Kaiser Permanente study finds adherence to recommendations is linked to better long-term survival after heart attack
By Jan Greene
Patients who followed more medical advice after a heart attack were more likely to survive years later, and their prospects improved with every additional recommendation they followed, according to new research from Kaiser Permanente published in the Journal of the American Heart Association.
The study was conducted in Kaiser Permanente Northern California, which has about 4.4 million members. The study assessed how many recommendations patients were following at 30 and 90 days after their heart attacks and examined the association between adherence and survival in the years following the heart attack. The recommendations included taking 4 cardiovascular medications, not smoking, and achieving blood pressure and cholesterol control.
Researchers found high compliance with individual components of post-heart attack medical advice among Kaiser Permanente patients ranging from 67% taking prescribed non-aspirin antiplatelet drugs to 88% taking high cholesterol medications at 30 days. Patterns were similar at the 90-day mark. At the 30-day mark, nearly 70% of the patients achieved either 5 or 6 of the 6 guideline recommendations examined. By 90 days, a little over half of patients achieved 6 or 7 of the 7 recommendations examined.
“Our findings support the value of comprehensive secondary prevention efforts such as cardiac rehabilitation programs and patients’ own commitment to their recovery and a healthy lifestyle,“ said lead author Matthew D. Solomon, MD, PhD, a cardiologist with Kaiser Permanente in Oakland, and adjunct investigator with the Kaiser Permanente Division of Research.
Those who followed all of the recommendations had significantly greater long-term survival, and survival increased with each additional guideline followed. Adherence to one additional guideline recommendation was associated with 8% to 11% lower risk of death, while patients who met all guideline recommendations had 39% to 43% lower mortality compared with those who followed the fewest recommendations.
The study included 25,000 patients who had heart attacks between 2008 and 2014. Patients were followed using data from the electronic health record for a median of about 3 years and up to a maximum of 7 years.
Those results are a positive reflection on Kaiser Permanente Northern California’s cardiac rehabilitation program, said senior author Alan S. Go, MD, an internist and research scientist with the Division of Research in Oakland. “The high percentage of people achieving all or nearly all of the recommended guidelines highlights the benefits of our integrated health care delivery system’s ability to ensure high-quality follow-up care in recovery after a heart attack,” Go said.
Kaiser Permanente’s cardiac rehabilitation program in Northern California is comprehensive and home-based. Patients receive an exercise prescription and a care plan that targets smoking cessation, medication adherence, cholesterol management, blood pressure control, dietary advice, stress reduction, and weight management. Enrollment is 77%, compared with typical nationwide participation in cardiac rehabilitation programs of around 30%. Kaiser Permanente has been a national leader in successful secondary prevention and an innovator in home-based cardiac rehabilitation.
While modern-day cardiac care may seem quick and simple — such as receiving medications and stents to clear a blockage — it’s still vital that patients take follow-up care seriously, Solomon said. “People often think they are ‘fixed’ after they are treated for a heart attack,” he said. “But our findings show that following all the recommended treatments after a heart attack is critical to long-term health and wellness. Doctors and patients must work to ensure every single evidence-based recommendation is followed. Following ‘most’ of the recommended treatments is not enough.”
The study was funded by a research grant from Genentech and support from The Permanente Medical Group Physician Researcher Program.
Other co-authors include Thomas K. Leong, MPH, Stephen Sidney, MD, MPH, Sue Hee Sung, MPH, and Catherine Lee, PhD, of the Kaiser Permanente Division of Research; Eleanor Levin, MD, of Stanford University; Jamal S. Rana, MD, PhD, of Kaiser Permanente Oakland Medical Center; Marc G. Jaffe, MD, of Kaiser Permanente South San Francisco Medical Center; and Anthony DeMaria, MD, of the University of California San Diego.