Relationship Between Adherence to Evidence-Based Pharmacotherapy and Long-term Mortality After Acute Myocardial Infarction

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Abstract
Clinical trials have demonstrated that selected pharmacotherapies reduce cardiovascular mortality.1,2 However, their projected survival impact in the real world is less known, in part because of variations in drug adherence.3,4 Although it is known that adherence to evidence-based pharmacotherapy predicts better survival,5-11 no population outcome study has attempted to differentiate whether these associations are attributable to the drug's biological responsiveness (herein termed drug effect) or to the adoption of healthier lifestyles that often accompany adherent behaviors (herein termed healthy adherer effect). If mortality gains are directly attributable to biological responsiveness, then one might hypothesize that outcome benefits correlate with adherence intensity and that survival-adherence gains follow a “dose-response”–type gradient. If confirmed, interventions that selectively target and improve drug-taking behaviors should translate into important mortality advantages when applied to real-world populations.

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