Self-Reported Medication Adherence Important

September 25, 2007 — A new study shows that stable coronary heart disease (CHD) patients who reported nonadherence to their medication had a greater-than-twofold increased risk of subsequent cardiovascular (CV) events.[1] Dr Anil K Gehi (Emory University School of Medicine, Atlanta, GA) and colleagues report their findings in the September 10, 2007 issue of the Archives of Internal Medicine.
"We've shown that simply asking the patient whether they were adherent to their medication is a pretty decent way to identify those patients we might need to focus on," Gehi told heartwire.
"The bottom line is that medication nonadherence is a big predictor of adverse cardiovascular outcomes, and we found that the risk associated with nonadherence was equivalent to that associated with diabetes or smoking. Nonadherence is really a big deal that a lot of physicians don't look at carefully, and that it's not a difficult thing to find out."
Target nonadherent with simple measures
Gehi and colleagues studied just over 1000 patients with established coronary disease participating in the Heart and Soul Study who were already completing a large questionnaire and asked them a single question: "In the past month, how often did you take your medications as your doctor prescribed?"
Nonadherence was defined as taking medications as prescribed 75% of the time or less. CV events (coronary heart disease death, MI [myocardial infarction], or stroke) were identified by review of medical records during 3.9 years of follow-up.
Of the patients, 83 (8.2%) reported nonadherence to their medications, and 146 (14.4%) developed CV events. Nonadherent patients were more likely than adherent participants to develop CV events (22.9% vs 13.8%; p=0.03).
Self-reported nonadherence remained independently predictive of CV events even after adjusting for baseline cardiac disease severity, traditional risk factors, and depressive symptoms (hazard ratio [HR] 2.3; p=0.006).
"We have shown that it's not a difficult thing to find out about adherence," says Gehi, "but this is something that perhaps physicians overlook. Our study helps emphasize how important it is; then, something can be done about addressing the specific issues relating to adherence with that patient."
Those who are found to be nonadherent can be targeted with a number of approaches; Gehi suggests such strategies as pillboxes, getting family involved in medication, and arranging more frequent follow-up visits.
"Also, sometimes simply explaining to a patient what a pill is for and the importance of that medication can make a big difference," he says.
Source
Gehi AK, Ali S, Na B, et al. Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease. The Heart and Soul Study. Arch Intern Med. 2007;167:1798-1803.