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Assessing the Impact of Medication Adherence on Long-Term Cardiovascular Outcomes
Sameer Bansilal1, Jose Maria Castellano2, Ester Garrido3
1Icahn School of Medicine at Mount Sinai School, New York, New York.
Insights
High medication adherence in patients with cardiovascular disease significantly lowers major adverse cardiovascular events (MACE) and reduces healthcare costs. Maintaining at least 40% adherence is crucial for continued benefits, highlighting the need for novel adherence improvement strategies.
Area of Science:
- Cardiovascular Medicine
- Pharmacoeconomics
- Health Outcomes Research
Background:
- Guideline-recommended therapies are effective in reducing major adverse cardiovascular events (MACE) post-myocardial infarction (MI) or in atherosclerotic disease (ATH).
- However, patient adherence to these crucial therapies remains suboptimal, potentially limiting their effectiveness.
Purpose of the Study:
- To investigate the association between medication adherence levels and long-term MACE.
- To evaluate the impact of adherence on direct medical costs in patients with MI or ATH.
Main Methods:
- A large health insurer claims database was used to identify patients hospitalized for MI or diagnosed with ATH.
- Medication adherence was assessed using the proportion of days covered for statins and ACE inhibitors, categorizing patients into fully adherent (≥80%), partially adherent (40%-79%), and nonadherent (<40%).
- Primary outcome was a composite of all-cause death, MI, stroke, or coronary revascularization; annual direct medical costs were also estimated.
Main Results:
- In the post-MI cohort (n=4,015), full adherence was associated with significantly lower MACE rates compared to nonadherent (18.9% vs. 26.3%) and partially adherent (18.9% vs. 24.7%) groups at 2 years.
- In the ATH cohort (n=12,976), full adherence also showed significantly lower MACE rates versus nonadherent (8.42% vs. 17.17%) and partially adherent (8.42% vs. 12.18%) groups.
- Full adherence led to substantial cost savings in MI hospitalizations, with reductions of $369-$440 (post-MI) and $371-$907 (ATH) compared to lower adherence levels.
Conclusions:
- Full adherence to guideline-recommended therapies significantly reduces MACE and healthcare costs in patients with MI or ATH.
- A threshold of >80% adherence shows a significant benefit in post-MI patients, while maintaining at least 40% adherence is necessary for sustained benefits.
- Developing novel strategies to enhance medication adherence is critical for improving cardiovascular outcomes and reducing healthcare expenditures.
Background:
Although guideline-recommended therapies reduce major adverse cardiovascular events (MACE) in patients after myocardial infarction (MI) or those with atherosclerotic disease (ATH), adherence is poor.
Objectives:
The goal of this study was to determine the association between medication adherence levels and long-term MACE in these patients.
Methods:
We queried the claims database of a large health insurer for patients hospitalized for MI or with ATH. The primary outcome measure was a composite of all-cause death, MI, stroke, or coronary revascularization. Using proportion of days covered for statins and angiotensin-converting enzyme inhibitors, patients were stratified as fully adherent (≥80%), partially adherent (≥40% to ≤79%), or nonadherent (<40%). Per-patient annual direct medical (ADM) costs were estimated by using unit costs from 2 national files.
Results:
Data were analyzed for 4,015 post-MI patients and 12,976 patients with ATH. In the post-MI cohort, the fully adherent group had a significantly lower rate of MACE than the nonadherent (18.9% vs. 26.3%; hazard ratio [HR]: 0.73; p = 0.0004) and partially adherent (18.9% vs. 24.7%; HR: 0.81; p = 0.02) groups at 2 years. The fully adherent group had reduced per-patient ADM costs for MI hospitalizations of $369 and $440 compared with the partially adherent and nonadherent groups, respectively. In the ATH cohort, the fully adherent group had a significantly lower rate of MACE than the nonadherent (8.42% vs. 17.17%; HR: 0.56; p < 0.0001) and the partially adherent (8.42% vs. 12.18%; HR: 0.76; p < 0.0001) groups at 2 years. The fully adherent group had reduced per-patient ADM costs for MI hospitalizations of $371 and $907 compared with the partially adherent and nonadherent groups.
Conclusions:
Full adherence to guideline-recommended therapies was associated with a lower rate of MACE and cost savings, with a threshold effect at >80% adherence in the post-MI population; at least a 40% level of long-term adherence needs to be maintained to continue to accrue benefit. Novel approaches to improve adherence may significantly reduce cardiovascular events.
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