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CVS study gauges optimal adherence measure
January 13th, 2014
WOONSOCKET, R.I. – CVS Caremark Corp. said new research it conducted with Brigham and Women's Hospital validates the efficacy of a widely used standard for optimal medication adherence.
Published in the January 2014 issue of the American Heart Journal, the study confirmed that patients must achieve a Medication Possession Ratio (MPR) of at least 80% to lower their risk of hospital readmission after a heart attack, CVS announced Monday. That MPR signifies they adhere to 80% or more of their prescription medications.
Patients with more moderate levels of medication adherence after a heart attack — MPRs of 60% to 79% — realized less clinical benefit from their prescriptions and had higher levels of disease-related clinical events. According to CVS, an MPR of 80% has long been considered optimal, but that threshold had little empirical support.
"These findings underscore the ongoing need for interventions to help patients improve their adherence while confirming the level of optimal adherence needed to see clinical benefit," study co-author Troy Brennan, executive vice president and chief medical officer at CVS Caremark, said in a statement. "Interventions could range from identifying ways to remove financial barriers to determining how best to simplify complicated treatment regimens, to providing tools to help remind and motivate patients about the importance of taking their medications as directed."
CVS said the researchers assessed the impact of adherence on clinical outcomes for more than 4,100 myocardial infarction (MI) patients who had filled a prescription for at least one of the medications in the study (beta-blocker, statin, angiotensin converting enzyme inhibitor, or angiotensin receptor blocker) that were prescribed after hospital discharge. The study gauged outcomes based on a patient's first hospital readmission for a major vascular event (fatal or non-fatal acute MI, unstable angina, stroke or congestive heart failure) or coronary revascularization (coronary bypass, stenting or angioplasty).
Patients who achieved adherence equal to or greater than 80% MPR for each of the study medications were much less likely than the control group to experience a major vascular event or undergo revascularization, the study found. For example, CVS said, patients with optimal adherence of 80% MPR or greater were 24% more likely not to be readmitted to the hospital for another heart-related issue than the control group. Patients with MPRs of 60% to 79% had no significant reduction in clinical outcomes versus the control group, despite achieving greater levels of medication adherence.
"While it is widely accepted that patients who are adherent to prescribed medications for chronic conditions have better outcomes than nonadherent patients, there has not been solid data that defines the optimal level of adherence," stated study lead author Niteesh Choudhry, associate physician in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women's Hospital and associate professor at Harvard Medical School. "This research clearly demonstrates that the long-held industry standard of 80% MPR is associated with improved health outcomes and reduced adverse coronary events for post-heart attack patients. The data also highlights that it is important for patients who have had a heart attack to reach optimal adherence for all of their recommended medications in order to derive maximal clinical benefit"
Titled "Untangling the Relationship Between Medication Adherence and Post-Myocardial Infarction Outcomes," the study was based on a secondary analysis of data from the randomized MI FREEE (Free Rx Event and Economic Evaluation) trial conducted by Aetna and Brigham and Women's Hospital the full results of which were previously published in the New England Journal of Medicine in 2011.