Full adherence to guideline-recommended therapies is associated with a reduced rate of major adverse cardiovascular events (MACE) as well as cost-savings in patients with cardiovascular disease, according to a new study published in the Journal of the American College of Cardiology.
Researchers at the Icahn School of Medicine at Mount Sinai in New York City set out to determine the association between medication adherence levels and long-term MACE in patients after myocardial infarction (MI) or in those with atherosclerotic disease. The patients were stratified as fully adherent (greater than or equal to 80%), partially adherent (greater than or equal to 40% but less than or equal to 70%), or nonadherent (less than 40%) to statins and angiotensin-converting enzyme (ACE) inhibitors.
Data were analyzed for 4,015 post-MI patients and 12,976 patients with atherosclerotic disease. The primary outcome measure was a composite of all-cause death, MI, stroke, or coronary revascularization. Per-patient annual direct medical (ADM) costs were estimated by using unit costs from two national files.
In the post-MI cohort, the fully adherent group had a significantly lower rate of MACE compared with the nonadherent group (19% vs. 26%, respectively; hazard ratio [HR], 0.73; P = 0.0004) and the partially adherent group (19% vs. 25%; HR, 0.81; P = 0.02) at two years. The fully adherent group had reduced per-patient ADM costs for MI hospitalizations of $369 and $440 compared with the partially adherent and nonadherent groups, respectively.
In the atherosclerotic disease cohort, the fully adherent group had a significantly lower rate of MACE compared with the nonadherent group (8% vs. 17%, respectively; HR, 0.56; P < 0.0001) and the partially adherent group (8% vs. 12%; HR, 0.76; P < 0.0001) at two years. The fully adherent group had reduced per-patient ADM costs for MI hospitalizations of $371 and $907 compared with the partially adherent and nonadherent groups, respectively.
The authors concluded that full adherence to guideline-recommended therapies was associated with a lower rate of MACE as well as cost savings in these patients.