Impact of medication therapy discontinuation on mortality after myocardial infarction
Ho, P et al
Arch Intern Med 2006; 166: 1842-7
The results of this study can be condensed into one dramatic point
Post-MI Nonadherence increases the risk of death in the first year
by a factor of four
Data
Results: Of 1521 patients discharged with the following three medications, aspirin, beta-blockers, and statins,
- 184 discontinued use of all 3 medications at 1 month post-discharge;
Survival rate 1 year post discharge: 88.5% - 56 discontinued use of 2 medications at 1 month post-discharge;
Survival rate 1 year post discharge: 96.4% - 272 discontinued use of 1 medication at 1 month post-discharge;
Survival rate 1 year post discharge: 97.8% - 1009 continued taking all 3 medications at 1 month post-discharge;
Survival rate 1 year post discharge: 97.8%
Patients who discontinued all medications had a lower survival rate than those who continued taking one or two of the three prescribed medications.
Of the demographic factors analyzed, the most significant finding was that patients who did not complete high school were more likely to discontinue all three medications than the group that did graduate from high school.
CME
A related CME course is available at www.archinternmed.com
Commentary
Given the congruence of these results with other studies, neither the extent of noncompliance or the extent of its effect on mortality are surprising. Nonetheless, the numbers are dramatic and convincing.
