Improving Medication Adherence After a Heart Attack

Patients receiving follow-up care more than 6 weeks after a heart attack are much less likely to stick to their medication regimen.

Each year, about 1 million patients in the United States are hospitalized for acute myocardial infarction (AMI). Of these patients, 470,000 are expected to have a recurrent major adverse cardiovascular event.

Up to half of readmitted patients report not receiving any outpatient follow-up care prior to their readmission, and studies have shown that patients who don’t receive follow-up care are up to 10 times more likely to be readmitted to the hospital.

For a new study published online in JAMA Cardiology, researchers from the Duke Clinical Research Institute sought to determine the relationship between the timing of outpatient follow-up care and rates of medication adherence for recommended secondary prevention.

Current clinical guidelines for AMI recommend secondary prevention with certain drugs, including aspirin, statins, beta-blockers, P2Y12 receptor inhibitors, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers—all of which have demonstrated long-term survival benefits for post-AMI patients. Despite these benefits, the researchers found that adherence rates at 90 days were significantly lower among patients who received follow-up care more than 6 weeks after discharge compared with those who received care within 6 weeks (range of 56.8%-61.3%, vs. 64.7%-69.3%).

“These data support the concept that medication adherence is modifiable via improved care transitions,” the authors concluded.

Their analysis was based on data from nearly 21,000 Medicare patients older than 65 years who were discharged alive after AMI. The researchers further stratified patient characteristics by time to first follow-up visit.

“Patients with longer times to their first follow-up appointment were more likely to be men, black, and live in communities with lower median household income, lower median home value, and lower rates of education compared with patients with earlier follow-up visits,” they observed.

Lead study author Tracy Y. Wang, MD, MHS, MSc, told Pharmacy Times that pharmacists are in a good position to overcome any barriers to adherence.

“Some meds have high co-pays (eg, certain antiplatelet medications), and our [health-system] pharmacists are instrumental in ascertaining pharmacy availability, drug affordability, and patient understanding of why the medication is necessary,” Dr. Wang explained.

Community pharmacists are also well-positioned to promote medication adherence to patients each time they visit the pharmacy. Pharmacists should ask patients how they’re feeling, remind them of the clinical importance for each prescription, and encourage them to return for a refill.

Dr. Wang also stressed the importance of follow-up care for all AMI patients.

“Follow-up care isn’t just a routine maintenance appointment,” Dr. Wang asserted. “This is an opportunity to titrate medication doses (particularly antihypertensive medications) as blood pressures change post-AMI, as well as reinforce lifestyle modifications key to secondary prevention.”