Myocardial infarction: failure to take medication increased the risk of dying.

Clinical bottom line (level 2b)

  1. One in eleven women with a myocardial infarction died within 2 years.
  2. Women who failed to take their medication were at increased risk of dying.
Gallagher et al: Journal of the American Medical Association 1993; 270 (6): 742-744
Expires March 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: acute hospitals, USA

505 patients (aged range 30 to 69 years, 100% female) with a myocardial infarction within the previous 5 to 21 days

Excluded if
  • adherence data not available



    • Factors studied:
  • complications including cardiogenic shock, persistent hypotension, atrioventricular block, atrial fibrillation, ventricular fibrillation, congestive heart failure, age, smoking, race, marital status, education, clinical severity
  • poor adherence to study medication


    • Patients received either propranolol hydrochloride or placebo.

    A Cox proportional hazards model was used to adjust for confounding factors.

    ?100% followed for 26 months
    Outcomes studied:
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death 2 years 32/505 6.3%
    (4.2% to 8.5%)    		 16
    (12 to 24)

    prognostic factor for
    death     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    poor adherence to study medication 26 months 2.4
    (1.1 to 5.6)     		13
    (4 to 180)

    Comments

    1. Patients were enrolled in a randomised controlled trial comparing propranolol and placebo.

    Citation

    1. Gallagher EJ, Viscoli CM, Horwitz RI: The relationship of treatment adherence to the risk of death after myocardial infarction in women. Journal of the American Medical Association 1993; 270 (6): 742-744
    Search Terms:
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient women with a myocardial infarction
    Intervention or Exposure adherence to treatment
    Outcome death