Rising Trends in Medication Non-compliance and Associated Worsening Cardiovascular and Cerebrovascular Outcomes Among Hospitalized Adults Across the United States

Abstract

Introduction Small-scale studies have described concerning rates of non-compliance/nonadherence towards groups of medications for primary and secondary prevention. Trends in cardiovascular and cerebrovascular events (CCE) among hospitalized patients with a non-compliant behavior towards medication, on the whole, remains unexplored on a large scale. Methods Using the National Inpatient Sample databases (2007-2014), we sought to assess the prevalence and trends in all-cause mortality and CCE in adult patients hospitalized with medication non-compliance. We compared baseline characteristics and comorbidities in the non-compliant patients with and without concomitant in-hospital CCE. Results We identified 7,453,831 adult hospitalizations with medication non-compliance from 2007 to 2014, of which 867,997 (11.6%) patients demonstrated in-hospital CCE. Non-compliant patients with CCE consisted of a higher number of older, white, male patients having greater comorbid risk factors. Non-compliant patients with CCE had higher all-cause in-hospital mortality (3% vs. 0.7%), frequent transfers [4.4% vs. 1.8% transfers to short-term hospitals, and 17.6% vs. 11.6% other transfers (skilled nursing or intermediate care facilities)], lower routine discharges (59.4% vs. 71.1%), and higher mean hospital charges ($52,740 vs. $30,748) compared to non-compliant patients without CCE. Remarkably, this study demonstrates the rising trend in medication non-compliance across all age, sex, and race groups, and related in-hospital mortality, CCE, transfers to other facilities, and the health care cost from 2007 to 2014. Conclusions We observed rising trends in the prevalence of medication non-compliance and subsequent in-hospital mortality in hospitalizations among adults from 2007 to 2014. Non-compliant patients with inpatient CCE demonstrated rising trends in all-cause mortality, complications, health care utilization, and cost from 2007 to 2014.

Patient Adherence to Therapy After Myocardial Infarction: A Scoping Review

“…A detailed overview of the characteristics of and key outcomes from the 13 articles is provided in Tables 2 and 4 respectively. Five randomized control studies were conducted in USA 11,13,15,16 and three in Iran, 12 Denmark, 14 China 18 (Tables 2 and 3).…”

“…6 studies were randomized controlled trials, 2 of which were double-blind 11 and without blinding. 12 One study was conducted using a retrospective design (analysis of national stationary sample databases) 13 and the other study was a cohort design based on a nationwide registry. 14…”

“…18 Two studies conducted retrospective researches using National Patient Registration System to investigate predictors and risk of hospitalization in elderly patients after MI with the aim of subsequently improving adherence to therapy. [12][13][14]…”

Patient compliance: A concept analysis

“…Patients with chronic diseases who have previously been hospitalized are frequently readmitted for reasons such as non-compliance with therapy and lifestyle adjustments (Tun, 2021 ). Non-compliance can lead to ineffective treatment outcomes, higher hospitalization rates, reduced discharge rates, complications, increased healthcare costs, and death (Desai et al, 2019 ).…”

The Role of Home Medication Storage Location in Increasing Medication Adherence for Older Adults

“…Other consequences of medication nonadherence include waste of medication, disease progression, and an overall lower quality of life (4). There is a rising trend in medication nonadherence across all age, sex, and racial groups in the US (5), which is particularly concerning for older adults as the likelihood to be prescribed long term medications increases with age (6, 7).…”