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Association of medical noncompliance and long-term adverse outcomes, after myocardial infarction in a minority and uninsured population.
Transl Res. 2009 Aug; 154(2):78-89.TR

Abstract

The association of noncompliance with evidence-based medical therapies after myocardial infarction (MI) on long-term outcomes is not well recognized in minority and uninsured populations. Consecutive MI patients at a large urban hospital were followed for compliance with evidence-based medications (aspirin, clopidogrel, statins, beta blockers, and angiotensin converting enzyme inhibitors [ACEIs]/angiotensin receptor blockers [ARBs]). Noncompliance was defined as proportion of days covered < or =80%. The outcome was combined mortality and MI. Kaplan-Meier analyses were used to explore the impact of noncompliance > or =4 medications. Of the 509 patients (86% minorities, 77% uninsured, and 54% diabetics), 132 (25.9%) presented with ST segment elevation with myocardial infarction (STEMI) and 377 (74.1%) with a non-ST segment elevation with myocardial infarction (NSTEMI), revascularization was performed in 297 (58.4%) patients, 72 (14.2%) patients died, 22 (4.3%) patients had an MI, and 91 (17.9%) patients had either event at a median follow-up of 2 (0.5-2.9) years. Noncompliance > or = 4 medications was significantly associated with adverse survival compared with compliant patients (29.7% vs 78.9%). After adjusting for traditional risk factors, The Global Registry of Acute Coronary Events risk score for predicting death during 6 months post-discharge, revascularization, left ventricular (LV) function, coronary artery disease (CAD) severity, and punctual clinic visits, noncompliance with > or = 4 evidence-based medications was an independent factor associated with death or MI (hazard ratio [HR], 2.83; 95% confidence interval [CI]=1.60-5.01) in this minority and uninsured population.

Authors+Show Affiliations

Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County (Cook County Hospital), Chicago, IL 60612, USA. amit_p_amin@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19595439

Citation

Amin, Amit P., et al. "Association of Medical Noncompliance and Long-term Adverse Outcomes, After Myocardial Infarction in a Minority and Uninsured Population." Translational Research : the Journal of Laboratory and Clinical Medicine, vol. 154, no. 2, 2009, pp. 78-89.
Amin AP, Mukhopadhyay E, Nathan S, et al. Association of medical noncompliance and long-term adverse outcomes, after myocardial infarction in a minority and uninsured population. Transl Res. 2009;154(2):78-89.
Amin, A. P., Mukhopadhyay, E., Nathan, S., Napan, S., & Kelly, R. F. (2009). Association of medical noncompliance and long-term adverse outcomes, after myocardial infarction in a minority and uninsured population. Translational Research : the Journal of Laboratory and Clinical Medicine, 154(2), 78-89. https://doi.org/10.1016/j.trsl.2009.05.004
Amin AP, et al. Association of Medical Noncompliance and Long-term Adverse Outcomes, After Myocardial Infarction in a Minority and Uninsured Population. Transl Res. 2009;154(2):78-89. PubMed PMID: 19595439.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of medical noncompliance and long-term adverse outcomes, after myocardial infarction in a minority and uninsured population. AU - Amin,Amit P, AU - Mukhopadhyay,Ekanka, AU - Nathan,Sandeep, AU - Napan,Sirikarn, AU - Kelly,Russell F, Y1 - 2009/06/11/ PY - 2008/11/25/received PY - 2009/04/25/revised PY - 2009/05/15/accepted PY - 2009/7/15/entrez PY - 2009/7/15/pubmed PY - 2009/9/18/medline SP - 78 EP - 89 JF - Translational research : the journal of laboratory and clinical medicine JO - Transl Res VL - 154 IS - 2 N2 - The association of noncompliance with evidence-based medical therapies after myocardial infarction (MI) on long-term outcomes is not well recognized in minority and uninsured populations. Consecutive MI patients at a large urban hospital were followed for compliance with evidence-based medications (aspirin, clopidogrel, statins, beta blockers, and angiotensin converting enzyme inhibitors [ACEIs]/angiotensin receptor blockers [ARBs]). Noncompliance was defined as proportion of days covered < or =80%. The outcome was combined mortality and MI. Kaplan-Meier analyses were used to explore the impact of noncompliance > or =4 medications. Of the 509 patients (86% minorities, 77% uninsured, and 54% diabetics), 132 (25.9%) presented with ST segment elevation with myocardial infarction (STEMI) and 377 (74.1%) with a non-ST segment elevation with myocardial infarction (NSTEMI), revascularization was performed in 297 (58.4%) patients, 72 (14.2%) patients died, 22 (4.3%) patients had an MI, and 91 (17.9%) patients had either event at a median follow-up of 2 (0.5-2.9) years. Noncompliance > or = 4 medications was significantly associated with adverse survival compared with compliant patients (29.7% vs 78.9%). After adjusting for traditional risk factors, The Global Registry of Acute Coronary Events risk score for predicting death during 6 months post-discharge, revascularization, left ventricular (LV) function, coronary artery disease (CAD) severity, and punctual clinic visits, noncompliance with > or = 4 evidence-based medications was an independent factor associated with death or MI (hazard ratio [HR], 2.83; 95% confidence interval [CI]=1.60-5.01) in this minority and uninsured population. SN - 1931-5244 UR - https://www.unboundmedicine.com/medline/citation/19595439/Association_of_medical_noncompliance_and_long_term_adverse_outcomes_after_myocardial_infarction_in_a_minority_and_uninsured_population_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1931-5244(09)00153-4 DB - PRIME DP - Unbound Medicine ER -