Discontinuation  of secondary prevention medication after myocardial infarction – the role of general  practitioners and patients

Klaus Bally; Ronny Buechel; Peter Buser; Benedict Martina; Peter Tschudi; Andreas Zeller

doi:10.4414/smw.2013.13896

Original article

Vol. 143 No. 4546 (2013)

Discontinuation of secondary prevention medication after myocardial infarction – the role of general practitioners and patients

Klaus Bally
Ronny Buechel
Peter Buser
Benedict Martina
Peter Tschudi
Andreas Zeller

DOI: https://doi.org/10.4414/smw.2013.13896
Cite this as:: Swiss Med Wkly. 2013;143:w13896
Published: 03.11.2013

Summary

BACKGROUND: Despite the significant benefits of secondary prevention (SP) medication after acute myocardial infarction (MI), evidence suggests that these medications are neither consistently prescribed nor appropriately adhered to by patients. The aim of this study was to investigate the role of general practitioners (GPs) and patients regarding discontinuation of SP medication after MI and reasons for discontinuation.

METHODS: In this observational study, GPs of patients who had suffered acute MI provided information on discontinuation of SP medication 6 and 12 months after hospital discharge. A questionnaire-based approach was used (a) to assess the consistent use of SP medication after MI, (b) to determine reasons for stopping SP medication, (c) to quantify the involvement of GPs and patients regarding discontinuation, and (d) to analyse potential factors that are associated with discontinuation of medication.

RESULTS: Of 204 subjects 6 and 12 months after hospital discharge 83% and 75% patients, respectively, were still on recommended SP medication. Overall, one or more SP medications were stopped (53 medications) or modified (15 medications) in 52 (25%) patients. Adverse side effects were the main reason for stopping medication (63%). GPs reported being responsible for initiating discontinuation or modification more frequently than patients (62% vs 38%, p = 0.065).

CONCLUSION: The consistent use of evidence-based pharmacotherapy 6 and 12 months after myocardial infarction was adequate. Three out of four patients were still on recommended SP medication after 1 year of follow-up. Two-thirds of medication discontinuations were initiated by GPs, predominantly because of side effects.

