medication adherence for heart attack survivors

A recent study published in JAMA Internal Medicine sought to determine whether a curated system of medication reminders would increase medication adherence and improve the outcome of heart attack survivors. It was found that the compound intervention integrating wireless pill bottles, financial incentives, and social support did not significantly improve medication adherence nor clinical outcomes. More research on medication adherence in heart attack survivors is needed in order to further therapeutic advancement.

For heart attack survivors, treatment lasts much longer than the mere duration of their hospital stay; they must work closely with their physicians to establish a regime that will decrease their risk for another heart attack. To achieve this, doctors typically prescribe β-blockers, statins, aspirin, and other anti-platelet drugs. However, prior research has shown that medication adherence in heart attack survivors is low—at a dismal 39%, increasing to only 44% when copayments were waived. Given the medications’ clinical benefits, generally low cost, and simple schedule, researchers are perplexed as to why this is the case. A new study published recently in JAMA Internal Medicine tested a combined intervention, comprising of electronic reminders, financial incentives, and social support, with the goal of reducing repeated cardiovascular events among heart attack survivors through improved medication adherence.

The randomized clinical trial consisting of a 12-month intervention was conducted from 2013 through 2016. Investigators were blinded to study group, but participants were not.1509 heart attack survivors ranging from ages 18 to 80 were recruited. Patients were eligible if they were currently prescribed at least 2 of 4 study medications (statin, aspirin, β-blocker, antiplatelet agent). They also had to be hospital inpatients for 1 to 180 days and discharged home with a principal diagnosis of acute myocardial infarction. All participants in the intervention group received a combination of financial incentives, social support, and wireless pill bottles that electronically monitored and collected data upon their opening. Control group patients received usual care and had no additional contact with study staff after initial enrolment.

Following statistical analyses, researchers observed no significant difference in medication adherence, repeat heart-related hospitalizations, or medical costs between the intervention and control groups. However, the negative results from this intervention remain important—they highlight the fact that current approaches are not proving effective enough to significantly improve medication adherence in heart attack survivors. In all, the researchers stress that further research in this area will lead to improvement in patient medication adherence and hopefully, better clinical outcomes.

Written by Rebecca Yu


Volpp, K. G., Troxel, A. B., Mehta, S. J., Norton, L., Zhu, J., Lim, R., … & Levin, T. (2017). Effect of Electronic Reminders, Financial Incentives, and Social Support on Outcomes After Myocardial Infarction: The HeartStrong Randomized Clinical Trial. JAMA Internal Medicine.

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