Circulation: Lack of medical adherence after PCI increases death

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After undergoing a drug-eluting stent (DES) procedure, one in six patients delay filling clopidogrel prescriptions on the day of discharge. According to Researchers from the Denver VA Medical Center in Denver, not filling these prescriptions increase the rates of adverse events including death and MI, according to a study published in the April 20 edition of Circulation: Cardiovascular Quality and Outcomes.

“Although small gaps in therapy may not have immediate consequences for many cardiovascular medications, filling a prescription for clopidogrel and taking the medication without gaps is particularly important after DES implantation," the authors wrote.

To measure the adverse outcomes, P. Michael Ho, MD, and colleagues evaluated 7,402 patients who underwent a DES implantation in one or more of the coronary arteries between Jan. 1, 2004, and Dec. 20, 2007.

The researchers evaluated the primary endpoints of mortality and MI and compared the results of patients who filled their prescription on the day of hospital discharge, and those who did not.

Of the 7,402 patients, 16.3 percent delayed filling their prescription by at least one day (average of three days)—165 patients never filled their prescription. According to the authors, those who delayed filling perscriptions were older, had a greater number of comorbidities and were prescribed a greater number of cardiovascular medications at the time of discharge.

After a mean follow-up of 664 days, those who had filled their prescription had less risk for mortality and MI than those who delayed filling the clopidogrel prescription, 14.3 versus 7.9 percent, respectively.

Within the first 30 days, for those patients who neglected to fill prescriptions, mortality and MI events occurred at a high rate, 28.5 versus 12.2 percent, respectively.

In addition, those who refrained from filling prescriptions immediately saw greater rates of adverse effects, one, three and five days after surgery.

Of those who filled the prescriptions of clopidogrel immediatly but at the same time delayed filling a perscription for statin therapy had no additional risk for adverse events.

“The finding that one in six patients have a delay in filling clopidogrel after hospital discharge and the association of this delay with adverse outcomes stresses the need to improve the transition process for patients from the inpatient setting to outpatient care,” the authors noted.

Ho and colleagues speculated that delaying filling a prescription of clopidogrel by heart patients may be associated with high drug costs, the logistics of obtaining the medication at discharge and a lack of understanding of the intake regiment.

The researchers recommended that use of a pharmacist of “transition coach” could be beneficial to help to provide patients with an education of the importance of filling and taking the drug after a DES stent procedure.

“These findings highlight potential opportunities to improve the care of patients after stent implantation in the transition from hospital discharge to the outpatient setting to avoid gaps in clopidogrel therapy,” the authors concluded.