References

Organization WHO: Global status report on noncommunicable diseases 2010. In: Edited by Organization WHO. Geneva: World Health Organization; 2010.
Wietlisbach V, Paccaud F, Rickenbach M, Gutzwiller F. Trends in cardiovascular risk factors (1984-1993) in a Swiss region: results of three population surveys. Prev Med. 1997;26(4):523–33.
Wieser S, Ruethemann I, De Boni S, Eichler K, Pletscher M, Radovanovic D, et al. Cost of acute coronary syndrome in Switzerland in 2008. Swiss Med Wkly. 2012;142:w13655.
Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(23):2999–3054.
Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology, Bassand JP, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernandez-Aviles F et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007;28(13):1598–660.
Freemantle N, Cleland J, Young P, Mason J, Harrison J. beta Blockade after myocardial infarction: systematic review and meta regression analysis. BMJ. 1999;318(7200):1730–7.
Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D,Badano LP, Blömstrom-Lundqvist C, Borger MA et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569–619
Eagle KA, Kline-Rogers E, Goodman SG, Gurfinkel EP, Avezum A, Flather MD, et al. Adherence to evidence-based therapies after discharge for acute coronary syndromes: an ongoing prospective, observational study. Am J Med. 2004;117(2):73–81.
Gehi AK, Ali S, Na B, Whooley MA: Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease: the heart and soul study. Arch Intern Med. 2007;167(16):1798–803.
Lee HY, Cooke CE, Robertson TA: Use of secondary prevention drug therapy in patients with acute coronary syndrome after hospital discharge. J Manag Care Pharm. 2008;14(3):271–80.
Ho PM, Spertus JA, Masoudi FA, Reid KJ, Peterson ED, Magid DJ, et al. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med. 2006;166(17):1842–7.
Bally K, Martina B, Halter U, Isler R, Tschudi P. Barriers to Swiss guideline-recommended cholesterol management in general practice. Swiss Med Wkly. 2010;140(19-20):280–5.
Melloni C, Alexander KP, Ou FS, LaPointe NM, Roe MT, Newby LK, et al. Predictors of early discontinuation of evidence-based medicine after acute coronary syndrome. Am J Cardiol. 2009;104(2):175–81.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. Strobe Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9.
Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M, et al. Universal definition of myocardial infarction. Circulation. 2007;116(22):2634–53.
Luepker RV, Apple FS, Christenson RH, Crow RS, Fortmann SP, Goff D, et al. Case definitions for acute coronary heart disease in epidemiology and clinical research studies: a statement from the AHA Council on Epidemiology and Prevention; AHA Statistics Committee; World Heart Federation Council on Epidemiology and Prevention; the European Society of Cardiology Working Group on Epidemiology and Prevention; Centers for Disease Control and Prevention; and the National Heart, Lung, and Blood Institute. Circulation. 2003;108(20):2543–9.
Newby LK, LaPointe NM, Chen AY, Kramer JM, Hammill BG, DeLong ER, et al. Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease. Circulation. 2006;113(2):203–12.
Ho PM, Magid DJ, Shetterly SM, Olson KL, Maddox TM, Peterson PN, et al. Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease. Am Heart J. 2008;155(4):772–9.
Maddox TM, Ho PM. Medication adherence and the patient with coronary artery disease: challenges for the practitioner. Curr Opin Cardiol. 2009;24(5):468–72.
Butler J, Arbogast PG, BeLue R, Daugherty J, Jain MK, Ray WA, Griffin MR. Outpatient adherence to beta-blocker therapy after acute myocardial infarction. J Am Coll Cardiol. 2002;40(9):1589–95.
Horne R. Patients’ beliefs about treatment: the hidden determinant of treatment outcome? J Psychosom Res. 1999;47(6):491–5.
Sigurdsson EL, Jonsson JS, Thorgeirsson G. Medical treatment and secondary prevention of coronary heart disease in general practice in Iceland. Scand J Prim Health Care. 2002;20(1):10–5.
Krumholz HM, Vaccarino V, Ellerbeck EF, Kiefe C, Hennen J, Kresowik TF, et al. Determinants of appropriate use of angiotensin-converting enzyme inhibitors after acute myocardial infarction in persons > or = 65 years of age. Am J Cardiol. 1997;79(5):581–6.
Vermeer NS, Bajorek BV. Utilization of evidence-based therapy for the secondary prevention of acute coronary syndromes in Australian practice. J Clin Pharm Ther. 2008;33(6):591–601.
Cuisset T, Quilici J, Fugon L, Cohen W, Roux P, Gaborit B, et al. Non-adherence to aspirin in patients undergoing coronary stenting: negative impact of comorbid conditions and implications for clinical management. Arch Cardiovasc Dis. 2011;104(5):306–12.
Wu TY, Jen MH, Bottle A, Molokhia M, Aylin P, Bell D, Majeed A. Ten-year trends in hospital admissions for adverse drug reactions in England 1999–2009. J R Soc Med. 2010;103(6):239–50.
Griffo R, Ambrosetti M, Tramarin R, Fattirolli F, Temporelli PL, Vestri AR, et al. Effective secondary prevention through cardiac rehabilitation after coronary revascularization and predictors of poor adherence to lifestyle modification and medication. Results of the ICAROS Survey. Int J Cardiol. 2012; May 8 (Epub ahead of print)

How to Cite

1.

