Adherence to antiplatelet treatment with P2Y12 receptor inhibitors. Is there anything we can do to improve it? A systematic review of randomized trials

Abstract

Antiplatelet therapy is the cornerstone of treatment for patients with acute coronary syndromes (ACS) and/or undergoing percutaneous coronary interventions. Non-adherence to medication after ACS may lead to increased morbidity, mortality, and costs to the healthcare system due to elevated risk of stent thrombosis, myocardial infarction or death. Medication adherence is an issue of growing concern regarding the improvement of health system performance. Promoting medication adherence offers a rare opportunity to simultaneously improve health outcomes while reducing costs of treatment in patients with coronary artery disease (CAD). The aim of this systematic review was to critically discuss adherence to antiplatelet treatment with P2Y12 receptor inhibitors in CAD patients. After a systematic investigation of the literature in databases including PubMed, CENTRAL and Google Scholar, using appropriate keywords, and considering clinical randomized, prospective observational and retrospective studies, reporting on adherence to treatment with inhibitors of P2Y12 platelet receptors or educational interventions aimed to improve medication adherence in patients with CAD, seven articles were considered eligible for inclusion in this systematic review. Reported adherence to clopidogrel, despite catastrophic consequences of its premature discontinuation, is low. We identified several determinants of low adherence and early discontinuation of clopidogrel. We also present data on the usefulness, utilization and credibility of different methods of medication adherence assessment, and suggest and critically discuss available interventions aimed at improvement of adherence to clopidogrel, still showing the need for innovative approaches to achieve enhanced medication adherence and improve health outcomes after acute myocardial infarction.

Adherence to treatment — a pivotal issue in long-term treatment of patients with cardiovascular diseases. An expert standpoint

“…In several studies the age of patients was indicated as one of the factors affecting adherence to medication [8,14,[18][19][23][24]. Comorbidity burden increasing with age is associated with the necessity of polypharmacy.…”

The readiness for hospital discharge of patients after acute myocardial infarction: a new self-reported questionnaire

“…Nurse judgement of low discharge readiness was associated with a six-to nine-fold increase in readmission risk; however, patient self-assessment was associated neither with readmission nor with visits in emergency department [19]. Patient self-assessment is a purely subjective assessment, while nurse evaluation is more objective [20,21]. Such an approach was applied in RHD MIS in the first and second subscale.…”

Relation of the Readiness for Hospital Discharge after Myocardial Infarction Scale to socio-demographic and clinical factors. An observational study

“…The previously published RHD-MIS validation study showed a-Cronbach coefficient of 0.789, indicating a high level of reliability and homogeneity of the questionnaire [9]. The RHD-MIS consists of 23 questions divided into three subscales: subjective (1) and objective assessment of patient knowledge of the disease (2) and the patient's expectations (3).…”

“…Effective education should positively influence the patient's behaviour in reducing risk factors, self-control and adherence to prescribed pharmacotherapy [7,[9][10][11]. On the other hand, non-adherence to medical recommendations results in serious health and economic consequences [12][13][14][15].…”