Clinical InvestigationAcute Ischemic Heart DiseasePersistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study
Section snippets
Study design and population
TRANSLATE-ACS is an observational study of acute ST-segment elevation MI or non–ST-segment elevation MI patients treated with percutaneous coronary intervention (PCI) (clinical trial no. NCT01088503). Inclusion and exclusion criteria, collected variables, and the details of data collection have been previously described.11 Briefly, the study was broadly inclusive and excluded only patients who were not able or willing to provide written informed consent for longitudinal follow-up and those who
Patterns of medication persistence by 6 months
Our final study population included 7,955 MI patients treated with PCI. Nearly all patients were discharged on aspirin (98%), an ADPRi (99.5%), statins (95%), β-blockers (93%), and ACEIs/ARBs (74%). At 6 months post-MI, 5,509 patients (69%) were persistent with all evidence-based cardiovascular medications prescribed at discharge. Of those who discontinued at least 1 medication (31% of total), 2,265 patients were moderately persistent (continued use of 40%-80% of all medications prescribed at
Discussion
Although the use of guideline-based therapies in the management of coronary artery disease is strongly recommended to improve morbidity and mortality, we found that up to one-third of contemporary patients are no longer persistent with therapies prescribed at discharge by 6 months post-MI. Reasons cited for discontinuation of medications vary according to medication class and include side effects, physician decision, and financial burden. Private insurance, prescription coverage insurance, and
Disclosures
Dr Mathews, Ms Honeycutt, Dr Henry, and Dr Chang have no relevant disclosures to report. Dr Wang reports research funding from AstraZeneca, Gilead, Lilly, The Medicines Company, and Canyon Pharmaceuticals (all significant); educational activities or lectures (generates money for Duke) for AstraZeneca (modest); and consulting (including CME) for Medco (modest) and American College of Cardiology (significant). Dr Zettler reports being an employee of Eli Lilly & Company. Dr Fonarow reports being a
Acknowledgements
We would like to thank Erin Hanley, MS, for her editorial contributions to this manuscript. Ms Hanley did not receive compensation for her contributions, apart from her employment at the institution where this study was conducted.
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2022, International Journal of CardiologyCitation Excerpt :Overall, a similar, even stronger, tendency was found when we stratified the medical care outcomes into reperfusion therapy or CAG, Cardiovascular pharmacotherapy, and CR (Appendix E fig. E.1). This tendency was opposite or unclear in the two studies focusing on composite medical care. [3,29,32,75,89–165] The 78 included studies on inequity in mortality included more than 13 million ACS patients (up to 6.6 million per study).
Sources of funding: TRANSLATE-ACS was funded by Daiichi Sankyo Ltd and Eli Lilly USA (clinicaltrials.gov no. NCT01088503). The Duke Clinical Research Institute is the coordinating center for this study, which represents a collaborative effort with the American College of Cardiology. Robin Mathews is supported by grant number KM1CA156687 from the National Institute of Health/National Cancer Institute.
William S. Weintraub, MD served as guest editor for this article.