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Improving Adherence to Cardiovascular Medications


Medication adherence is a growing concern to healthcare providers and stakeholders (i.e., payers) because of the mounting evidence that non-adherence is prevalent and associated with adverse outcomes and higher costs of care. The measurement of medication adherence and use of interventions to improve adherence are rare in routine clinical practice, thus medication adherence has been called "the next frontier in quality improvement," and is an important part of cardiovascular outcomes research. This article focuses on cardiovascular medication adherence and discusses studies that address: 1) different methods of measuring adherence, 2) prevalence of non-adherence, 3) association between non-adherence and outcomes, 4) reasons for non-adherence, and 5) interventions to improve medication adherence.

Findings show that while there are many different methods for assessing medication adherence, non-adherence to cardiovascular medications is common and associated with adverse outcomes. For example, one study found that following hospitalization for acute myocardial infarction (AMI), nearly 25% of patients had not filled their cardiac medications seven days after hospital discharge. Another study found that medication non-adherence was strongly associated with adverse cardiac events, including death from cardiac heart disease, MI, and stroke. The authors also found that non-adherence is not solely a patient problem but is impacted by both providers and the healthcare system. One study showed that less than 50% of patients were able to list all of their medications and fewer understood their purpose, suggesting that system factors like the educational process at hospital discharge can impact medication adherence.

To date, interventions targeting medication adherence have produced only modest success. Multi-modal interventions have shown the most promise in improving adherence, but require the clinical personnel to manage and coordinate multiple intervention components. Integrated health systems like VA may be able to implement these interventions more easily than other healthcare systems.

PubMed Logo Ho P, Bryson C, and Rumsfeld J. Medication adherence: Its importance in cardiovascular outcomes. Circulation June 16, 2009;119(23):3028-35.

Drs. Ho and Bryson are supported by HSR&D Career Development Awards. All authors are part of VA/HSR&D's Ischemic Heart Disease Quality Enhancement Research Initiative (IHD-QUERI).

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.