Bally K, Buechel R, Buser P, Martina B, Tschudi P, Zeller A. Discontinuation of secondary prevention medication after myocardial infarction – the role of general practitioners and patients. Swiss Med Wkly [Internet]. 2013 Nov. 3 [cited 2024 Apr. 23];143(4546):w13896. Available from: https://smw.ch/index.php/smw/article/view/1770

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Most read articles by the same author(s)

Christoph Merlo, Klaus Bally, Benedict Martina, Peter Tschudi, Andreas Zeller, Management and outcome of severely elevated blood pressure in primary care , Swiss Medical Weekly: Vol. 142 No. 0304 (2012)
Matthias Briel, Jim Young, Peter Tschudi, Christa Hugenschmidt, Heiner C. Bucher, Wolf Langewitz, Shared-decision making in general practice: Do patients with respiratory tract infections actually want it? , Swiss Medical Weekly: Vol. 137 No. 3334 (2007)
Christophe von Garnier, Martina Meyer, Jörg Leuppi, Edouard Battegay, Andreas Zeller, Smoking cessation counselling: Impact of chart stickers and resident training , Swiss Medical Weekly: Vol. 140 No. 1112 (2010)
Matthias Briel, James Young, Peter Tschudi, Kurt E. Hersberger, Christa Hugenschmidt, Wolf Langewitz, Heiner C. Bucher, Prevalence and influence of diagnostic tests for acute respiratory tract infections in primary care , Swiss Medical Weekly: Vol. 136 No. 1516 (2006)
Christian Mueller, Peter Buser, B-type natriuretic peptide (BNP): can it improve our management of patients with congestive heart failure? , Swiss Medical Weekly: Vol. 132 No. 4344 (2002)
Ruedi Isler, Silvana Romerio, Ursina Halter, Simon Heiniger, Malte Persike, Bodo Röers, Benedict Martina, Peter Tschudi, Klaus Bally, One-on-one long-term tutorials in general practitioners practice - a successful new teaching concept in primary care medicine , Swiss Medical Weekly: Vol. 139 No. 1112 (2009)
Klaus Bally, Benedict Martina, Ursina Halter, Ruedi Isler, Peter Tschudi, Barriers to Swiss guideline-recommended cholesterol management in general practice , Swiss Medical Weekly: Vol. 140 No. 1920 (2010)

<< < 1 2

[1] Organization WHO: Global status report on noncommunicable diseases 2010. In: Edited by Organization WHO. Geneva: World Health Organization; 2010.

[2] Wietlisbach V, Paccaud F, Rickenbach M, Gutzwiller F. Trends in cardiovascular risk factors (1984-1993) in a Swiss region: results of three population surveys. Prev Med. 1997;26(4):523–33.

[3] Wieser S, Ruethemann I, De Boni S, Eichler K, Pletscher M, Radovanovic D, et al. Cost of acute coronary syndrome in Switzerland in 2008. Swiss Med Wkly. 2012;142:w13655.

[4] Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(23):2999–3054.

[5] Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology, Bassand JP, Hamm CW, Ardissino D, Boersma E, Budaj A, Fernandez-Aviles F et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J. 2007;28(13):1598–660.

[6] Freemantle N, Cleland J, Young P, Mason J, Harrison J. beta Blockade after myocardial infarction: systematic review and meta regression analysis. BMJ. 1999;318(7200):1730–7.

[7] Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D,Badano LP, Blömstrom-Lundqvist C, Borger MA et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569–619

[8] Eagle KA, Kline-Rogers E, Goodman SG, Gurfinkel EP, Avezum A, Flather MD, et al. Adherence to evidence-based therapies after discharge for acute coronary syndromes: an ongoing prospective, observational study. Am J Med. 2004;117(2):73–81.

[9] Gehi AK, Ali S, Na B, Whooley MA: Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease: the heart and soul study. Arch Intern Med. 2007;167(16):1798–803.

[10] Lee HY, Cooke CE, Robertson TA: Use of secondary prevention drug therapy in patients with acute coronary syndrome after hospital discharge. J Manag Care Pharm. 2008;14(3):271–80.

