The Study of Adherence to Drug Therapy at the Stage of Outpatient Follow-up in Patients with Acute Myocardial Infarction (Data from the PROFIL-IM Registry)

Abstract

Aim. To assess adherence to the recommended therapy at the stage of outpatient follow-up and its impact on long-term outcomes in patients after acute myocardial infarction based on the materials of the prospective PROFILE-IM registry.Material and methods. The PROFILE-IM register included 160 patients who applied to one of the polyclinics in Moscow after a myocardial infarction. The combined endpoint (CE) included death from any cause, cardiovascular events (nonfatal myocardial infarction, nonfatal cerebral stroke), emergency hospitalizations for cardiovascular diseases, significant cardiac arrhythmias. Patients' adherence to therapy was assessed using the original questionnaire "Scale of Adherence of the National Society of Evidence-based Pharmacotherapy" (NODF) and a direct standardized patient survey by a doctor about taking medications. Visits to the doctor were carried out every two months, data from the first year of patient follow-up are presented.Results. In a personal interview with a doctor, the ratio of the proportion of committed, partially committed and non-committed patients did not change significantly over the entire follow-up period, while the proportion of committed patients was 81-85%. The "NODF Adherence Scale" showed that the proportion of non-committed patients was about 10 times higher than with direct patient responses to the doctor, and the proportion of non-committed and partially committed patients remained high at all stages of follow-up (respectively 28% and 10% at the beginning of the study, 18% and 10% at the end of the study). Among the main factors of non-commitment, there was a decrease in the importance of forgetfulness and an increase in factors such as fear of side effects of medications, doubt about the need for long-term use of medications and well-being. A direct relationship of adherence with the male sex, the presence of hypertension, a feedback relationship with alcohol consumption was revealed. The risk of CE in non-committed patients was higher compared to the group of committed and partially committed patients (p<0.01).Conclusion. The proportion of non-committed and partially committed patients remained high at all stages of follow-up. There was a direct relationship between adherence to therapy with the male sex, the presence of hypertension in the anamnesis, and a feedback relationship with alcohol consumption. Low adherence to therapy significantly increased the risk of cardiovascular events.

Keywords

• outpatient registry
• acute myocardial infarction
• secondary drug prevention
• therapy adherence
• survival analysis