Exposure information was collected from the regional registry of all drugs dispensed by public and private pharmacies (Pharm); this registry is described in detail elsewhere and in the appendix.18 (link) All drugs in this study were included in the patients' health care plans and are equally available to all residents in accordance with the universal health care coverage provided to residents of Italy.
Drug exposure was defined on the basis of recommendations by international and national guidelines for secondary prevention after AMI.1 (link),2 Information about prescriptions of platelet aggregation inhibitors Anatomical Therapeutic Chemical (ATC) classification system: B01AC04, B01AC05, B01AC06), beta blocking agents (ATC: C07), agents acting on the renin-angiotensin system (ATC: C09), and HMG-CoA reductase inhibitors (ATC: C10AA) were retrieved for all patients.
Adherence was calculated according to the proportion of days covered (PDC) on the basis of the defined daily doses (DDDs) and was calculated separately for each drug. The choice to use this approach was based on preliminary research.19 (link) Patients were defined as adherent when 75% or more of their individual follow-up was covered by a daily dose of the medication (i.e., PDC ≥ 75%). Inpatient regimens were excluded from this calculation because drugs are dispensed by the facility during inpatient treatment and thus cannot be retrieved from the Pharm database.
The following treatments were considered in the analysis: no EB drug therapy (<75% PDC of any of the drugs) and therapy with one, two, three, or four EB drugs. Sensitivity analyses were performed using a 50% cutoff for PDC and 50% and 75% cutoffs for the pill-count approach.
Drug exposure was defined on the basis of recommendations by international and national guidelines for secondary prevention after AMI.1 (link),2 Information about prescriptions of platelet aggregation inhibitors Anatomical Therapeutic Chemical (ATC) classification system: B01AC04, B01AC05, B01AC06), beta blocking agents (ATC: C07), agents acting on the renin-angiotensin system (ATC: C09), and HMG-CoA reductase inhibitors (ATC: C10AA) were retrieved for all patients.
Adherence was calculated according to the proportion of days covered (PDC) on the basis of the defined daily doses (DDDs) and was calculated separately for each drug. The choice to use this approach was based on preliminary research.19 (link) Patients were defined as adherent when 75% or more of their individual follow-up was covered by a daily dose of the medication (i.e., PDC ≥ 75%). Inpatient regimens were excluded from this calculation because drugs are dispensed by the facility during inpatient treatment and thus cannot be retrieved from the Pharm database.
The following treatments were considered in the analysis: no EB drug therapy (<75% PDC of any of the drugs) and therapy with one, two, three, or four EB drugs. Sensitivity analyses were performed using a 50% cutoff for PDC and 50% and 75% cutoffs for the pill-count approach.
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