Early Medication Nonadherence After Acute Myocardial Infarction: Insights into Actionable Opportunities from the TRANSLATE-ACS Study

Cardiovascular disease is one of the leading causes of morbidity and mortality in the United States,1 yet rates of mortality associated with coronary artery disease have declined in recent years. This decline has been partially attributed to the use of evidence-based therapies, such as aspirin, adenosine diphosphate (ADP) receptor inhibitors, beta-blockers, and statins, that reduce risks of recurrent cardiovascular adverse events.2,3 National inpatient registries demonstrate high prescription rates of these medications at discharge from the index myocardial infarction (MI) hospital4, 5; however, a prescription does not necessarily translate into continued adherence to a prescribed regimen. Prior literature has shown that patient adherence to prescribed therapies remains poor, with more than 25% of patients not filling prescription medications within a week after discharge for an acute MI.6 Medication nonadherence is a widely recognized problem in healthcare and has been associated with worse patient outcomes and increased healthcare costs.7–9 Nonadherence to antiplatelet therapy after percutaneous coronary intervention (PCI) is of particular concern due to the increased risk of stent thrombosis.10 Therefore, a better understanding of modifiable factors contributing to nonadherence may help inform actionable opportunities to optimize longitudinal patient outcomes. The TReatment with ADP receptor iNhibitorS: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS) study is a longitudinal observational study of PCI-treated MI patients that rigorously assesses adherent behaviors via a validated, 8-question Morisky Medication Adherence Scale (MMAS).11–13 The reasons for poor medication adherence are likely multifactorial. TRANSLATE-ACS collects detailed information on patient sociodemographic, economic, and clinical factors, as well as assesses the quality of patient-provider interactions. As a result, TRANSLATE-ACS offers a unique opportunity to: 1) determine the incidence and degree of cardiovascular medication nonadherence early after hospital discharge in a contemporary PCI-treated MI population; 2) evaluate patient and provider factors independently associated with cardiovascular medication nonadherence; and 3) assess the association of medication nonadherence on subsequent mortality and readmission risk.