Circulation: Post-AMI patients not likely to fill prescription after one week

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Patients fill most of their discharge prescriptions within one week after acute MI (AMI), and the one-year mortality rate was higher for the patients who did not fill all of their discharge medications after AMI, according to a study published online in the Febrary issue of Circulation.

Cynthia A. Jackevicius, BSc, MSc, PharmD, from department of health policy, management, and evaluation at the University of Toronto, and colleagues conducted a population-based cohort study using an AMI registry linked with administrative data from 104 acute care hospitals in Ontario, Canada, from 1999/2000 to 2000/2001. The primary outcome was one-year mortality.

The investigators examined 4,591 post-AMI patients greater than 65 years of age for whom 12,832 prescriptions were written. Of those prescriptions, 73 percent and 79 percent were filled within seven and 120 days, respectively.

By 120 days after discharge, more cardiac than noncardiac prescriptions were filled (82 percent versus 35 percent, respectively), the researchers reported.

However, only 74 percent of patients filled all their discharge prescriptions by 120 days after discharge after the exclusion of acetylsalicylic acid, which is also available over the counter in Ontario, the authors wrote.

Jackevicius and colleagues found that patients who filled none of their discharge medications within 120 days after AMI had an 80 percent increased odds of death; those who filled only some of their medications had a 44 percent increased odds of death.

The authors reported that patients who received discharge medication counseling as documented in their charts had a significantly lower risk of one-year mortality.

Prescriptions for cardiac medications, which made up the vast majority of prescriptions, were more likely to be filled than noncardiac prescriptions; however the lowest fill rate for cardiac medications was for antiplatelets, according to the investigators.

The researchers found several factors associated with primary adherence: Patients identified as low income, those with a cardiologist as the responsible physician and those who received discharge medication counseling were more likely to fill their prescriptions.

The authors suggested that to reduce primary nonadherence, it would be prudent to follow up with patients one to two weeks after discharge. They also noted that older patients were less likely to fill their prescriptions, so special attention to these patients may help target those least likely to comply.

In general, Jackevicius and colleagues said that the recognition of factors associated with filling discharge prescriptions in the post-AMI population may aid in targeting interventions such as discharge medication counseling and postdischarge follow-up to improve primary nonadherence and mortality.