after an acute coronary syndrome (ACS) reduces the risk of new cardiovascular events. However, several studies showed poor adherence. Our study aim was to assess the risk of a composite endpoint of major cardiovascular events (MACE) and all-cause mortality according to the adherence to these drugs in patients after an ACS in a primary health care cohort. METHODS: Population-based observational cohort study of patients with a first episode of ACS during 2009-2016. DATA SOURCE: Information System for Research in Primary Care (SIDIAP) database. Drug adherence was evaluated through proportion of days covered (PDC). RESULTS: We included 7152 patients and 5692 (79.6%) were adherent (PDC ≥ 75%) to the study drugs during the first year after the event. Adherents to any combination showed a significant reduction of the composite endpoint risk (HR 0.80 [0.73-0.88]), and a significant lower probability of the composite endpoint than nonadherents for all drugs, except beta-blockers. Adherents to 2 (HR 1.2; 95% CI 1.0-1.3) and 1 drug (HR 1.5; 95% CI 1.2-1.8) had higher composite endpoint risk compared to adherents to 4-3 drugs. CONCLUSION: Adherence to any combination of recommended drugs reduced the composite endpoint risk, regardless the number of drugs prescribed. Adherence to a combination of 4-3 drugs was significantly associated with a reduced mortality risk compared with adherents to 2 or 1, but it was not significant for MACE.
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Sotorra‐Figuerola et al. (2021) conducted a cohort in Acute coronary syndrome (ACS) (n=7,152). Adherence to pharmacological therapy for secondary prevention (PDC ≥ 75%) vs. Nonadherence was evaluated on Composite of major cardiovascular events (MACE) and all-cause mortality (HR 0.80, 95% CI 0.73-0.88). Adherence to any combination of recommended secondary prevention drugs after an acute coronary syndrome reduced the risk of major cardiovascular events and all-cause mortality.
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