The Association Between Medication Non-Adherence and Early and Late Readmission Rates for Patients with Acute Coronary Syndrome

Abstract

Unplanned hospital readmission forms costly, but preventable burdens on healthcare system. This study was designed to evaluate cardiovascular-related readmission rate after discharge of acute coronary syndrome (ACS) patients and its relationship with medication adherence at a university hospital, Saudi Arabia. Methods: A total of 370 consecutive patients presenting with ACS were involved. The inclusion criteria were clinical and coronary angiography diagnostic data of ACS. Exclusion criteria included heart valve disease, myocarditis, hepatic disease, and history of acute infection during the previous two weeks. Patients were divided into index admission group (n = 291) and unplanned readmission group (n = 79). Readmission and medication adherence rates were evaluated during 1-30, 31-180, 181-365, and 366-548 days post-ACS discharge. Medication adherence was estimated with a (yes/no) questionnaire. Results: The overall readmission rate was 21.4%; individual rates were 30.4%, 38.0%, 27.8%, and 3.8% and the overall medication adherence rate was 62.03%, while individual rates were 54.2%, 70.0%, 63.6%, and 33.3% during the four periods, respectively. There were strong correlations between medication non-adherence and readmission rates. Heart failure, ST-elevated myocardial infarction, unstable angina, cerebrovascular accident, and arrhythmia represented the top causes. Body mass index was higher in readmission group. There were significant correlations between smoking, hypertension, cerebrovascular accident, ischemic heart disease, previous stent, instent restenosis, and LDL-cholesterol as predictor factors and readmission rate. Conclusion:The cardiovascular-related unplanned readmission rate post-ACS discharge was 21.4%, and medication non-adherence rate was 37.97%. There were strong correlations between them in the time frames from 1-month to 1.5-year post-discharge. The individual rates decreased by time, but the first month showed lower rates than the following 5 months and this indicated the role of factors other than medication non-adherence in readmission. The rates are generally consistent with the international levels but utilizing technology can further improve medication adherence and reduce readmission rates.

Temporal characteristics and associated factors of discontinuation and outcomes after percutaneous coronary intervention

“…Because temporary discontinuation was associated with MACE in the survival curves and time-dependent Cox regression analyses, this temporal characteristic may reflect the impact of medication adherence on adverse outcomes ( Kronish et al, 2020 ; Princip et al, 2023 ). However, the existing literature also shows that other outcomes and psychological symptoms after PCI have a similar temporal characteristic ( Gu et al, 2016 ; Williams et al, 2021 ; Murad et al, 2022 ; Vulcanescu et al, 2023 ). Therefore, in addition to the effect of medication adherence on outcomes, this temporal characteristic may also reflect the physical and psychological stress effect of ischemic heart disease or PCI ( Vilchinsky et al, 2017 ; Birk et al, 2019 ; Kronish et al, 2020 ; Henein et al, 2022 ; Princip et al, 2023 ).…”

The Impact of Psychosomatic Factors on Treatment Adherence of Acute Myocardial Infarction Survivors; A Two-Year Follow-Up Study

“…Poor adherence to treatment reduces the control of disease recurrence risk factors, including blood pressure, coagulation status, fat profile, etc., and consequently increases the risk of MACE happening in patients. [ 27 ]…”

A real-world evidence study to evaluate the efficacy of software-driven digital therapeutics on major adverse cardiovascular events, vitals, adherence to medication and lifestyle changes among patients with coronary artery disease or post-coronary interventions

“…9 Post-ACS discharge, reported rate of unplanned readmissions due to cardiovascular issues is 21.4%, and the rate of non-adherence to medication is 37.97%. 10 The adherence rate to post-PCI medications among patients with STEMI is also relatively low (28.4%). 11 Indians are more susceptible to frequent hospitalizations due to complications of CAD, with admission rates being much higher for populations under 40 years old.…”