Łukasz Pietrzykowski1, Michał Kasprzak2, Piotr Michalski1, Agata Kosobucka1, Tomasz Fabiszak2, Aldona Kubica1. 1. Department of Health Promotion, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland. 2. Department of Cardiology, Collegium Medicum, Nicolaus Copernicus University, M. Curie Skłodowskiej 9 St., 85-094 Bydgoszcz, Poland.
Abstract
The discontinuation of recommended therapy after myocardial infarction predisposes patients to serious thrombotic complications. The aim of this study was a comprehensive analysis of permanent as well as short- and long-term discontinuation of pharmacotherapy, taking into consideration the basic groups of medications and nonadherence determinants in a one-year follow-up in post-myocardial infarction (MI) patients. MATERIAL AND METHODS: The study was a single center cohort clinical trial with a one-year follow-up including 225 patients (73.3% men, 26.7% women) aged 62.9 ± 11.9 years. In eight cases (3.6%), the follow-up duration was less than one year due to premature death. The following factors were analyzed: lack of post-discharge therapy initiation; short-term therapy discontinuation (<30 days); long-term therapy discontinuation (≥30 days); and permanent cessation of therapy. The analysis of therapy discontinuation was performed based on prescription filling data. RESULTS: Occupational activity (Odds Ratio (OR) 5.15; 95% Confidence interval (CI) 1.42-18.65; p = 0.013) and prior MI (OR 5.02; 95% CI 1.45-16.89; p = 0.009) were found to be independent predictors of a lack of post-discharge therapy initiation with P2Y12 receptor inhibitors. We found no independent predictors of lack of post-discharge therapy initiation with other medications, whether analyzed separately or together. Age above 65 years (Hazard Ratio (HR)-1.59; 95% CI 1.15-2.19; p = 0.0049) and prior revascularization (HR-1.44; 95% CI 1.04-2.19; p = 0.0273) were identified as independent predictors of therapy discontinuation. Multilogistic regression analysis showed no independent predictors of the cessation of any of the medications as well as the permanent or temporary simultaneous discontinuation of all medications. CONCLUSIONS: The vast majority of post-MI patients discontinue, either temporarily or permanently, one of the essential medications within one year following myocardial infarction. The most likely medication class to be discontinued are statins. Older age and prior cardiac revascularization are independent determinants of therapy discontinuation.
The discontinuation of recommended therapy after myocardial infarction predisposes patients to serious thrombotic complications. The aim of this study was a comprehensive analysis of permanent as well as short- and long-term discontinuation of pharmacotherapy, taking into consideration the basic groups of medications and nonadherence determinants in a one-year follow-up in post-myocardial infarction (MI) patients. MATERIAL AND METHODS: The study was a single center cohort clinical trial with a one-year follow-up including 225 patients (73.3% men, 26.7% women) aged 62.9 ± 11.9 years. In eight cases (3.6%), the follow-up duration was less than one year due to premature death. The following factors were analyzed: lack of post-discharge therapy initiation; short-term therapy discontinuation (<30 days); long-term therapy discontinuation (≥30 days); and permanent cessation of therapy. The analysis of therapy discontinuation was performed based on prescription filling data. RESULTS: Occupational activity (Odds Ratio (OR) 5.15; 95% Confidence interval (CI) 1.42-18.65; p = 0.013) and prior MI (OR 5.02; 95% CI 1.45-16.89; p = 0.009) were found to be independent predictors of a lack of post-discharge therapy initiation with P2Y12 receptor inhibitors. We found no independent predictors of lack of post-discharge therapy initiation with other medications, whether analyzed separately or together. Age above 65 years (Hazard Ratio (HR)-1.59; 95% CI 1.15-2.19; p = 0.0049) and prior revascularization (HR-1.44; 95% CI 1.04-2.19; p = 0.0273) were identified as independent predictors of therapy discontinuation. Multilogistic regression analysis showed no independent predictors of the cessation of any of the medications as well as the permanent or temporary simultaneous discontinuation of all medications. CONCLUSIONS: The vast majority of post-MI patients discontinue, either temporarily or permanently, one of the essential medications within one year following myocardial infarction. The most likely medication class to be discontinued are statins. Older age and prior cardiac revascularization are independent determinants of therapy discontinuation.
Authors: Jacek Kubica; Piotr Adamski; Piotr Niezgoda; Aldona Kubica; Przemysław Podhajski; Malwina Barańska; Julia M Umińska; Łukasz Pietrzykowski; Małgorzata Ostrowska; Jolanta M Siller-Matula; Jolita Badarienė; Stanisław Bartuś; Andrzej Budaj; Sławomir Dobrzycki; Łukasz Fidor; Mariusz Gąsior; Jacek Gessek; Marek Gierlotka; Robert Gil; Jarosław Gorący; Paweł Grzelakowski; Tomasz Hajdukiewicz; Miłosz Jaguszewski; Marianna Janion; Jarosław Kasprzak; Adam Kern; Artur Klecha; Andrzej Kleinrok; Wacław Kochman; Bartosz Krakowiak; Jacek Legutko; Maciej Lesiak; Marcin Nosal; Grzegorz Piotrowski; Andrzej Przybylski; Tomasz Roleder; Grzegorz Skonieczny; Grzegorz Sobieszek; Agnieszka Tycińska; Dariusz Wojciechowski; Wojciech Wojakowski; Jarosław Wójcik; Marzenna Zielińska; Aleksander Żurakowski; Giuseppe Specchia; Diana A Gorog; Eliano P Navarese Journal: Cardiol J Date: 2021-06-07 Impact factor: 2.737