Tags

Type your tag names separated by a space and hit enter

Adherence to agents acting on the renin-angiotensin system in secondary prevention of non-fatal myocardial infarction: a self-controlled case-series study.
Eur Heart J Cardiovasc Pharmacother. 2015 Oct; 1(4):254-9.EH

Abstract

AIMS

In accordance with current guidelines, patients discharged after acute myocardial infarction (AMI) are usually prescribed agents acting on the renin-angiotensin system (ACE-I/ARB). However, adherence to prescribing medications is a recognized problem and most studies demonstrating the value of adherence were limited by their non-randomized design and by 'healthy-adherer' bias. Herein we sought to evaluate the relationship between adherence to ACE-I/ARB and risk of subsequent AMIs, by using the self-controlled case-series design which virtually eliminates interpersonal confounding, being based on intrapersonal comparisons.

METHODS AND RESULTS

We linked data from three longitudinal registries containing information about hospitalizations, drug prescriptions, and vital status of all residents in an Italian region. From 30 089 patients hospitalized for AMI in the years 2009-11, we enrolled the 978 with non-fatal re-AMIs at Days 31-365 after discharge, receiving at least one ACE-I/ARB prescription collected at any of the regional pharmacies. Using information on prescriptions, each individual's observation time was then divided into periods exposed or unexposed to ACE-I/ARB. The relative re-AMI incidence rate ratios (IRRs) of ACE-I/ARB exposure were estimated by conditional Poisson regression. During drug-covered periods, the risk of AMI recurrence was ∼20% lower, i.e. the IRR (rate of recurrent AMI in exposed versus unexposed periods) was 0.79 (95% CI 0.66-0.96, P = 0.001). The benefit of ACE-I/ARB was confirmed also by sensitivity analyses considering only first recurrences, excluding cases with AMI within previous 3 years, or with long, not AMI, hospital re-admission.

CONCLUSIONS

Poor adherence to ACE-I/ARB prescription medication was associated with a 20% increased risk of recurrent AMI. This was consistent with previous research, but the SCSS study design, even if not randomized, eased previous concerns about healthy-adherer bias.

Authors+Show Affiliations

Istituto di Cardiologia, Azienda Universitario-Ospedaliera S. Orsola-Malpighi, Via Massarenti 9, Bologna 40138, Italy paortol@tin.it paolo.ortolani@aosp.bo.it.Servizio di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria di Udine, Udine, Italy Agenzia Sanitaria Regionale, Regione Emilia Romagna, Bologna, Italy.Agenzia Sanitaria Regionale, Regione Emilia Romagna, Bologna, Italy.Istituto di Cardiologia, Azienda Universitario-Ospedaliera S. Orsola-Malpighi, Via Massarenti 9, Bologna 40138, Italy.Agenzia Sanitaria Regionale, Regione Emilia Romagna, Bologna, Italy.Istituto di Cardiologia, Azienda Universitario-Ospedaliera S. Orsola-Malpighi, Via Massarenti 9, Bologna 40138, Italy.Agenzia Sanitaria Regionale, Regione Emilia Romagna, Bologna, Italy.

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study

Language

eng

PubMed ID

27532449

Citation

Ortolani, Paolo, et al. "Adherence to Agents Acting On the Renin-angiotensin System in Secondary Prevention of Non-fatal Myocardial Infarction: a Self-controlled Case-series Study." European Heart Journal. Cardiovascular Pharmacotherapy, vol. 1, no. 4, 2015, pp. 254-9.
Ortolani P, Di Bartolomeo S, Marino M, et al. Adherence to agents acting on the renin-angiotensin system in secondary prevention of non-fatal myocardial infarction: a self-controlled case-series study. Eur Heart J Cardiovasc Pharmacother. 2015;1(4):254-9.
Ortolani, P., Di Bartolomeo, S., Marino, M., Vagnarelli, F., Guastaroba, P., Rapezzi, C., & De Palma, R. (2015). Adherence to agents acting on the renin-angiotensin system in secondary prevention of non-fatal myocardial infarction: a self-controlled case-series study. European Heart Journal. Cardiovascular Pharmacotherapy, 1(4), 254-9. https://doi.org/10.1093/ehjcvp/pvv028
Ortolani P, et al. Adherence to Agents Acting On the Renin-angiotensin System in Secondary Prevention of Non-fatal Myocardial Infarction: a Self-controlled Case-series Study. Eur Heart J Cardiovasc Pharmacother. 2015;1(4):254-9. PubMed PMID: 27532449.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adherence to agents acting on the renin-angiotensin system in secondary prevention of non-fatal myocardial infarction: a self-controlled case-series study. AU - Ortolani,Paolo, AU - Di Bartolomeo,Stefano, AU - Marino,Massimiliano, AU - Vagnarelli,Fabio, AU - Guastaroba,Paolo, AU - Rapezzi,Claudio, AU - De Palma,Rossana, Y1 - 2015/06/15/ PY - 2015/04/05/received PY - 2015/06/06/accepted PY - 2016/8/18/entrez PY - 2016/8/18/pubmed PY - 2016/8/18/medline KW - ACE-I KW - AMI KW - ARB KW - Adherence SP - 254 EP - 9 JF - European heart journal. Cardiovascular pharmacotherapy JO - Eur Heart J Cardiovasc Pharmacother VL - 1 IS - 4 N2 - AIMS: In accordance with current guidelines, patients discharged after acute myocardial infarction (AMI) are usually prescribed agents acting on the renin-angiotensin system (ACE-I/ARB). However, adherence to prescribing medications is a recognized problem and most studies demonstrating the value of adherence were limited by their non-randomized design and by 'healthy-adherer' bias. Herein we sought to evaluate the relationship between adherence to ACE-I/ARB and risk of subsequent AMIs, by using the self-controlled case-series design which virtually eliminates interpersonal confounding, being based on intrapersonal comparisons. METHODS AND RESULTS: We linked data from three longitudinal registries containing information about hospitalizations, drug prescriptions, and vital status of all residents in an Italian region. From 30 089 patients hospitalized for AMI in the years 2009-11, we enrolled the 978 with non-fatal re-AMIs at Days 31-365 after discharge, receiving at least one ACE-I/ARB prescription collected at any of the regional pharmacies. Using information on prescriptions, each individual's observation time was then divided into periods exposed or unexposed to ACE-I/ARB. The relative re-AMI incidence rate ratios (IRRs) of ACE-I/ARB exposure were estimated by conditional Poisson regression. During drug-covered periods, the risk of AMI recurrence was ∼20% lower, i.e. the IRR (rate of recurrent AMI in exposed versus unexposed periods) was 0.79 (95% CI 0.66-0.96, P = 0.001). The benefit of ACE-I/ARB was confirmed also by sensitivity analyses considering only first recurrences, excluding cases with AMI within previous 3 years, or with long, not AMI, hospital re-admission. CONCLUSIONS: Poor adherence to ACE-I/ARB prescription medication was associated with a 20% increased risk of recurrent AMI. This was consistent with previous research, but the SCSS study design, even if not randomized, eased previous concerns about healthy-adherer bias. SN - 2055-6845 UR - https://www.unboundmedicine.com/medline/citation/27532449/Adherence_to_agents_acting_on_the_renin_angiotensin_system_in_secondary_prevention_of_non_fatal_myocardial_infarction:_a_self_controlled_case_series_study_ L2 - https://academic.oup.com/ehjcvp/article-lookup/doi/10.1093/ehjcvp/pvv028 DB - PRIME DP - Unbound Medicine ER -