[11] Ho PM, Spertus JA, Masoudi FA, Reid KJ, Peterson ED, Magid DJ, et al. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med. 2006;166(17):1842–7.

[12] Bally K, Martina B, Halter U, Isler R, Tschudi P. Barriers to Swiss guideline-recommended cholesterol management in general practice. Swiss Med Wkly. 2010;140(19-20):280–5.

[13] Melloni C, Alexander KP, Ou FS, LaPointe NM, Roe MT, Newby LK, et al. Predictors of early discontinuation of evidence-based medicine after acute coronary syndrome. Am J Cardiol. 2009;104(2):175–81.

[14] von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. Strobe Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–9.

[15] Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M, et al. Universal definition of myocardial infarction. Circulation. 2007;116(22):2634–53.

[16] Luepker RV, Apple FS, Christenson RH, Crow RS, Fortmann SP, Goff D, et al. Case definitions for acute coronary heart disease in epidemiology and clinical research studies: a statement from the AHA Council on Epidemiology and Prevention; AHA Statistics Committee; World Heart Federation Council on Epidemiology and Prevention; the European Society of Cardiology Working Group on Epidemiology and Prevention; Centers for Disease Control and Prevention; and the National Heart, Lung, and Blood Institute. Circulation. 2003;108(20):2543–9.

[17] Newby LK, LaPointe NM, Chen AY, Kramer JM, Hammill BG, DeLong ER, et al. Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease. Circulation. 2006;113(2):203–12.

[18] Ho PM, Magid DJ, Shetterly SM, Olson KL, Maddox TM, Peterson PN, et al. Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease. Am Heart J. 2008;155(4):772–9.

[19] Maddox TM, Ho PM. Medication adherence and the patient with coronary artery disease: challenges for the practitioner. Curr Opin Cardiol. 2009;24(5):468–72.

[20] Butler J, Arbogast PG, BeLue R, Daugherty J, Jain MK, Ray WA, Griffin MR. Outpatient adherence to beta-blocker therapy after acute myocardial infarction. J Am Coll Cardiol. 2002;40(9):1589–95.

[21] Horne R. Patients’ beliefs about treatment: the hidden determinant of treatment outcome? J Psychosom Res. 1999;47(6):491–5.

[22] Sigurdsson EL, Jonsson JS, Thorgeirsson G. Medical treatment and secondary prevention of coronary heart disease in general practice in Iceland. Scand J Prim Health Care. 2002;20(1):10–5.

[23] Krumholz HM, Vaccarino V, Ellerbeck EF, Kiefe C, Hennen J, Kresowik TF, et al. Determinants of appropriate use of angiotensin-converting enzyme inhibitors after acute myocardial infarction in persons > or = 65 years of age. Am J Cardiol. 1997;79(5):581–6.

[24] Vermeer NS, Bajorek BV. Utilization of evidence-based therapy for the secondary prevention of acute coronary syndromes in Australian practice. J Clin Pharm Ther. 2008;33(6):591–601.

[25] Cuisset T, Quilici J, Fugon L, Cohen W, Roux P, Gaborit B, et al. Non-adherence to aspirin in patients undergoing coronary stenting: negative impact of comorbid conditions and implications for clinical management. Arch Cardiovasc Dis. 2011;104(5):306–12.

[26] Wu TY, Jen MH, Bottle A, Molokhia M, Aylin P, Bell D, Majeed A. Ten-year trends in hospital admissions for adverse drug reactions in England 1999–2009. J R Soc Med. 2010;103(6):239–50.

[27] Griffo R, Ambrosetti M, Tramarin R, Fattirolli F, Temporelli PL, Vestri AR, et al. Effective secondary prevention through cardiac rehabilitation after coronary revascularization and predictors of poor adherence to lifestyle modification and medication. Results of the ICAROS Survey. Int J Cardiol. 2012; May 8 (Epub ahead of print)