Adherence to High-Intensity Statins Following a Myocardial Infarction Hospitalization Among Medicare Beneficiaries

Abstract

Many patients filling high-intensity statins following a myocardial infarction do not continue taking this medication with high adherence for 2 years postdischarge. Interventions are needed to increase high-intensity statin use and adherence after myocardial infarction.

Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System

“…In a recent study by Jia et al, post-PCI patients randomly assigned to more frequent follow-up visits with a physician had higher rates of medication adherence (56 vs. 46%, p < 0.001), as well as lower rates of MACE, than those assigned to the “usual care” group [41]. Supporting this finding, visiting with a cardiologist after MI discharge has been associated with 10–20% higher adherence to high-dose statin therapy at 6 months as well as similarly increased rates of persistence at 2 years [34]. Timing may be important in light of the observation of an association between patients who visit a provider within 6 weeks of MI discharge and a 5–10% higher (in absolute terms) adherence to post-MI therapies both short and long term [42•].…”

“…This likely explains why prescription drug coverage has previously and, in recent literature, continues to be positively associated with medication adherence. In contrast, a lack of medication coverage is negatively associated with adherence [32–34]. Consistent with these observations, Choudhry et al demonstrated that eliminating copayments for medications resulted in a 4–6% absolute increase in rates of medication adherence ( P < 0.001) [35].…”

“…Polypharmacy is common among CAD patients and continues to be associated with significantly lower rates of adherence [33, 34]. While pill boxes discussed above are the current mainstays for addressing polypharmacy, the so-called “polypill,” consisting of multiple pharmacologic therapies formulated together in one pill, has been heralded as a panacea for polypharmacy.…”

Drugs don’t work in patients who don’t take them

“…At 182 and 730 days after discharge, 54.8% and 36.7% of beneficiaries, respectively, remained on high‐intensity statins with high adherence. Whites, beneficiaries with fewer comorbidities, low‐income subsidy, and a high‐intensity statin fill prior to their MI and those who had cardiac rehabilitation and cardiologist visits post‐MI were more likely to remain on high‐intensity statins with high adherence …”

Nonadherence in the Learning Healthcare System

“…However, as the authors themselves concede, their results are somewhat dependent on how they define discontinuation, reinitiation, and persistence—definitions which are not consistent throughout the literature. 12,15 More concerning is the large number of patients excluded by the current analysis. From an initial sample of >900 000 patients, >500 000 were excluded for not having comprehensive Medicare coverage (A+B+D−Health Maintenance Organization).…”