National Adherence to Medical Management of Aortic Aneurysms



      The purpose of this study was to describe levels of adherence to guideline-based medical management in patients with aortic aneurysms, using an analogous population with coronary artery disease as a comparator. Adherence among those with aortic aneurysms has never been studied.


      Adult patients with an aortic aneurysm or coronary artery disease diagnosed between 2004 and 2018 in the Optum Clinformatics deidentified Datamart were queried. Aneurysms were subclassified as thoracic, abdominal, or both. Receipt of an antihypertensive or antihyperlipidemic was determined through pharmacy claims. Adherence was determined as receipt of the indicated pharmacologic(s) after a diagnosis of aneurysm or coronary artery disease. Adherence was compared between those with aneurysms and coronary disease using univariable logistic regression.


      After exclusions, 194,144 patients with an aortic aneurysm and 3,946,782 with coronary artery disease were identified. Overall adherence was low (45.0%) and differed significantly by aneurysm subtype: highest in isolated thoracic (45.9%) and lowest in isolated abdominal aneurysms (42.6%). Adherence levels declined significantly after 1 year by about 15% in each aneurysm subtype. All subtypes of aneurysm had a significantly lower odds of adherence compared to those with coronary disease with odds ranging from 0.61 in those with isolated abdominal aneurysms to 0.80 with isolated thoracic aneurysms.


      Adherence among those with aortic aneurysms is very low, differs by subtype, and declines with time. Levels of adherence in those with aortic aneurysms is significantly lower compared to those with coronary artery disease. This should prove a reasonable target for implementation initiatives.

      Graphical Abstract


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Yang Q
        • Cogswell ME
        • Flanders WD
        • et al.
        Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults.
        JAMA. 2012; 307: 1273-1283
        • Heidenreich PA
        • Trogdon JG
        • Khavjou OA
        • et al.
        Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association.
        Circulation. 2011; 123: 933-944
        • Norman PE
        • Jamrozik K
        • Lawrence-Brown MM
        • et al.
        Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm.
        BMJ. 2004; 329: 1259
        • Ashton HA
        • Buxton MJ
        • Day NE
        • et al.
        The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial.
        Lancet. 2002; 360: 1531-1539
        • Gouveia E Melo R
        • Silva Duarte G
        • Lopes A
        • et al.
        Incidence and prevalence of thoracic aortic aneurysms: a systematic review and meta-analysis of population-based studies.
        Semin Thorac Cardiovasc Surg. 2022; 34: 1-16
      1. Centers for Disease Control and Prevention, National Center for Health Statistics. CDC WONDER Online Database. Available at: Accessed November 3, 2022.

        • Fihn SD
        • Gardin JM
        • Abrams J
        • et al.
        2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease.
        J Am Coll Cardiol. 2012; 60: e44-e164
        • Hiratzka LF
        • Bakris GL
        • Beckman JA
        • et al.
        2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine.
        Circulation. 2010; 121: 1544-1579
        • The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)
        2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult.
        Eur Heart J. 2014; 35: 2873-2926
        • Chaikof EL
        • Dalman RL
        • Eskandari MK
        • et al.
        The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.
        J Vasc Surg. 2018; 67 (e2): 2-77
        • Baroletti S
        • Dell'Orfano H
        Medication adherence in cardiovascular disease.
        Circulation. 2010; 121: 1455-1458
        • Newby LK
        • Allen LaPointe NM
        • Chen AY
        • et al.
        Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease.
        Circulation. 2006; 113: 203-212
        • Jackevicius CA
        • Mamdani M
        • Tu JV.
        Adherence with statin therapy in elderly patients with and without acute coronary syndromes.
        JAMA. 2002; 288: 462-467
        • Braun MM
        • Stevens WA
        • Barstow CH.
        Stable coronary artery disease: treatment.
        Am Fam Physician. 2018; 97: 376-384
        • Task Force on the management of stable coronary artery disease of the European Society of Cardiology
        2013 ESC guidelines on the management of stable coronary artery disease. The Task Force on the management of stable coronary artery disease of the European Society of Cardiology.
        Rev Esp Cardiol. 2014; 67: 135
        • Khatib R
        • Marshall K
        • Silcock J
        • Forrest C
        • Hall AS.
        Adherence to coronary artery disease secondary prevention medicines: exploring modifiable barriers.
        Open Heart. 2019; 6e000997
        • Kolandaivelu K
        • Leiden BB
        • O'Gara PT
        • Bhatt DL.
        Non-adherence to cardiovascular medications.
        Eur Heart J. 2014; 35: 3267-3276
        • Ho PM
        • Spertus JA
        • Masoudi FA
        • et al.
        Impact of medication therapy discontinuation on mortality after myocardial infarction.
        Arch Intern Med. 2006; 166: 1842-1847
        • Jackevicius CA
        • Li P
        • Tu JV.
        Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction.
        Circulation. 2008; 117: 1028-1036