Acute MI Often Changes Compliance With Prescribed Statins Interview with:

Ian Kronish, MD, MPH Florence Irving Assistant Professor of Medicine Center for Behavioral Cardiovascular Health Columbia University Medical Center

Dr. Ian Kronish

Ian Kronish, MD, MPH
Florence Irving Assistant Professor of Medicine
Center for Behavioral Cardiovascular Health
Columbia University Medical Center What is the background for this study?

Dr. Kronish: Prior studies have shown that adherence to statins is suboptimal both in patients prescribed statins for primary prevention and in high-risk patients who are prescribed statins to prevent recurrent events. But, to our knowledge, prior studies had not examined the impact of a hospitalization for a myocardial infarction (MI) on subsequent adherence to statins. We wondered whether the hospitalization would serve as a wake-up call that led patients to become more adherent after the MI. At the same time, we were concerned that the physical and psychological distress that arises after a hospitalization for an MI may lead to a decline in statin adherence. What are the main findings?

Dr. Kronish: We learned that among Medicare beneficiaries prescribed statins in the year before an MI, those who were nonadherent before the MI (i.e., took their statins less than 80% of the time as per pharmacy refill records) were about twice as likely to become adherent after the MI as compared to patients who were hospitalized for a non-cardiac reason (i.e., pneumonia) or who had no hospitalizations. This confirmed our hypothesis that a hospitalization for an MI can indeed serve as a “teachable moment” that motivates better health behaviors such as adherence to essential cardioprotective medications.

At the same time, we learned that Medicare beneficiaries who were adherent before the MI were somewhat more likely to become nonadherent after the MI than patients who had no hospitalizations. Interestingly, we also learned that patients who were adherent before a hospitalization for pneumonia were also more likely to become nonadherent after hospitalization than patients without hospitalizations. This confirmed our second hypothesis that a hospitalization can be a disruptive event to the manner in which patients take their medications. What should readers take away from your report?

Dr. Kronish: Overall, about 40% of patients were nonadherent to statins in the year after an MI,  and this proportion was higher in the year after as compared to the year before an MI. Addressing this adherence problem represents a major public health opportunity as statins are proven treatments that improve outcomes in post-MI patients.

Our findings suggest some possible approaches to improving statin adherence. First, our finding that patients who were nonadherent before the event were more likely to become adherent after the event suggests that the hospitalization is an opportune time for an adherence intervention that takes advantage of the salience of the event to increase motivation to take cardioprotective medications. Our finding that the hospitalization was associated with a downward trend in adherence among those who were adherent before the event suggests that we must redouble our efforts to ensure smooth transitions from hospital to home, optimizing communication about medications and the importance of adherence, and carefully following up with patients after they leave the hospital to ensure they understand which medications they should be taking, paying special attention to the psychological, physical, and cognitive impact that a hospitalization can have on a patient and how this might adversely impact health behaviors like medication adherence. What recommendations do you have for future research as a result of this study?

Dr. Kronish: Future research might test adherence interventions that incorporate approaches for remotely tracking medication adherence after patients are discharged from the hospital after MIs. One might test whether monitoring and intervening when patients have not filled essential cardioprotective medications with statins could have a positive impact. With the advent of e-prescribing, it is now feasible to track whether patients are picking up their refills. Another approach might to even incorporating electronic pill caps that can wirelessly transmit data to an adherence monitoring program. While this second approach may not be feasible to implement on a wide scale, it might be considered for the highest risk patients. Another avenue for research could include intensively monitoring patients during a hospitalization to learn what aspects of the hospitalization contribute to a worsening of adherence after discharge among a subset of patients. Thank you for your contribution to the community.

The Impact of Hospitalization for Acute Myocardial Infarction on Adherence to Statins Among Older Adults
Ian M. Kronish, Joseph S. Ross, Hong Zhao, and Paul Muntner
Circ Cardiovasc Qual Outcomes.2016;CIRCOUTCOMES.115.002418published online before print May 24 2016, doi:10.1161/CIRCOUTCOMES.115.002418

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on June 17, 2016 by Marie Benz MD FAAD