Adherence with cardiovascular medications and the outcomes in patients with coronary arterial disease: “Real‐world” evidence

Abstract

Background Cardiovascular medications are vital for the secondary prevention of coronary arterial disease (CAD). However, the effect of cardiovascular medication may depend on the optimal adherence of the patients. This meta‐analysis aims to determine the magnitude of adherence to vascular medications that influences the absolute and relative risks (RRs) of mortality in patients with CAD in real‐world settings. Methods The Cochrane Library, PubMed, and EMBASE databases were searched through March 1, 2022. Prospective studies reporting association as RR and 95% confidence interval between cardiovascular medication adherence and any cardiovascular events and/or all‐cause mortality in patients with CAD were included. A one‐stage robust error meta‐regression method was used to summarize the dose‐specific relationships. Results A total of 18 studies were included. There is a significant inverse linear association between cardiovascular medication adherence and cardiovascular events (pnonlinearity = .68) or mortality (pnonlinearity = .82). The exposure‐effect analysis showed that an improvement of 20% cardiovascular medication adherence was associated with 8% or 12% lower risk of any cardiovascular events or mortality, respectively. In subgroup analysis, the benefit was observed in adherence of stain (RR: 0.90, for cardiovascular events, RR: 0.85, for mortality), angiotensin‐converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB)(RR: 0.90, for mortality), and antiplatelet agent (RR: 0.89 for mortality) but not in beta‐blocker (RR: 0.90, p = .14, for cardiovascular events, RR: 0.97, p = .32 for mortality). Estimated absolute differences per 1 million individuals per year for mortality associated with 20% improvement were 175 cases for statin, 129 cases for antiplatelet, and 117 cases for ACEI/ARB. Conclusion Evidence from the real word showed poor adherence to vascular medications contributes to a considerable proportion of all cardiovascular disease events and mortality in patients with CAD.

In‐hospital outcomes in unhoused patients with cardiogenic shock in the United States: Insights from The National Inpatient Sample 2011−2019

“…Unhoused patients, when interviewed, endorse that stigmatization from health care professionals, tradeoffs between basic needs and medications, and situational instability are some of the unique challenges faced 28 . Concerns regarding long‐term medication adherence limit the use of coronary revascularization in low SES and unhoused patients in the community 29,30 . Collaboration between health care and social service sectors are needed to see meaningful improvements in care for the unhoused 31 .…”

“…28 Concerns regarding long-term medication adherence limit the use of coronary revascularization in low SES and unhoused patients in the community. 29,30 Collaboration between health care and social service sectors are needed to see meaningful improvements in care for the unhoused. 31 Access to affordable housing has been shown to improve medication adherence in unhoused populations.…”

Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) scientific statement on the simplification of the drug regimen for secondary cardiovascular prevention

“… 6 In a more recent study, a 20% improvement in adherence to cardiovascular treatments was associated with an 8% reduction in the risk of cardiovascular events. 7 In a Canadian observational study investigating the prevalence of therapeutic adherence after 120 days from hospitalization for a MI, adherence to treatments prescribed at discharge was observed in 74% of patients, and 1-year mortality was higher among those with lower adherence compared with those who were fully adherent. 8 In a more recent observational study enrolling 4349 patients with MI, a poor adherence (defined as a percentage of days of drug possession per year <80%) was reported for most drug classes (47.6% for dual antiplatelet therapy, 23.5% for lipid-lowering therapy, 47.3% for angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers, and 88.1% for beta-blockers).…”

A Retrospective Cohort Study of the 2018 Angiotensin Receptor Blocker (ARB) Recalls and Subsequent Drug Shortages on Patients with Hypertension

“…4,5 Previous, non-recall-related gaps in anti-hypertension treatment have been associated with increased all-cause and cardiovascular-disease-specific emergency department visits, hospitalizations, and mortality. [18][19][20][21] Additionally, two studies from Alberta and Ontario, Canada found increases in hypertension-related emergency department visits among valsartan users immediately after Health Canada's recall. 22,23 However, the Canadian studies did not use a comparison group and the downstream clinical impact of the recall and subsequent valsartan shortage on U.S. patients with hypertension is unknown.…”