Socio-demographic differences in adherence to evidence-based drug therapy after hospital discharge from acute myocardial infarction: a population-based cohort study in Rome, Italy

• Published in: Journal of clinical pharmacy and therapeutics Vol. 37; no. 1; pp. 37 - 44
• Main Authors: Kirchmayer, U., Agabiti, N., Belleudi, V., Davoli, M., Fusco, D., Stafoggia, M., Arcà, M., Barone, A. P., Perucci, C. A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-02-2012; Blackwell; Hindawi Limited
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Cohort Studies; Coronary heart disease; Evidence-Based Medicine; evidence-based pharmacotherapy; Female; Follow-Up Studies; Heart; Humans; Italy; Logistic Models; Male; Medical sciences; Medication Adherence; Middle Aged; Multivariate Analysis; Myocardial Infarction - drug therapy; Myocarditis. Cardiomyopathies; patient characteristics; Patient Discharge; pharmacoepidemiology; Pharmacology. Drug treatments; prescription records; preventive prescribing; Sex Factors; socio-economic factors; Socioeconomic Factors; Italy; Europe; Human; Myocardial infarction; Hospital discharge; Acute; Pharmacotherapy; Cardiovascular disease; Pharmacovigilance; Coronary heart disease; Myocardial disease; Adhesion; Epidemiology; pharmacoepidemiology; Prevention; Treatment; Sociodemographic factor; Medical prescription; Cohort study; evidence-based pharmacotherapy; prescription records; patient characteristics; Economic aspect; preventive prescribing; Public health; socio-economic factors
• ISSN: 0269-4727; 1365-2710
• DOI: 10.1111/j.1365-2710.2010.01242.x

Summary
What is known and Objective:  Adherence to evidence‐based drug therapy after acute myocardial infarction has increased over the last decades, but is still unsatisfactory. Our objectives are to set out to analyse patterns of evidence‐based drug therapy after acute myocardial infarction (AMI), and evaluating socio‐demographic differences.
Methods:  A cohort of 3920 AMI patients discharged from hospital in Rome (2006–2007) was selected. Drugs claimed during the 12 months after discharge were retrieved. Drug utilization was defined as density of use (boxes claimed/individual follow‐up; chronic use = 6+ boxes/365 days) and therapeutic coverage, calculated through Defined Daily Doses (chronic use: ≥80% of individual follow‐up). Patterns of use of single drugs and their combination were described. The association between poly‐therapy and gender, age and socio‐economic position (small‐area composite index based on census data) was analysed through logistic regression, accounting for potential confounders.
Results and Discussion:  Most patients used single drugs: 90·5% platelet aggregation inhibitors (antiplatelets), 60·0%β‐blockers, 78·1% agents acting on the renin–angiotensin system (ACEIs/ARBs), 77·8% HMG CoA reductase inhibitors (statins). Percentages of patients with ≥80% of therapeutic coverage were 81·9% for antiplatelets, 17·8% for β‐blockers, 64·4% for ACEIs/ARBs and 76·1% for statins. The multivariate analysis showed gender and age differences in adherence to poly‐therapy (females: OR = 0·84; 95% CI 0·72–0·99; 71–80 years age‐group: OR = 0·82; 95% CI 0·68–0·99). No differences were observed with respect to socio‐economic position.
What is new and Conclusion:  The availability of information systems offers the opportunity to monitor the quality of care and identify weaknesses in public health‐care systems. Our results identify specific factors contributing to non‐adherence and hence define areas for more targeted health‐care interventions. Our results suggest that efforts to improve adherence should focus on women and older patients.