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December 21, 2020Journal of the American Heart AssociationOpen Access

Difference in Medication Adherence Between Patients Prescribed a 30‐Day Versus 90‐Day Supply After Acute Myocardial Infarction

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Why the study?

Evidence-based medication adherence rates after a myocardial infarction are low, and it was hypothesized that 90-day prescriptions are underused and may improve adherence compared with 30-day fills.

Does a 90-day prescription supply improve 12-month medication adherence compared to a 30-day supply in patients after myocardial infarction treated with percutaneous coronary intervention?

Population

353 259 patients with myocardial infarction treated with PCI

Comparison

Filling 90-day vs 30-day prescriptions of evidence-based medications

Design

Registry-based retrospective cohort study

Follow-up

12 months

Key result

Filling 90-day versus 30-day prescriptions after myocardial infarction was associated with higher 12-month adherence for statins (83.1% vs 75.3%, P<0.01) and other evidence-based medications.

Authors

JRJennifer A. RymerEFEileen FonsecaDBDurgesh Bhandary

Discussion

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Overview

90-day fills were associated with higher post-MI adherence; leaves open whether this extends to outcomes or warrants practice change.

Key Points

  • To compare medication adherence rates between 30-day and 90-day prescriptions after myocardial infarction.
  • Examined patients with myocardial infarction treated with percutaneous coronary intervention from 2011 to 2015.
  • Linked National Cardiovascular Data Registry with Symphony Health pharmacy data to analyze prescription fills.
  • Compared 12-month adherence rates across different medication classes and supply lengths.
  • 90-day adherence rates were significantly higher for statins (83.1% vs. 75.3%), β-blockers (72.7% vs. 62.9%), ACE inhibitors/ARBs (71.1% vs. 60.9%), and P2Y 12 inhibitors (78.5% vs. 66.6%); P&lt;0.01 for all.
  • Medication switches were infrequent in the 30-day group (14.7% for P2Y 12 inhibitors) compared to 90-day fills (6.3%).
  • Overall, patients with 90-day prescriptions reported higher adherence and fewer medication changes.

Study Design

Type

Observational (n=353,259)

Multicenter

Yes

Structured PICO

Does a 90-day prescription supply improve 12-month medication adherence compared to a 30-day supply in patients after myocardial infarction treated with percutaneous coronary intervention?

P
Population
353,259 patients with myocardial infarction treated with percutaneous coronary intervention, followed for 12 months to assess medication adherence.
E
Exposure
90-day prescription supply of evidence-based medications (statins, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and P2Y12 inhibitors) after discharge.
C
Comparator
30-day prescription supply of the same evidence-based medications.
O
Outcome
12-month medication adherence rates by evidence-based medication class.surrogate

Main Result

Absolute Event Rate: 83.1% vs 75.3%

p-value: p=<0.01

Prescribing a 90-day supply of evidence-based medications after myocardial infarction is associated with significantly higher 12-month adherence compared to a 30-day supply.

Cite This Study

Rymer et al. (2020) conducted an observational in Acute myocardial infarction (n=353,259). 90-day prescription supply vs. 30-day prescription supply was evaluated on 12-month medication adherence (statins) (p=<0.01). Filling 90-day versus 30-day prescriptions after myocardial infarction was associated with higher 12-month adherence for statins (83.1% vs 75.3%, P<0.01) and other evidence-based medications.

synapsesocial.com/papers/6a5ebac77279e6e036d943c2https://doi.org/10.1161/jaha.119.016215
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