Effect of adherence to evidence-based therapy after XXXX on all-cause mortality.

@entity1 @entity712 @entity7774 @entity117 @entity741 @entity583
PURPOSE: Our aim is to estimate the effect of nonadherence to evidence-based cardioprotective medications on all-cause mortality in survivors of @entity583 ( @entity583 ). METHODS: A @entity1 -based retrospective cohort study of 1-year survivors of @entity583 , members of a health organization in Israel, between 2005 and 2010 was used. Adherence was measured using the proportion-of-days-covered metric and defined as a proportion of days covered >= 80%. In order to determine the independent impact of medication nonadherence on all-cause mortality, Cox proportional hazards models were constructed, adjusting for @entity1 demographic and clinical characteristics. RESULTS: Of 4655 @entity1 prescribed at least one medication, 864 died during an 8-year follow-up (median 4.5   years). Except for beta-blockers, medication nonadherence was significantly associated with increased adjusted all-cause mortality risk for @entity117 [hazard ratio ( @entity712 ), 1.28; 95% confidence interval (CI), 1.11-1.47], statins ( @entity712 , 1.36; 95%CI, 1.18-1.57), and @entity7774 -converting enzyme inhibitors/ @entity7774 receptor blockers only among @entity741 @entity1 with documented @entity712 ( @entity712 , 1.57; 95%CI, 1.16-2.14). Multidrug-combined therapy exerted incremental survival benefit in a dose-response gradient, exceeding that of single-component treatment. The highest risk of mortality was observed in @entity1 adherent to none of the medications compared with adherents to all medications, with a 38% increase in risk of mortality ( @entity712 , 1.38; 95%CI, 1.06-1.80). CONCLUSIONS: Outpatient nonadherence to evidence-based cardioprotective medications in @entity1 with @entity583 is common, and in the case of @entity117 , statin or combined therapy is associated with a marked risk increase in all-cause mortality. Further research is needed to elucidate the role of @entity7774 -converting enzyme inhibitor/ @entity7774 receptor blocker in @entity1 subgroups. Copyright    2015 John Wiley _ Sons, Ltd.
