ADHERENCE AND LONG-TERM TRENDS IN UPTAKE OF CARDIOPROTECTIVE MEDICATION FOLLOWING AN ACUTE MYOCARDIAL INFARCTION AMONG PEOPLE WITH DIABETES AND CKD – A PROSPECTIVE POPULATION-BASED STUDY

ADHERENCE AND LONG-TERM TRENDS IN UPTAKE OF CARDIOPROTECTIVE MEDICATION FOLLOWING AN ACUTE MYOCARDIAL INFARCTION AMONG PEOPLE WITH DIABETES AND CKD – A PROSPECTIVE POPULATION-BASED STUDY

Louisa Sukkar^1,2,3, Daniel O’Hara^4,5, Anna Campain¹, Carinna Hockham⁶, Amy Kang¹, Tamara Young¹, Min Jun¹, Kris Rogers¹, Alan Cass⁷, Carol Pollock^2,5,8, Sophia Zoungas^1,9, Celine Foote^1,10, David Peiris¹, Meg Professor^1,4,10,

¹The George Institute for Global Health, UNSW, Sydney, NSW, Australia
²Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
³Canterbury Hospital, Sydney, NSW, Australia
⁴NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
⁵Renal Department, Royal North Shore Hospital, Sydney, NSW, Australia
⁶The George Institute for Global Health, Imperial College, London, England
⁷Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
⁸Kolling Institute for Medical Research, Sydney, NSW, Australia
⁹School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
¹⁰Concord Repatriation General Hospital, Sydney, NSW, Australia

Abstract

Aim: To determine adherence to cardioprotective medications among people with chronic kidney disease (CKD) and/or diabetes following an acute myocardial infarction (AMI).
Background: Renin-angiotensin system (RAS) inhibitors and lipid-lowering therapies significantly improve long-term outcomes after AMI, but adherence among people with CKD or diabetes is not well defined.
Methods: We identified people surviving an AMI hospitalisation between 2006 and 2014 characterised by CKD (eGFR<60mL/min/1.73m2) and diabetes status in a population-based cohort of people aged ≥45 years in a universal healthcare setting. Medication adherence was measured as the proportion of days covered (PDC) post AMI by a dispensed prescription with both a lipid-lowering agent and a RAS inhibitor over the first 12 months. Adherence was defined as PDC≥80% for both medication classes. Results: 11,751 participants were admitted for an AMI between 2006 and 2014, of whom 11,470 (97.6%) survived to hospital discharge and were followed for a mean 3.0 years (SD 2.54). People with CKD and/or diabetes were older, with a greater burden of cardiovascular risk factors including high blood pressure and hyperlipidaemia than people with neither condition. Adherence over 12 months was highest in people with both CKD and diabetes, followed by diabetes alone, CKD alone, and neither condition, respectively (47.5% [95%CI 44.2-50.8], 40.3% [95%CI 33.2-47.9], 31.3% [95%CI 29.4-33.2]) and 23.7% [95%CI 22.7-24.7]). Compared with utilisation pre-AMI, adherence increased (8.5-14.0% across groups) in the first 3 months following the AMI, and did not decline over time. Conclusions: Adherence to cardioprotective medications following an AMI is low overall but is higher among those with chronic diseases. Concerted efforts are needed to support improved adherence in these high-risk populations.

Biography

Dr Daniel O’Hara is a nephrologist and clinical researcher undertaking a PhD with the University of Sydney and the NHMRC Clinical Trials Centre. Daniel’s research interests include improving patient education and support to enhance adherence, implementation of evidence-based guidelines into real-world care, improving outcomes in the care of Aboriginal and Torres Strait Islander peoples, and the development of robust clinical trials to generate new evidence to guide patient care.