Medication Adherence After ACS Slightly Improving

Studies have reported that up to half of patients discontinue prescribed therapies soon after hospital discharge. This is no surprise to pharmacists, as they know that nonadherence rates increase over time and often approach 50%.

For patients with acute coronary syndrome (ACS) who progress to myocardial infarction (MI), secondary prevention therapies are critical for positive long-term outcomes. The July 2015 issue of the American Heart Journal included an analysis that found adherence to these treatments is improving, but still nowhere near ideal.

The study investigators were nevertheless encouraged by more widespread use of evidence-based guidelines, and they believed that the effect on medication adherence might be positive.

They assessed treatment persistence among 7955 hospitalized MI patients participating in the TRANSLATE-ACS trial from 2010 to 2012. Patients were considered persistent if they remained on 5 medications—aspirin, adenosine diphosphate receptor inhibitors, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins—for a full 6 months after discharge, as determined by self-report.

Almost one-third of MI patients had discontinued 1 or more medications in that time period. This nonadherence most often stemmed from drug-related side effects and physician instruction (57% combined), whereas 8% of patients indicated they could not afford the medication and had to discontinue it.

Certain patient populations were more likely to have adherence issues, including older patients, those on dialysis, black patients, and those with atrial fibrillation. Depression also lowered the likelihood of treatment persistence.

Patients who had private insurance, prescription cost assistance, and outpatient follow-up arranged before discharge were more likely to take medication as prescribed.

The investigators concluded that many risk factors for nonadherence are identifiable, and that modifiable risk factors include those associated with transitions of care from hospital to outpatient facilities. Thus, they encouraged tailored interventions to help patients adhere to medications.