Medication adherence in patients after percutaneous coronary intervention due to acute myocardial infarction: From
Damian Swieczkowski1, Mariusz Mogielnicki2, Natalia Cwalina3
11st Department of Cardiology, Medical University of Gdansk, Poland. d.swieczkowski@gumed.edu.pl.
Insights
Medication adherence after acute myocardial infarction (AMI) is crucial for secondary prevention. Poor adherence to antiplatelet therapy post-percutaneous coronary intervention (PCI) is common, necessitating improved patient support and interventions.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Medication adherence is vital for secondary prevention in acute myocardial infarction (AMI) patients.
- Higher adherence correlates with improved cardiovascular outcomes.
- Focus on antiplatelet therapy adherence post-percutaneous coronary intervention (PCI) reveals poor adherence and high discontinuation rates.
Purpose of the Study:
- To investigate factors influencing non-adherence to antiplatelet therapy after PCI.
- To highlight the practical impact and importance of adherence research in AMI invasive treatment.
- To advocate for collaborative efforts to design interventions improving patient adherence.
Main Methods:
- Review of existing research on adherence predictors post-PCI.
- Identification of factors like lack of education, comorbidities, depression, marital status, and financial limitations.
- Emphasis on the need for both randomized controlled trials and large-cohort, real-world observations.
Main Results:
- Adherence to antiplatelet therapy after PCI is often poor, with significant discontinuation within 12 months.
- Predicting factors for non-adherence include limited patient education, comorbidities, depression, marital status, and financial constraints.
- The precise role of financial limitations requires further detailed investigation.
Conclusions:
- Improving medication adherence, particularly to antiplatelet therapy, is critical for secondary prevention after AMI and PCI.
- Multifaceted interventions addressing patient education, comorbidities, mental health, and financial barriers are needed.
- Collaboration among researchers, clinicians, pharmacists, and policymakers is essential to enhance patient adherence and cardiovascular outcomes.
Abstract:
Adherence to medication is one of the most significant challenges of secondary prevention in patients after an acute myocardial infarction (AMI). Indeed, it has been well established that higher adherence is associated with better cardiovascular outcomes. Research pertaining to secondary prevention after AMI treated with percutaneous coronary intervention (PCI) focuses mainly on the adherence to antiplatelet therapy. Adherence levels have been found to be particularly poor and thus, insufficient with regards to prevention; with a high rate of discontinuation of therapy occurring during the 12-month follow-up. There are numerous predicting factors associated with non-adherence to antiplatelet therapy in patients after PCI. These include, but are not limited to, a lack of education on antiplatelet treatment, various comorbidities, depression, or even, unmarried status. Financial limitations of the patient also play a relevant role, however, the nature of this impediment is problematic and requires further investigation. It would seem beneficial to carry out advanced research based on a randomized and double-blind protocol, however, large-cohort, real-world observations are also essential to investigate non-adherence across a broad array of treatment settings above and beyond the scope of prospective clinical trials. Research about adherence under the context of invasive treatment of AMI has a tremendous practical impact and should be considered a matter of importance concerning both clinicians and scientists. Close collaboration between not only researchers, health practitioners, i.e. physicians and pharmacists, but also politicians, is strongly recommended to aid in designing an intervention that might improve patient adherence.
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