Hospital Strategies to Address Non-Adherence to Guideline-Recommended Dual Antiplatelet Therapy After Myocardial Infarction: Findings From the Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study (ARTEMIS)

Introduction: Guidelines recommend dual antiplatelet therapy (DAPT) for at least 1 year after acute myocardial infarction (MI), yet DAPT non-adherence is prevalent, often related to medication cost, and can lead to adverse cardiovascular events. Little is known about strategies used by hospitals in community practice to improve DAPT adherence. Methods: ARTEMIS is an ongoing cluster randomized trial examining the impact of copayment assistance on 1- year DAPT adherence and clinical outcomes after acute MI (NCT# 02406677). Enrolled post-MI patients were surveyed on medication cost burden. Participating hospitals were surveyed regarding discharge medication management practices. Results: From June 2015 to May 2016, 7008 post-MI patients discharged on DAPT from 265 U.S. hospitals participating in ARTEMIS were surveyed. Financial hardship affording medications was reported by 48% of patients, and 46% reported cost as an extremely important consideration when choosing to take a medication; 17% of patients admitted to not filling a prescription in the past due to cost. While 89% of hospitals screened patients’ ability to afford the cost of prescription medications, only 17% of hospitals routinely called the patient’s pharmacy to check out-of-pocket cost burden and 22% of hospitals routinely discharged patients with a filled prescription. Approximately half of hospitals offered discount vouchers for P2Y12 inhibitor (57%) or free P2Y12 inhibitor samples (53%). Hospitals variably employed other strategies to improve patient medication adherence (Figure). Conclusions: Cost is a significant factor in patient decision-making regarding taking prescription medications. Hospitals currently use a variety of strategies in attempts to improve adherence, although use of medication management interventions has been low. In this setting, ARTEMIS is poised to examine the impact of copayment reduction on both medication adherence and patient outcomes.