2 October 2006
Scientists report that discontinuation of medical therapy after myocardial infarction (MI) is common and associated with a significant increase in mortality, in one of a series of articles in the Archives of Internal Medicine highlighting the contribution of nonadherence to shortfalls in disease management.
Michael Ho (Denver Veterans Affairs Medical Center, Colorado, USA) and colleagues report that more than one in eight patients stopped taking all their cardioprotective medication within 1 month of suffering an MI, and that these patients had a nearly four-fold greater risk of dying during 1 year of follow-up than those who continued with at least one medication.
Although advances in the treatment of acute MI have led to declines in hospital mortality, the risk of recurrent events and mortality after the index MI remains very high during the following year, explain the researchers.
To examine whether nonadherence to medications could be to blame, Ho and team studied the use of aspirin, beta blockers, and statins at 1 month after MI hospitalization, and 12-month mortality, in 1521 patients prescribed all three medications at discharge.
The results showed that 184 patients discontinued use of all three medications, 56 the use of two medications, and 272 the use of one medication, with 1009 continuing to take all three medications at 1 month.
Overall, the survival rate among patients who discontinued use of all medications was lower than that for those who continued to take one or more drugs, at 88.5% versus 97.7% (p<0.001).
Mutivariable analysis showed that patients who discontinued use of all three medications were at significantly increased risk of death during follow-up relative to those who continued therapy, with a hazard ratio (HR) of 3.81.
Furthermore, discontinuation of each medication was associated with increased mortality. Aspirin discontinuation was associated with an HR of 1.82 relative to its continued use. HRs for beta-blocker and statin discontinuation were 1.96 and 2.86, respectively.
Noting that older age and lack of high-school education were associated with therapy discontinuation, the authors conclude: "These findings highlight the need to improve the care of patients in the transition from the hospital setting to outpatient care to ensure that patients continue to take medications that have demonstrated mortality benefit after MI."
In other reports in the same issue, researchers also demonstrate that medication nonadherence is prevalent among patients with diabetes, with adverse outcomes, and that coaching during care transition, communication when prescribing new medications, and nonadherence due to cost are all critical factors determining adherence in general.
In an accompanying editorial, Patrick O'Connor (HealthPartners Research Foundation, Minneapolis, Minnesota) outlined the major challenges faced in addressing the problem of medication nonadherence. These include the need to accept that physicians are part of the problem, the development of systems to provide information at prescription and reduce medication errors, and the implementation of various approaches to simplifying regimens.
"A common theme that unifies many of the challenges we face is the need to use medications judiciously, to systematically attempt to keep the number of medications and daily doses to a minimum, and to improve communication between health care providers and patients at care transitions," he said. 认领此贴。前段时间家中电脑故障，逃管已经下了通牒了，得抓紧干活才行。 治疗中断增加心梗后死亡率
在the Archives of Internal Medicine中一系列文章中一篇关于疾病治疗的不足中治疗中断起的作用 ，科学家们认为心梗后医学治疗中断是常见的，并且与死亡率明显上升相关。
美国科罗拉多州Denver Veterans Affairs 医学中心的Michael Ho 和同事们报道超过八分之一的病人患心梗后一个月内停止服用所有保护心脏的药物，这些病人比那些继续服用至少一种药得病人在患病后一年内死亡的危险高约4倍。
作者:admin@医学,生命科学 2011-10-19 17:52