Prevalence and factors influencing medication adherence after acute myocardial infarction: a systematic review and meta-analysis.
Ruolan Liao, Shihan Zhang, Qi Zhou et al.
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In 30 seconds
This systematic review and meta-analysis pooled objectively measured adherence to secondary-prevention medications after acute myocardial infarction (AMI), using 18 retrospective cohort studies with 680,966 participants from eight countries. Random-effects estimates showed adherence varied by medication class: 64.9% (95% CI 56.1-73.8%) for statins, 58.9% (95% CI 49.3-68.4%) for beta-blockers, 56.7% (95% CI 45.3-68.0%) for P2Y12 inhibitors, and 41.4% (95% CI 27.2-55.6%) for multiple-drug therapy (≥ 2 classes). Adherence was associated with patient and care factors, while substantial heterogeneity remained.
Key findings
- Pooled adherence was 64.9% (95% CI 56.1-73.8%) for statins and 41.4% (95% CI 27.2-55.6%) for multiple-drug therapy (≥ 2 classes).
- Prior cardiovascular medication use was associated with higher adherence to statins (OR = 1.33, 95% CI 1.15-1.54), beta-blockers (OR = 1.62, 95% CI 1.49-1.75), and ACEI/ARB (OR = 1.77, 95% CI 1.65-1.89).
- Higher adherence was associated with percutaneous coronary intervention (OR = 2.16, 95% CI 1.34-3.46) and discharge from a cardiology ward (OR = 1.57, 95% CI 1.37-1.80).
- Lower adherence was associated with female sex (OR = 0.78, 95% CI 0.74-0.84), age ≥85 years (OR = 0.48, 95% CI 0.38-0.60), and COPD (OR = 0.78, 95% CI 0.72-0.84).
Why it matters
Adherence to secondary-prevention medication after AMI was not universal, and pooled estimates differed across drug classes. The reported associations identify patient and care characteristics that may help frame adherence assessment and support. Because the evidence is observational and heterogeneous, these factors should be interpreted as correlates rather than causes or proof that a particular intervention will improve adherence.
What to keep in mind
All included studies were retrospective cohorts, and substantial heterogeneity remained within subgroups, limiting the certainty and generalisability of pooled estimates.