ACC: 27% of AMI patients don't adhere to docs' orders
doctor and patient - 82.37 Kb
CHICAGO—Six weeks after an acute MI hospital discharge, 27 percent of PCI patients disregarded doctors' orders for medication, according to a poster presented March 26 at the 61st annual American College of Cardiology (ACC) scientific session. Medication adherence is a multifaceted problem leaving much room for improvement in patient follow-up after discharge.

The study evaluated 2,487 acute MI patients who were treated with PCI and enrolled in the TRANSLATE-ACS observational study. TRANSLATE-ACS is an ongoing registry that aims to provide a better understanding of antiplatelet therapy use in AMI patients post-PCI.

“The thing that makes TRANSLATE-ACS pretty unique is that it follows up with patients with a phone call six weeks and six months after discharge to assess how they are doing with their medications,” Robin Matthews, MD, cardiologist in training at the Duke Clinical Research Institute in Durham, N.C., told Cardiovascular Business.

During the current evaluation, Matthews et al evaluated antiplatelet use among acute MI patients using a Morisky Questionnaire six weeks after hospital discharge.

Patients were split into three groups: low adherence, medium adherence and high adherence.

The questionnaire consisted of a series of questions including: whether patients understood the types of medications they were prescribed at hospital discharge; whether they understood the procedure they underwent in the hospital; and what the importance was of these medications and procedures.

Additionally, the patients underwent a self-assessment that included questions about whether they missed any medication doses, whether they had taken the medications prescribed vigilantly and what their own perceptions were about their own health (whether they were depressed, etc.).

“What we found was that 27 percent of patients at six weeks were nonadherent in terms of the medications they were supposed to be taking,” said Matthews. “That means that 73 percent of patients do adhere to their medications.

“While this sounds decent, it’s still a very high-risk population. Even 73 percent is actually unacceptably too low for such a short period of time after the procedure,” he noted.

The next question was why. Why were patients nonadherent? The researchers looked at various factors including past medical history, differences in presentation and what occurred at discharge.

“Are patients treated differently at discharge and does that play a part in why some patients may be less adherent than others?” Matthews asked.

The researchers found that patients who had lower adherence were younger, were more likely to be employed and less likely to be insured. Those who had low adherence were also more likely to have undergone a prior PCI and were more likely to have depression.

Those who had lower adherence rates also were less likely to have a follow-up appointment scheduled and were less likely to receive explanation for medication during their hospitalization by their physician.

“There are logical aspects here that we can definitely improve upon,” said Matthews.

“Additionally, we looked at whether it makes a difference if you are less adherent to these medications,” he offered. “Does this mean you fare worse?” The short answer is yes.

Matthews and colleagues found that 11.6 percent with low adherence to medications were likely to undergo an unplanned rehospitalization within six weeks of discharge compared with 9.1 percent of those with medium adherence and 8.1 percent with high adherence.

“This signifies that there is a statistically significant difference between those patients who do not adhere to medications and those who do,” Matthews offered.

“One of the conclusions here is that 27 percent is an unacceptably higher number of nonadherence in a short period of time.”

Additionally, he said there are definite differences in the makeup of patients who are less likely to be adherent to medications upon discharge. “We can probably identify these patients when they are in the hospital,” Matthews offered.

He said one way to remedy the problem is to focus on better communication at discharge. “Good follow-up, better communication and improving the assessment for these types of barriers could help to reduce the risk for a patient being rehospitalized earlier.”

While Matthews admitted that costs may be a factor in nonadherence, he said, it is a multifaceted problem.

“We have health literacy issues, provider-related issues and health system issues," he said. "There are multiple issues here, and while costs are definitely one of them, if you focus on just one of these issues, you will end up missing the boat.”