Robin Mathews (Duke Clinical Research Institute, Duke University Medical Centre, Durham, USA) and others report, in Circulation: Cardiovascular Quality Outcomes, that patients with low adherence to prescribed medication after a myocardial infarction are more likely to report difficulty in understanding written communication and a lack of information about the risks of non-adherence than patients with high adherence. Therefore, the authors advise tailored patient education may represent an opportunity to optimise patient adherence.
Mathews et al state that non-adherence to antiplatelet therapy after percutaneous coronary intervention (PCI) is a “particular concern” because of the increased risk of stent thrombosis that is associated with not taking oral antiplatelet therapy. They, therefore, conducted their study to determine the incidence and degree of cardiovascular medication non-adherence early after hospital discharge in a contemporary PCI-treated myocardial infarction population and also evaluated the factors independently associated with non-adherence. The authors explain that “a better understanding of modifiable risk factors contributing to non-adherence may help to inform actionable opportunities to optimise longitudinal patient outcomes.”
Mathews et al reviewed data from TRANSLATE-ACS (Treatment with ADP receptor inhibitors: longitudinal assessment of treatment patterns and events after acute coronary syndromes), which they explain “rigorously assessed” adherent behaviours via the Morisky Medication Adherence Scale (MMAS). In the study, of 7,425 patients with acute myocardial infarction, 71% reported having high medical adherence (with a MMAS score of 8), 25% had moderate adherence (with a MMAS score of 7), and 4% had low adherence (with a MMAS score of 5). A recent survey by Harris Poll (conducted on behalf of Daiichi-Sankyo and Eli Lilly), not related to this study, found that 52% of acute coronary syndrome patients taking oral antiplatelet therapy report missing taking their medication or changing d the way that they take it.
A notable finding of their study, Mathews et al claim, was that patients with low adherence “more often admitted limitations in their ability to learn about their medical condition because of difficulty understanding written health information; this findings suggests that patients with low medication adherence have lower health literacy compared with patients with higher medication adherence”. The authors also report that while a large majority of patients reported receiving written discharge medications and instructions, patients with lower adherence were less likely to “report a provider explaining the rationale and potential side effects for each medication”.
In the Harris Poll survey (of 275 paitents), 12% of respondents reported that they were not told that non-adherence to oral antiplatelet therapy was associated with serious health risks, 20% claimed their questions about oral antiplatelet therapy were not addressed by their healthcare team, and 54% could not remember being asked at their follow-up visit if they filled in their oral antiplatelet medication prescription. Mathews et al state, as “a substantial proportion of patients” in their study report suboptimal adherence to prescribed medication after a myocardial infarction, “tailored patient education and pre-discharge planning, as well as the availability of continued patient interactions with the health system early after hospital discharge, may represent key actionable opportunities to optimise patient adherence.”
After the results of the Harris Poll survey were published, the Preventive Cardiovascular Nurses Association (PCNA), Society for Cardiovascular Angiography and Interventions (SCAI), and Mended Hearts (a US non-profile organisation aimed at supporting patients with heart disease), launched a new campaign—“After the Stent: Follow Your Action Plan”—aimed at encouraging healthcare professionals to improve the knowledge and practices relating to oral antiplatelet medication adherence of patients with acute coronary syndromes. They have also developed an oral antiplatelet medication risk assessment questionnaire for healthcare professionals to use with their patients.
Mathews told Cardiovascular News: “Non-adherence to prescribed therapies is a significant problem across all domains of medicine however the reasons for medication non-adherence are complex and multifactorial. Though some factors such as race and age are not modifiable, others such as health literacy, patient perception of side effects, and out of pocket expenses, can be influenced. The transition from hospital to home represents an opportunity to increase the likelihood that a patient will be adherent and the discharge process should include an assessment of possible barriers to adherence after patients leave the hospital. Once these have been identified, a patient tailored strategy can be used to address these barriers.”