Background: Incomplete medication adherence is common, results in poor outcomes, and remains resistant to change in patients with acute coronary syndromes (ACS). However, few studies, if any, have reported patterns of adherence at multiple time points during patients’ transition from the hospital to their community.
Objective: To describe patterns of self-reported medication adherence at admission and over a post-discharge transitional period of 12 months.
Methods: Adult patients (n=2187) hospitalized for ACS enrolled in the “Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education” (TRACE-CORE) cohort from GA and MA completed the 8-item Morisky Medication Adherence Scale (range: 0-8) in person during hospitalization and via telephone interviews at 1-, 3-, 6-, and 12- month(s) after discharge. High, medium, and low adherence were defined as scale scores of 8, 6-7 and 0-5, respectively and analyzed. Repeated measures ANOVA was used to test for differences in mean adherence across the assessment periods.
Results: Participants were 66% male, 16% non-Hispanic black, 81% non-Hispanic white, and aged 61.3 ± 11.34 years. High adherence was reported by 25% at baseline, increased to 50.9% at 1-month, and subsequently dropped to 46%, 45%, and 44% by 3,6, and 12 months, respectively (table). Mean adherence scores (n=906) increased from 6.15(SD=1.78) at baseline to 7.05 (1.23) at 1-month then slightly decreased and leveled off [6.95(1.31), 6.93(1.31), 6.89(1.36); p<0.001 for changes over time]. Baseline differed from all other scores and 1-month scores differed from baseline, 6-, and 12-months.
Conclusion: A major increase in high adherence from baseline to 1-month was followed by a slight decline from 3 to 12 months post discharge. The improvement in adherence from baseline may have been prompted by the “teachable moment” resulting from an ACS. Further research may delineate interventional factors during this transition period that may improve long-term adherence.