Adherence to secondary prevention medicines suboptimal among CHD patients
Treatment nonadherence, whether intentional or not and despite seemingly good adherence, remains an issue among patients receiving medicines for the secondary prevention of coronary heart disease (CHD), according to a study presented at the Singapore Prevention & Cardiac Rehabilitation Symposium (SPCRS) 2017.
Ninety-three CHD patients (mean age 66.25 years; 75.3 percent male; 86 percent Caucasian) who underwent elective percutaneous coronary intervention (PCI) reported that they took their medications as prescribed. They also expressed confidence in their knowledge of how to take the medicines and what they were for. [SPCRS 2017, abstract N28]
On the contrary, interview data from 10 patients in the original sample revealed treatment nonadherence, classified as either intentional or nonintentional, to be an issue for all of them. The main reasons for intentional nonadherence were perceived side effects of medicines, particularly statins, and a belief that these drugs have little benefit or are even detrimental to health.
Furthermore, the patients seemingly lacked the knowledge of why they were taking the medicines. For example, one patient thought it odd to be prescribed medications that “all did the same job … [of] thinning the blood.”
The investigators pointed out that the finding may have important implications given that “as the global population ages more, patients will need to take medicines for chronic conditions, such as CHD, and so nonadherence to medicines and the associated adverse health outcomes and higher costs of care will become more prevalent.”
“As adherence to secondary prevention medicines after elective PCI seems suboptimal, it is recommended that a coproduction model be used to encourage, educate and support patients’ adherence so that their risk of CHD progression is lessened,” they added.
Additional investigation is warranted to explore the extent of nonadherence to medicines in an elective PCI patient group, as well as to determine how healthcare professionals can support these patients, the investigators said.
PCIs have been increasingly used to help relive angina symptoms, with more than 90,000 procedures performed each year in the UK alone. Nevertheless, medicines are recommended to be prescribed after the procedure for the secondary prevention of CHD. [https://www.ucl.ac.uk/nicor/audits/adultpercutaneous/documents/2014-annual-report.pdf; Eur Heart J 2005;26:804-811]
Current guidelines recommend that high-statin therapy be initiated in patients aged ≤75 years to reduce the risk of atherosclerotic cardiovascular disease. Moderate-intensity statin therapy may be used in those with contraindications to high-intensity statin but who would otherwise benefit from it, or in patients who are predisposed to statin-associated adverse effects. [Am Fam Physician 2014;90:260-65]