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Medication Adherence and Long-Term CV Outcomes

J Am Coll Cardiol; 2016 Aug; Bansilal, Castellano, et al

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A reduction in major adverse cardiovascular events (MACE) and cost savings were observed among patients with better medication adherence, a recent study found. Among the 4,015 post-myocardial infarction (MI) patients and 12,976 patients with atherosclerotic disease (ATH) included, the primary outcomes measure was a composite of all-cause death, MI, stroke, or coronary revascularization. Patients were stratified as fully adherent (≥80%), partially adherent (≥40% to ≥79%), or nonadherent (<40%). Researchers found:

• In the post-MI cohort at 2 years, the fully adherent group had a significantly lower rate of MACE than the nonadherent (18.9% vs 26.3%; HR, 0.73) and partially adherent (18.9% vs 24.7%; HR, 0.81) groups.

• The fully adherent group had reduced per-patient annual direct medical (ADM) costs for MI hospitalizations of $369 and $440 compared with the partially adherent and nonadherent groups, respectively.

• In the ATH cohort at 2 years, the fully adherent group had a significantly lower rate of MACE than the nonadherent (8.42% vs 17.17%; HR, 0.56) and the partially adherent (8.42% vs 12.18%; HR, 0.76) groups.

• The fully adherent group had reduced per-patient ADM costs for MI hospitalizations of $371 and $907 vs the partially adherent and nonadherent groups, respectively.

Citation: Bansilal S, Castellano JM, Garrido E, et al. Assessing the impact of medication adherence on long-term cardiovascular outcomes. J Am Coll Cardiol. 2016;68(8):789-801. doi:10.1016/j.jacc.2016.06.005.

Commentary: C. Everett Koop, the former Surgeon General of the United States, said, “medicines don’t work in people who don’t take them.” There are excellent data on the efficacy of many of our medications, and yet many patients regularly miss doses. The causes for suboptimal adherence are numerous, including cost of medications, patient-physician communication, patient education, motivation, and simple forgetfulness. The act of taking medications is influenced by many factors, and all these factors come together at a point in time when the patient is not directly engaged with the health care system. It is at that moment that each patient remembers and decides to either take their medications or not take their medications. It may be helpful for patients to try some apps for smartphones and tablets to help them organize their approach to taking medications. Examples of some of these apps include: Care4Today, Dosecast, Medisafe, MedSimple, MyMedREc, MyMeds, and OnTimeRx.1 —Neil Skolnik, MD

1. Skolnik N, Notte C. Take your medicines! Family Practice News. http://www.familypracticenews.com/?id=2633&tx_ttnews[tt_news]=496561&cHash=f3d8b55b90d2eb5f1443156 e8d42e346. Accessed August 29, 2016.

Citation:

Bansilal S, Castellano JM, Garrido E, et al. Assessing the impact of medication adherence on long-term cardiovascular outcomes. J Am Coll Cardiol. 2016;68(8):789-801. doi:10.1016/j.jacc.2016.06.005.

Commentary:

C. Everett Koop, the former Surgeon General of the United States, said, “medicines don’t work in people who don’t take them.” There are excellent data on the efficacy of many of our medications, and yet many patients regularly miss doses. The causes for suboptimal adherence are numerous, including cost of medications, patient-physician communication, patient education, motivation, and simple forgetfulness. The act of taking medications is influenced by many factors, and all these factors come together at a point in time when the patient is not directly engaged with the health care system. It is at that moment that each patient remembers and decides to either take their medications or not take their medications. It may be helpful for patients to try some apps for smartphones and tablets to help them organize their approach to taking medications. Examples of some of these apps include: Care4Today, Dosecast, Medisafe, MedSimple, MyMedREc, MyMeds, and OnTimeRx.1 —Neil Skolnik, MD

1. Skolnik N, Notte C. Take your medicines! Family Practice News. http://www.familypracticenews.com/?id=2633&tx_ttnews[tt_news]=496561&cHash=f3d8b55b90d2eb5f1443156 e8d42e346. Accessed August 29, 2016.

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