Cardiology Magazine — July-August 2011
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Cover Story
Jack Lewin, MD


A Problem for Patients, A Problem for our Health System

Taking medication as directed may seem elementary for most patients, but nonadherence among people with chronic disease is a complex and widespread problem. This is particularly true in cardiology, where nonadherence can lead to serious consequences like hospitalization, cardiac events and death.

Failure to take medications as prescribed causes 10 percent of hospital admissions and 125,000 deaths annually. The number of deaths caused by nonadherence is nearly as high as the number caused by stroke, which is the third leading cause of death in the U.S. Only 50 percent of patients take statins as prescribed after six months, according to an analysis of NDC Health Services 2000 data. After 12 months, this drops to just 32 percent of patients.

Two years out, less than 20 percent of patients take their statins as prescribed.

In addition to having obvious deleterious consequences for patients, nonadherence has negative consequences for our health care system. Nonadherence results in $100 billion each year in unnecessary hospital costs and costs the economy $300 billion per year, including hospital readmissions, extra provider visits and medical complications. Poor medication adherence is costing Americans their health, and costing the nation billions in unnecessary health care spending.

While we can all agree nonadherence should be reduced, what is difficult is determining how exactly to do it. There are many reasons why patients do not take their medications, for reasons as simple as “I forgot” to more complicated ones like being unable to afford what was prescribed, or not understanding their medication regimen or why their medication is important.

Clinicians can play a critical role in helping patients adhere to their medication if we first understand that nonadherence is a huge issue and then help patients overcome barriers to properly taking their medication. CardioSmart Associate Editor JoAnne Foody, MD, FACC, presented seven barriers to patients taking their drugs as prescribed at a consortium held in May on medication adherence.

They are: knowledge, motivation, provider support, lifestyle, social support, health literacy, and medication and disease-specific issues. While it certainly is not possible for providers to assist in all these areas, there are certain parts in which providers can take the lead. In particular, health care professionals can provide knowledge and support, by taking the time to explain to patients – in language that they can understand – what each prescription does and why the prescriptions are important to take. This is certainly challenging: providers have a very short time with each patient and There is a lot to be covered.

Understanding this, the American College of Cardiology (ACC) has partnered with the National Consumers League “Script Your Future” campaign (see sidebar) to off er medication adherence resources. The ACC highly encourages its members to visit and send their patients to the Script Your Future website (, which has resources for health care professionals on how to communicate better With patients and patient tools, such as free text message reminders, sample questions, medication lists and charts to keep track of medicines and fact sheets on common chronic conditions.

Additionally, health information technology (IT) can play a role in improving patient adherence. Many e-prescribing and electronic health record systems can tell providers if their patients have not filled a prescription or have not picked up a refill. From there, providers can follow up via phone or email to encourage patients to pick up their medication and understand why they did not initially. Although this only addresses a few of the ways in which a patient can be noncompliant, using technology in this fashion can substantially improve the quality of patient care offered.

The ACC also has made medication adherence a large part of its Hospital to Home (H2H) national quality Improvement initiative. This program has the goal of reducing all-cause readmission rates among patients discharged with heart failure or acute myocardial infarction by 20 percent by 2012. It plans to achieve this by focusing on three core concepts that provide opportunities to improve care transitions to reduce readmissions. The No. 1 care concept is making sure each patient is familiar and competent with their medication and has access to the prescriptions they need. Participants in this initiative are able to share what strategies they find work best in making this happen. By focusing on medication adherence as a core concept, participating health care providers and facilities are continually challenged to improve in this area.

Nonadherence is a complex and multi-faceted problem, for which there is no simple answer. However, addressing nonadherence is critical to reducing cardiovascular mortality over the next decade and to reducing health care costs. We must improve adherence if we are to live up to the ACC mission of providing high quality cardiovascular care and improving heart health.

Lewin is CEO of the American College of Cardiology.

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ACC Partners with National Consumers League on “Script Your Future” Campaign

The ACC has partnered with the National Consumers League’s “Script Your Future” campaign, a three-year effort focused on improving patient medication adherence for cardiovascular disease, diabetes and respiratory disease. The goal of the campaign is to raise awareness among consumers and their family caregivers about the importance of medication adherence as a vital first step toward a healthier life, and to provide tools and resources to make medication adherence easier. The campaign, which is supported by more than 100 stakeholders, will provide patient resources through partnerships with pharmacies, hospitals, medical offices and clinics, and health insurance plans; host community events and health fairs; and evaluate medication adherence awareness through research. Learn more at