Impact of treatment adherence on survival during long-term follow-up in patients after acute myocardial infarction: data from the PROFILE-IM registry

Aim. To assess the impact of treatment adherence on long-term outcomes over a ten-year period in patients with acute myocardial infarction (MI) based on data from the prospective PROFILE-MI registry.

Material and methods. The prospective PROFILE-IM registry included 160 patients attended a cardiologist at Moscow City Polyclinic No. 9 or one of its two branches in the period from March 1, 2014 to December 31, 2015. The vital status of patients was assessed 10 years after their discharge from the hospital.

Results. Analysis of the results of the NODF Adherence Scale survey made it possible to identify three categories of patients (n=158, two patients refused to fill out the questionnaire): committed – 98 (62%), non-committed – 16 (10%), partially committed – 44 (28%). The life status was analyzed after 1.5 and 10 years in patients of these groups, with a 95% response rate. At 1.5 years from the start of observation, fatal outcomes were recorded in 16 (10%) patients. After ten years of follow-up, the number of deaths increased to 43 (26.9%) patients. Patients who developed primary endpoint (PEP) were significantly older than those without it – 70.3±11.1 vs 58.6±10.5 years, p<0.001. According to multivariate analysis, the risk PEP developing during a ten-year follow-up was 2.7 times higher in non-adherent patients compared to adherent and partially adherent patients (p=0.027). The ten-year monitoring data indicate that the probability of PEP increases by 8.6% every year of the patient’s life.

Conclusion. The results of the study demonstrate that insufficient treatment adherence increases the likelihood of an adverse outcome during the ten-year followup period. Long-term monitoring of patients with insufficient treatment adherence is of particular importance in the context of secondary prevention.

1. Lukina YuV, Kutishenko NP, Martsevich SYu, Drapkina OM. Questionnaires and scores for assessing medication adherence — advantages and disadvantages of the diagnostic method in research and actual clinical practice. Cardiovascular Therapy and Prevention. 2020;19(3):2562. (In Russ.).

2. Kirchhof P, Benussi S, Kotecha D, et al.; ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Hear J. 2016;37(38):2893–962. DOI: 10.1093/eurheartj/ehw210.

3. Ponikowski P, Voors AА, Anker SD, et al.; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of. Eur Hear J. 2016;37(27):2129–200. DOI: 10.1093/eurheartj/ehw128. Erratum in: Eur Heart J. 2018;39(10):860. DOI: 10.1093/eurheartj/ehw383.

4. Williams B, Mancia G, Spiering W, et al.; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Hear J. 2018;39(33):3021–104. DOI: 10.1093/eurheartj/ehy339. Erratum in: Eur Heart J. 2019;40(5):475. DOI: 10.1093/eurheartj/ehy686.

5. Knuuti J, Wijns W, Saraste A, et al.; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Hear J. 2020;41(3):407–77. DOI: 10.1093/eurheartj/ehz425. Erratum in: Eur Heart J. 2020;41(44):4242. DOI: 10.1093/eurheartj/ehz825.

6. Zorina O, Fatkulina N, Saduyeva F, et al. Patient Adherence to Therapy After MyocardialInfarction: A Scoping Review. Patient Prefer Adherence. 2022;16:1613-22. DOI: 10.2147/PPA.S356653.

7. Shchinova AM, Potekhina AV, Dolgusheva YuA, et al. Adherence to therapy after myocardial infarction and methods for its improvement. Journal of atherosclerosis and dyslipidemias. 2022; 3(48):5-13. (In Russ.).

8. Martsevich SYu, Kutishenko NP, Sichinava DP, et al. Prospective outpatient tregistry of myocardial infarction patients (PROFILE-MI): study design and first results. Cardiovascular Therapy and Prevention. 2018;17(1):81-6. (In Russ.).

9. Lukina YuV, Kutishenko NP, Martsevich SYu, Drapkina OM. The Questionnaire Survey Method in Medicine on the Example of Treatment Adherence Scales. Rational Pharmacotherapy in Cardiology. 2021;17(4):576-83. (In Russ.).

10. Zullig LL, Ramos K, Bosworth HB. Improving medication adherence in coronary heart disease. Curr Cardiol Rep. 2017;19(11):113. DOI: 10.1007/s11886-017-0918-y.

11. Crawshaw J, Auyeung V, Norton S, Weinman J. Identifying psychosocial predictors of medication non-adherence following acute coronary syndrome: A systematic review and meta-analysis. J Psychosom Res. 2016;90:10-32. DOI: 10.1016/j.jpsychores.2016.09.003.

12. Dragomir A, Côté R, Roy L, et al. Impact of adherence to antihypertensive agents on clinical outcomes and hospitalization costs. Med Care. 2010;48(5):418-25. DOI: 10.1097/MLR.0b013e3181d567bd.

13. Sadeghiazar S, Mobasseri K, Gholizadeh L, et al. Illness acceptance, medication adherence and the quality of life in patients with heart failure: A path analysis of a conceptual model. Appl Nurs Res. 2022;65:151583. DOI: 10.1016/j.apnr.2022.151583.