Skipping medications can worsen health status even after revascularization in CAD patients: JACC
USA: A study published in the Journal of the American College of Cardiology, stresses the need for strategies to improve medication adherence in order to better health status outcomes in chronic coronary disease, irrespective of the treatment strategy.
According to recent findings from the ISCHEMIA trial, medication nonadherence was seen in more than 1 in 4 participants with a stable coronary disease which was tied to worse health status, regardless of whether they underwent conservative or invasive management.
The ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial randomized patients with CCD to guideline-directed medical therapy with or without angiography and revascularization. The study investigated the association of nonadherence with health status outcomes.
R. Angel Garcia, Cardiovascular Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA, and colleagues aimed to compare 12-month health status outcomes of adherent and nonadherent patients with CCD with a priori hypothesis that nonadherent patients would have better health status if randomized to invasive management.
For this purpose, the researchers assessed self-reported medication-taking behavior at randomization with a modified 4-item Morisky-Green-Levine Adherence Scale. Participants were classified as adherent or nonadherent. 7-item Seattle Angina Questionnaire (SAQ-7) summary score (SS), which entails from 0 to 100 (higher score = better) was used to assess twelve-month health status. Bayesian proportional odds models were used to evaluate the association of adherence with outcomes.
The study yielded the following findings:
- Among 4,480 randomized participants, 27.8% were nonadherent at baseline.
- Nonadherent participants had worse baseline SAQ-7 SS in both conservative (72.9 ± 19.3 vs 75.6 ± 18.4) and invasive (71.0 ± 19.8 vs 74.2 ± 18.7) arms.
- In adjusted analyses, adherence was associated with higher 12-month SAQ-7 SS in both treatment groups (mean difference in SAQ-7 SS with conservative treatment = 1.6 vs with invasive management = 1.9), with no interaction by treatment.
"Medication nonadherence was common among the patients with stable coronary disease in the ISCHEMIA trial and was associated with worse health status," the researchers wrote in their study. This was seen regardless of the treatment strategy.
Reference:
Garcia RA, Spertus JA, Benton MC, et al. Association of medication adherence with health outcomes in the ISCHEMIA trial. J Am Coll Cardiol. 2022;80:755-765.
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