Persistence with secondary prevention medications after acute myocardial infarction: Insights from the TRANSLATE-ACS study

Robin Mathews, Tracy Y. Wang, Emily Honeycutt, Timothy D. Henry, Marjorie Zettler, Michael Chang, Gregg C. Fonarow, Eric D. Peterson

Research output: Contribution to journalArticlepeer-review

74 Scopus citations


Background Persistent use of secondary prevention therapies after acute myocardial infarction (MI) is critical to optimizing long-term outcomes. Methods Medication persistence was assessed among 7,955 MI patients in 216 hospitals participating in the Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome study from 2010 to 2012. Persistence was defined as continuation of aspirin, adenosine diphosphate receptor inhibitors, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins from discharge to 6 months post-MI. Multivariable logistic regression modeling was used to determine factors associated with nonpersistence, defined as <80% persistence with all medication classes. Results Overall, 31% of MI patients stopped taking a least 1 medication by 6 months. The most common reasons cited for medications discontinuation were side effects and physician instruction (57%), whereas financial concerns were cited in 8% overall. After multivariable modeling, black race (odds ratio 1.36, 95% CI 1.15-1.62), older age (odds ratio 1.07, 95% CI 1.02-1.12), atrial fibrillation (odds ratio 1.67, 95% CI 1.33-2.09), dialysis (odds ratio 1.79, 95% CI 1.15-2.78), and depression (odds ratio 1.22, 95% CI 1.02-1.45) were associated with lower likelihood of persistence. Private insurance (odds ratio 0.85, 95% 0.76-0.95), prescription cost assistance (odds ratio 0.63, 95% CI 0.54-0.75), and outpatient follow-up arranged before discharge (odds ratio 0.89, 95% CI 0.80-0.99) were associated with higher persistence. Conclusions Nearly one-third of MI patients are no longer persistent with their prescribed medications by 6 months. Patients at high risk for nonpersistence may be identified by clinical and sociodemographic features. These observations underscore key opportunities to optimize longitudinal use of secondary prevention therapies.

Original languageEnglish (US)
Pages (from-to)62-69
Number of pages8
JournalAmerican Heart Journal
Issue number1
StatePublished - Jul 1 2015

Bibliographical note

Funding Information:
The TRANSLATE-ACS study was funded by Eli Lilly and Company and Daiichi Sankyo, Inc. All data analyses were performed independently by statisticians at the Duke Clinical Research Institute using SAS version 9.2 (SAS Institute, Cary, NC).

Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.


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