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Secondary prevention of MI- it's all or nothing say US researchers

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ARBs

Only patients who are fully adherent to all components in secondary MI prevention derive benefit- patients who  are only partially adherent derive none, say US researchers.

The Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) study was designed to test whether reducing financial barriers to drug access could improve clinical outcomes in secondary prevention.

The study of over 4,000 patients showed that patients who had suffered an MI were significantly less likely to have another major cardiac event—defined as an MI, angina, heart failure, or stroke—if the cost of statins, β-blockers, and ACE inhibitors/ARBs were covered in full by insurance rather than requiring co-payment. The difference in the primary outcome - a composite of major cardiac events plus revascularisation - was not statistically significant between the two coverage types.

However the researchers also found that only patients who were fully adherent to treatment were significantly less likely to experience a major vascular event or undergo coronary revascularisation. In fact there was no significant reduction in outcomes in patients who did not take their medication or were only partially adherent to treatment.

Patients were defined as partially adherent if they took their drugs 40% to 79% of the time and non-adherent if they took their drugs less than 40% of the time.

Lead investigator Dr Niteesh Choudhry of the Brigham and Women's Hospital, Boston - told theheart.org: ‘When we’re confronted by our patients or challenged by them about taking the medications, we often don't have a lot to stand on.

'This evidence isn't perfect, but it does make a very compelling case that you need to take your meds every day - and each and every one of those medications the guidelines recommend is important.’

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