Abstract 10073: Predictors of Adherence to Post-discharge Cardiac Medicines in a Low Income Underinsured Coronary Disease Population.
Introduction: Secondary chemoprophylaxis in coronary artery disease (CAD) reduces morbidity and mortality. In low-income populations, lack of access to post-discharge drugs significantly influences adherence and increases case fatality rates. This study addressed this barrier by providing patients one month of free cardiac drugs and then determining factors that additionally influence adherence.
Methods: Patients with an acute CAD event (n=190), were eligible if they had any of the following: < $50,000 household income, < 12th grade education, no medication insurance, or an inability to pay insurance co-pays. Patients were given a one month supply of 4 cardiac drugs (statin, beta blocker, aspirin, clopidogrel) at hospital discharge. Standardized interviews were conducted a month later to assess adherence, comorbidity, and psychosocial and demographic variables.
Results: Mean age of the study population was 55 ±11 years; 43% were non-white; 35% female; 63% had low social support; 27% < high school education; 94% had an annual household income < $50,000; 32% no medication insurance; and 73% were unable to pay co-pays. Nonadherence to clopidogrel was significantly associated with hospital readmission within one month of discharge (p<0.02) with an overall readmission rate of 8%. One month adherence rates were: 67.9% statins; 81.8% beta blockers; 83.1% aspirin; and 86.4% for clopidogrel. Multivariable regression showed that smoking (p< 0.009), side effects (p< 0.03), and male sex (p< 0.04) were associated with statin nonadherence, while only a history of diabetes (p< 0.01) was associated with aspirin nonadherence. Older age ( ≥ 55 years, p< 0.02) predicted clopidogrel nonadherence.
Conclusions: Providing free cardiac drugs at hospital discharge was insufficient to achieve optimal adherence in low income patients with CAD. Statin adherence was lowest, and a notable number failed to adhere to antiplatelet regimens. There was no consistent pattern that explained nonadherence across all agents. Volitional nonadherence is common even when persons are given free cardiac discharge medications.
- Cardiovascular disease prevention
- Patient education/teaching psychosocial aspects
- Behavioral aspects
- © 2011 by American Heart Association, Inc.