Medication Study: Medication Adherence After ACS Hospital Discharge

Multifaceted intervention strategies – including pharmacist-led medication reconciliation and tailoring; patient education; collaborative care between pharmacists and a patient's primary care clinician and/or cardiologist; and educational and medication refill reminder calls – after hospital discharge in patients with acute coronary syndrome (ACS) improved medication adherence, according to results of the Medication study presented Nov. 18 as part of AHA 2013 and published simultaneously in JAMA: Internal Medicine.

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The Multifaceted Intervention to Improve Medication Adherence and Secondary Prevention Measures (Medication) study looked at 241 patients from four Department of Veterans Affairs' medical centers for one year after discharge, who were randomly assigned to multifaceted intervention or usual care. Results showed that 89.3 percent of patients in the multifaceted intervention group were adherent to medication regimens compared with 73.9 percent in the usual care group (P = .003). Further, the mean proportion of days covered was higher in the multifaceted intervention group (0.94 vs. 0.87; P< .001). Researchers also found a greater proportion of intervention patients were adherent to clopidogrel (86.8 percent vs. 70.7 percent; P = .03), statins (93.2 percent vs. 71.3 percent; P < .001), and ACEI/ARB (93.1 percent vs. 81.7 percent; P = .03) but not beta -blockers (88.1 percent vs. 84.8 percent; P = .59). There were no statistically significant differences in the secondary outcomes of achieving blood pressure and low-density lipoprotein cholesterol level goals.

"These results suggest that hospitals and providers should develop systems of care to improve and maintain adherence to medications shown to reduce the risk of recurrent heart attacks and death," said P. Michael Ho, MD, PhD, FACC, study author and staff cardiologist at VA Eastern Colorado Health Care System in Denver. "The adherence levels in this study for both the enhanced follow-up and standard care groups were higher than adherence levels seen in many other patient groups, so an enhanced system such as the one studied might have an even greater impact outside of the VA."

However, the authors caution that moving forward, "additional studies are needed to understand the impact of the magnitude of adherence improvement shown in our study on clinical outcomes prior to broader dissemination of such an adherence program."

In a related editorial comment, Rita F. Redberg, MD, MSc, FACC, editor of JAMA Internal Medicine notes, "For many reasons, the relatively modest increases in already high rates of medication regimen adherence in the patients studied may not translate into improved outcomes even if maintained for three to five years or longer. Of course, we hope that they do. But before recommending investment in this strategy, it would be prudent to know that patient outcomes will actually improve."

Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Lipid Metabolism

Keywords: Pharmacists, Lipoproteins, LDL, Medication Adherence, Acute Coronary Syndrome, Follow-Up Studies, Patient Discharge, Primary Health Care

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