One in 8 adults with common heart diseases skip medications, delay filling prescriptions or take less medication than prescribed because of concerns about cost. This trend is more common in those not covered by Medicare (e.g. under 65).

Published in the American Heart Association’s journal Circulation, the study was led by Khurram Nasir, MD, MPH, MSc, Chief of the division of cardiovascular prevention and wellness and co-director of the Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas.

Medication non-compliance is a known problem for those with cardiovascular disease. In many cases the study reveals that this dynamic is a social determinant of health—that is an economic indicator that unfortunately, leads to far worse conditions as it frequently associates with more expensive care later because they become sicker and more likely to need care in an emergency room, be hospitalized or have more frequent doctor’s appointments. The costs to payers and society goes up.

The Study

The investigators analyzed survey responses from 14,279 adults (average age 65, 44% female) who took part in the National Health Interview Survey between 2013 and 2017. All had previously been diagnosed with coronary heart disease, heart-related chest pain, a heart attack of a stroke.

The Findings

1 in 8 Americans with these common heart diseases (2.2 million nationwide) had not taken their medication as prescribed due t cost concerns. This phenomena was three times more common in those under 65 as those over 65 have access via Medicare. Those under 65 include larger proportions of women (1 in 4), patients from low income families (1 in 3) and patients without health insurance (more than half). Race was less of a factor than economy. Those that cannot afford to take the medications as prescribed were 11 times more likely to request low-cost medication and 9 times more likely to use alternative, non-prescription therapies.

Funding

The National Center for Advancing Translational Sciences supported the study.

Call to action: Social determinants of health represent a fundamental element underlying health care. Hence in the doctor and patient relationship ones economy or economic conditions need to be understood. Many health systems are now requiring their medical records to include social determinant of health indicators—representing a sort of flag for the physician and staff to consider or factor in to the diagnosis. For example, if a physician is aware of a cost constraint they can consider the lower-cost drug options as they may be available. Whole person care, especially for those patients that could be “at risk” implies that they health provider understand and treat the person to factor in and include economic wherewithal.

Lead Research/Investigator

Khurram Nasir, MD, MPH, MSc, Chief of the division of cardiovascular prevention and wellness and co-director of the Center for Outcomes Research, Houston Methodist Hospital 

Co authors

Rohan Khera, M.D.; Javier Valero-Elizondo, M.D., M.P.H.; Sandeep R. Das, M.D., M.P.H.; Salim S. Virani, M.D., Ph.D.; Bita A. Kash, Ph.D., M.B.A.; James A. de Lemos, M.D.; and Harlan M. Krumholz, M.D., S.M. Author disclosures are in the manuscript.

Source: American Heart Association

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