Effectiveness and medication adherence in patients with ST- elevated myocardial infarction: Persian polypill study

Abstract

BACKGROUND: Polypill or fixed-dose combination has been recognized as an effective secondary prevention strategy for patients with cardiovascular disease (CVD). This study aimed to evaluate the effectiveness of the polypill on one-year medication adherence, patient satisfaction, and lipid profile control in patients with ST-elevation myocardial infarction (STEMI). METHODS: This was an open-label, multicentric, randomized clinical trial study of STEMI patients who were prescribed a polypill (Aspirin 81 mg, Atorvastatin 40 mg, Metoprolol Succinate 47.5 mg, and Valsartan 40 mg) versus usual care (continued with separate medications) for secondary prevention. The primary outcome was to compare one-year medication adherence between groups. Other outcomes included comparing patient satisfaction and lipid profile after 12 months of follow-up, as well as identifying predictor factors of medication adherence. RESULTS: Of 624 STEMI participants, 289 patients were treated with the polypill (79.2 male; mean age 61.67 +/- 8.54 years), and 335 patients received usual care (82.7 male; mean age 62.10 +/- 9.63 years). After one-year follow-up, no significant differences were detected between groups regarding medication adherence (p-value = 0.351) and cholesterol levels (p-value = 0.808). The polypill strategy was associated with increased patient satisfaction and better control of LDL-C (p-value = 0.043) and HDL-C (p-value < 0.001). Patients with a history of chronic kidney disease (OR: 13.392; p-value = 0.001), cerebrovascular disease (OR: 4.577; p-value = 0.011), and higher waist circumference (OR: 1.01; p-value = 0.002) demonstrated a lower probability of medication adherence. In contrast, in-hospital complications such as arrhythmia (OR: 0.039; p-value = 0.010), bleeding (OR: 0.034; p-value = 0.007), and higher ejection fraction (OR: 0.965; p-value = 0.002) were associated with a higher probability of medication adherence. CONCLUSION: In STEMI patients, participants treated with polypills were more satisfied and showed better lipid profile control. However, a longer follow-up duration is needed to examine the effectiveness of the polypill on medication adherence in this subgroup.