• Robin Mathews, Eric D Peterson, Emily Honeycutt, Chee Tang Chin, Mark B Effron, Marjorie Zettler, Gregg C Fonarow, Timothy D Henry, and Tracy Y Wang.
• From the Duke Clinical Research Institute, Durham, NC (R.M., E.D.P., E.H., T.Y.W.); National Health Centre Singapore, Singapore, Singapore (C.T.C.); Lilly, USA, LLC, Indianapolis (M.B.E., M.Z.); Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.); and Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital (T.D.H.). robin.mathews@duke.edu.
• Circ Cardiovasc Qual. 2015 Jul 1; 8 (4): 347-56.

BackgroundNonadherence to prescribed evidence-based medications after acute myocardial infarction (MI) can contribute to worse outcomes and higher costs. We sought to better understand the modifiable factors contributing to early nonadherence of evidence-based medications after acute MI.Methods And ResultsWe assessed 7425 acute MI patients treated with percutaneous coronary intervention at 216 US hospitals participating in TReatment with ADP receptor iNhibitorS: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS) between April 2010 and May 2012. Using the validated Morisky instrument to assess cardiovascular medication adherence at 6 weeks post MI, we stratified patients into self-reported high (score, 8), moderate (score, 6-7), and low (score, <6) adherence groups. Moderate and low adherence was reported in 25% and 4% of patients, respectively. One third of low adherence patients described missing doses of antiplatelet therapy at least twice a week after percutaneous coronary intervention. Signs of depression and patient-reported financial hardship because of medication expenses were independently associated with a higher likelihood of medication nonadherence. Patients were more likely to be adherent at 6 weeks if they had follow-up appointments made before discharge and had a provider explain potential side effects of their medications. Lower medication adherence may be associated with a higher risk of 3-month death/readmission (adjusted hazard ratio, 1.35; 95% confidence interval, 0.98-1.87) although this did not reach statistical significance.ConclusionsEven early after MI, a substantial proportion of patients report suboptimal adherence to prescribed medications. Tailored patient education and pre discharge planning may represent actionable opportunities to optimize patient adherence and clinical outcomes.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01088503.© 2015 American Heart Association, Inc.

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