Patient adherence to a medication is a critical factor in determining its safety and effectiveness. However, the adherence rate in individuals with chronic illness is approximately 50% in developed countries, and the rate is even lower in developing countries.1 In the United States, medication nonadherence is estimated to result in 125,000 deaths annually and is the cause of 33% to 69% of medication-related hospital admissions.2
In research on oral anticoagulants specifically, fewer than 50% of patients were found to be adherent after the first year of treatment.3 For medications with a shorter half-life, such as novel oral anticoagulants (NOACs), nonadherence is especially risky. Patients with atrial fibrillation (AF) who take a NOAC for stroke prevention must do so once or twice daily, and even one missed dose can reduce the anticoagulative effect of the drug and thus increase the risk for stroke.
“We know that anticoagulation is highly effective in preventing strokes in patients [with AF], but it only works if the patient takes it,” said Seth S. Martin, MD, MHS, FACC, FAHA, an assistant professor of medicine and cardiology at Johns Hopkins University School of Medicine and codirector of the Hopkins Lipid Center at the Ciccarone Center for the Prevention of Heart Disease in Baltimore. “One needs to consistently take it every day to get the maximum benefit,” Dr Martin told Cardiology Advisor.
In a recent review published in Medical Hypotheses, Boehme and colleagues proposed that the use of adherence-enhancing technologies could reduce the incidence of ischemic strokes in patients with AF.4 “We hypothesize that a main reason for the increase in incidence of ischemic strokes in patients diagnosed with [AF] is nonadherence in an aging society that per se has an increasing [AF] risk,” they wrote.