Accounting for Nonadherence
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Article, see p 2128
Medication nonadherence is a common and depressingly refractory problem. For cardiac medications, long-term adherence to statins, ACE inhibitors, and β-blockers hovers around 50% to 60%, regardless of insurance status, clinical indication, and setting. Even in the period immediately after acute myocardial infarction (AMI), a time during which one might expect patients to be particularly attuned to the importance of taking medications as prescribed, adherence is surprisingly low. In a study of Canadian adults ≥65 years of age who were discharged after hospitalization for AMI, only 80% of cardiovascular medications were filled in the first 120 days, with antiplatelet medications (excluding aspirin) filled by only 55% of the cohort.1 In an observational study of patients after percutaneous coronary intervention, ≈1 out of 3 people did not take their medications as prescribed, with many failing to take antiplatelet medications at least twice a week.2 Unfortunately, adherence data are typically invisible to frontline clinicians and health system leaders because we lack the integrated tracking systems needed to surveille for nonadherence and support quality improvement projects intended to address this important domain of care. Moreover, although evidence exists to support multidimensional approaches to improve adherence, few mechanisms are in place that would make healthcare systems accountable for the adherence of patients under their care.
In this issue of Circulation, Mathews et al3 once again bring nonadherence into focus by examining adherence to cardiovascular medications in the first 90 days after hospital …