gms | German Medical Science

14. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

15.11. - 16.11.2007, Frankfurt am Main

Does guideline adherence yield to better outcomes? A study on the treatment of acute myocardial infarction based on routine data

Meeting Abstract

  • corresponding author J. Küpper-Nybelen - PMV Research Group, University of Cologne
  • L. Heymans - PMV Research Group, University of Cologne
  • M. Hellmich - Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne
  • R. Griebenow - Clinics of Cologne, Clinic II for Internal Medicine, University of Cologne
  • I. Schubert - PMV Research Group, University of Cologne

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 14. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Frankfurt am Main, 15.-16.11.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07gaa05

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/gaa2007/07gaa05.shtml

Veröffentlicht: 12. November 2007

© 2007 Küpper-Nybelen et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Context: Studies reveal insufficient management of patients with coronary heart diseases.

Aim of the study: To investigate patient adherence to guidelines following acute myocardial infarction and to determine the association between guideline adherence and both mortality and subsequent infarction.

Material and method: Database: Statutory Health Insurance (SHI) sample AOK Hesse/KV Hesse, an 18.75% random sample of persons insured with the AOK insurance fund Hesse. Study population: all patients with a hospital discharge diagnosis of acute myocardial infarction in 2000/2001 who survived for at least 30 days (n=1111). Follow-up: at least 4 years. Key medication extracted from guidelines: inhibitors of platelet aggregation, beta-blockers, ace-inhibitors and lipid lowering drugs. Operationalisation of guideline adherence: 1. Dichotomous definition: two drugs for at least half of the observation period, 2. Continuous definition: expressed as percent compliance, i.e. ratio of observed treatment (sum of drugs per day) to full treatment (all four drugs every day). The association between guideline adherence and both mortality and further infarction was assessed using a multivariate time-dependent proportional hazard model.

Results: Of the 1111 persons, 333 (30%) died and 283 (26%) suffered a further infarction. Guideline adherence was poor. Only 146 persons (13%) received all four drugs on at least one day. Only 242 persons met the conditions of the dichotomous definition. These persons were younger and predominantly male (65%). The compliant group had an almost 50% lower risk of mortality as compared with the non-compliant group (HR: 0.52, 95% CI: 0.36-0.76). The association of compliance and further infarction was not statistically significant. According to the continuous definition, a 10% improvement in adherence results in a 27% reduction of the risk of mortality (HR: 0.73, 95% CI: 0.66-0.80) and a 36% reduction of the risk of a further myocardial infarction (HR: 0.64, 95% CI: 0.56-0.73).

Conclusion: The study reveals utilisation patterns and benefits in real life. The database allows further methodological research regarding the operationalisation of adherence.