MONDAY, Nov. 14 (HealthDay News) -- Heart attack patients are
more likely to take needed medications if they're free, U.S.
Less than half of patients discharged after a heart attack take
their prescribed medications, which increases hospitalizations,
deaths and costs to the health care system. This study was designed
to see if eliminating the co-pay fee might entice more patients to
take their meds.
"We found that medication adherence went up by about 4 to 6 percent," said lead researcher Dr. Niteesh K. Choudhry, an associate professor in Harvard Medical School's division of pharmacoepidemiology and pharmacoeconomics.
Although the gain in adherence was modest, patients saved about
$500 on average and benefited health-wise.
"This resulted in fewer major vascular events and lowered patient out-of-pocket spending for drugs and other health care services," Choudhry said. "And it didn't really change insurer spending."
"Adherence is a very complex problem," Choudhry said. "And, it's a bit of a rarity in health care to find an intervention that improves quality and is economically neutral."
The report was published in the Nov. 14 online edition of the
New England Journal of Medicine, to coincide with its presentation at the American Heart Association annual meeting in Orlando, Fla.
For the study, Choudhry's team used the claims processing system
of the health insurer Aetna, which helped fund the study. The study
included almost 6,000 patients who were treated and discharged from
the hospital after a heart attack.
The researchers randomly assigned about half the patients to get
their prescriptions for free and the remaining patients to continue
with their usual co-pay.
The medications were those usually prescribed after a heart
attack, including cholesterol and blood pressure-lowering
Choudhry's group tracked medication adherence and the number of
major cardiovascular events, including readmission for fatal or
nonfatal heart attack, unstable angina, heart failure or stroke and
procedures to open a blocked artery (revascularization).
They also looked at the patients' out-of-pocket costs plus their
overall health care expenses.
Overall, the patients' adherence rate ranged from 36 percent to
49 percent in the usual coverage group. Eliminating co-pays
improved adherence, but did not reduce the number of cardiovascular
events or revascularization procedures, the researchers found.
However, when they took into account all events, not only first
events, rates were cut by 11 percent in the patients with no
And when revascularizations were discounted, rates of events
dropped 14 percent.
Moreover, the rates of rehospitalization for another heart
attack, angina, heart failure and stroke also went down, they
Total health care spending was not increased, and patients saw a
relative reduction in out-of-pocket costs of 26 percent, the
The reasons why patients don't take their drugs vary, Choudhry
said. These include cost, side effects, the burden of taking a lot
of pills, forgetfulness and knowledge about the drugs, he said.
"Ultimately, we need to tackle each of these," said Choudhry.
Patients with chronic disease who do not take their medications
cost the heath care system hundreds of billions of dollars each
year, Choudhry said. "Non-adherence is a public health problem," he
Dr. Gregg C. Fonarow, a professor of cardiology at the
University of California, Los Angeles, and a spokesman for the
American Heart Association, said that after discharge many patients
fail to fill their prescriptions or discontinue taking needed
drugs, and the consequences can be fatal.
"This simple strategy of enhancing prescription coverage, particularly if coupled with other efforts to improve patient medication adherence, may enhance the quality of care and clinical outcomes for patients after [heart attack]," Fonarow said.
Another expert, Dr. Judith Hochman, director of the
Cardiovascular Clinical Research Center at New York University
Langone Medical Center in New York City, said the study results are
noteworthy. "What is impressive is that a small increase in the
rates of adherence resulted in reduced events," she said. "Can you
imagine if we increased adherence even more?"
Other ways to improve adherence might include having pills
contain more than one drug, patient education and electronic
reminders, she said.
For more information on heart attack, visit the
U.S. National Heart, Lung, and Blood