Optimal adherence to meds prescribed post-heart attack lowers hospital readmissions

Optimal medication adherence is important for patients who have had a heart attack in order to get maximum clinical benefit, according to a study published in the January 2014 issue of the American Heart Journal.

Researchers from CVS Caremark and Brigham and Women’s Hospital, analyzed data from the randomized Myocardial Infarction (MI) FREEE (Free Rx Event and Economic Evaluation) Trial (conducted by Aetna and Brigham and Women’s Hospital), published in 2011 in the New England Journal of Medicine. The researchers evaluated the impact of adherence on clinical outcomes for more than 4,100 MI patients who had filled a prescription for at least 1 of the study medications (beta-blocker, statin, angiotensin converting enzyme inhibitor, or angiotensin receptor blocker) prescribed after hospital discharge. Outcomes were measured based on a patient’s first hospital re-admission for a major vascular event (fatal or non-fatal acute MI, unstable angina, stroke, congestive heart failure) or coronary revascularization (coronary bypass, stenting or angioplasty).

The study confirmed that patients need to achieve a Medication Possession Ratio (MPR) of at least 80%-meaning they are adherent to 80% or more of their prescription medications-in order to reduce their risk of hospital readmission after a heart attack. Patients with more moderate levels of medication adherence following a heart attack (60% to 79% MPR) derived less clinical benefit from their prescribed medications and had higher levels of disease-related clinical events. An MPR of 80% has long been considered optimal, but this threshold had little empirical support.

“The study confirms the long-held industry standard that a MPR of 80% is the optimal adherence level to improve health outcomes and reduce the likelihood of adverse coronary events in patients who have had a heart attack,” Troyen Brennan, MD, chief medical officer, CVS Caremark, told FormularyWatch.

“The study found patients who were adherent to 80% or more of their prescription medications were 24% more likely not to be readmitted to the hospital after a heart attack,” Dr Brennan added.

“With medication nonadherence accounting for $290 billion in annual excess healthcare costs, CVS Caremark is developing initiatives to ensure patients take their medications as prescribed,” Dr Brennan said.

CVS Caremark is evaluating and piloting models to predict patient behavior to better target interventions, medication reminders to combat forgetfulness, and digital innovations to engage patients and encourage adherence, according to Dr Brennan.