Medication nonadherence linked to unnecessary cardiovascular hospitalizations in older patients

Older patients with high cholesterol or high blood pressure are at particular risk for unnecessary hospitalizations if they don't follow doctor's orders on taking their medications, according to new research from Express Scripts (NASDAQ: ESRX) presented this week.   

Data from two studies show that patients 65 and older who did not take their medicines as prescribed had around a 30 percent higher risk of hospitalization for cardiovascular disease when compared to patients who took their medications as prescribed.  The two studies were presented at the American Heart Association's Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke 2012 Scientific Sessions.

"Many hospitalizations and emergency room visits may be avoided if you take your statin and blood pressure medications as prescribed," said Donald Pittman, PharmD, national practice leader of the Cardiovascular Therapeutic Resource Center at Express Scripts and the lead researcher for both studies.  "Conditions like high cholesterol and high blood pressure are usually asymptomatic, so patients often forget how important it is to take these medicines.  The failure to remain on treatment can increase the risk of heart attack, stroke or cardiovascular-related death."

High cholesterol and cardiovascular diseases such as high blood pressure, heart failure and heart attack are more prevalent conditions among the 65 and older population.  These conditions can be well-managed with affordable prescription medications. 

One study, looking at patients age 65 and older using cholesterol-lowering medications known as statins, found that the least-adherent patients had a 28 percent increased risk of cardiovascular hospitalizations compared with the adherent patients.  The second study, looking at the 65 and older population using high blood pressure medications, showed that the least-adherent patients had a 31 percent higher cardiovascular hospitalization rate during the one-year follow-up period.

The risk of emergency room visits was also highest among the least-adherent patients in both studies, with a 43 percent higher rate for those using statin medications and a 29 percent higher rate for those using antihypertensive medications.

Additionally, the study focused on antihypertensive medications found that the greatest risk of cardiovascular hospitalizations and emergency room visits within the least-adherent group were Medicare Part D plan patients, with a 42 percent increased risk of hospitalization and a 49 percent higher risk for an emergency room visit.  In both studies, patients covered by Medicare Part D had higher prevalence of hypertension, coronary artery disease, stroke, heart failure and diabetes than those in other prescription benefit plans.

"Even when you account for unique attributes of the Medicare population – such as a higher prevalence of co-morbidities – it's still resoundingly clear that improving adherence to these medications can help keep people healthier and avoid unnecessary cardiovascular hospitalizations," said Pittman.

Past data suggest, on average, one-third to one-half of all patients do not comply with prescribed treatment regimens.  In the two new studies, one-in-four of the study subjects were nonadherent to statins, and one-in-seven members were not adherent to their hypertension medications. 

"It's encouraging that the patients in these studies were actually more adherent overall than the broader population," said Dr. Woody Eisenberg, chief medical officer for Medicare and a co-author of the research.  "Still, the issue of nonadherence is significant and is one that can be addressed by health care policy makers that are trying to manage Medicare costs by including pharmacists as providers of clinical care with a focus on adherence to essential medications."  

Express Scripts has recently launched ScreenRx(SM), a breakthrough solution in the fight against the nation's costliest health condition: medication nonadherence.

ScreenRx is a proprietary adherence solution from the Express Scripts Research & News Solutions Lab. It detects future risk for nonadherence and tailors interventions for individual patients. Leveraging the power of predictive modeling, the tool identifies patients at highest risk for not following their doctors' orders. Once identified, patients receive personalized interventions to help them stay on their therapy.

In 2011, medication nonadherence cost the United States healthcare system $317.4 billion in treating medical complications that could have been avoided if patients had taken their medication.  This amount is higher than the total medical cost of treating diabetes, congestive heart failure and cancer combined.