Medication adherence helps lower CVD-related hospitalizations in older adults

Adherence to medications contributes to a reduced risk of hospitalization due to cardiovascular disease (CVD) in older people with coronary heart disease (CHD), reports a Vietnam study.

“Healthcare providers should consider incorporating adherence assessment into the long-term care for older patients with coronary heart disease,” the researchers said.

A total of 643 participants (mean age 73 years, 74.3 percent male) were included in this study, of whom 491 (76.4 percent) were classified as ‘adherent’.

Nearly one in four participants (23.3 percent) were admitted to the hospital over 6 months of follow-up, and 9.2 percent of these were related to CVD. Notably, the nonadherent group showed a significantly higher CVD-related hospitalization rate than the adherent group (13.8 percent vs 7.7 percent; p=0.023). [Br J Clin Pharmacol 2025;91:1771-1779]

Logistic regression models showed a positive relationship between medication adherence and a significantly reduced likelihood of CVD-related hospitalization (adjusted odds ratio [aOR], 0.48, 95 percent confidence interval [CI], 0.27‒0.86). Medication adherence also appeared to reduce all-cause hospitalization (aOR, 0.75, 95 percent CI, 0.49‒1.15).

Forgetfulness

“In our study, there was a significant prevalence of nonintentional nonadherence due to forgetfulness,” the researchers said. “This finding indicates a need for further intervention studies incorporating strategies such as sending reminders to those who forget their pills, using pillboxes, or maintaining a calendar of medication use to improve adherence.”

Medication adherence in older people can also be influenced by physiological changes due to ageing, including cognitive decline and physical limitations. This is especially true for individuals living in low- and middle-income countries, who experience additional barriers compared with those living in high-income or developed countries. [Epidemiol Rev 2013;35:75-83; Heliyon 2022;8:e09716]

“Examples of these barriers may include limited access to medicines, varying educational backgrounds affecting health literacy levels, and resources to support medication adherence,” the researchers said.

In a recent systematic review of factors affecting medication adherence of adults with chronic diseases, socioeconomic status and social support were found to have a positive effect on adherence. [Syst Rev 2019;8:112]

“In patients taking long-term medicines for CVD prevention, their perception of health goals may affect medication adherence,” the researchers said. “In low- and middle-income countries, poor medication adherence has also been influenced by a lack of knowledge, negative beliefs, and negative attitudes.” [Int J Pharm Pract 2018;27:223-231]

In these settings, implementing simplified regimens such as the use of single-pill combinations could potentially help, as shown in studies in Africa on arterial hypertension. [Cardiol Ther 2024;13:431-442; JAMA 2024;332:1070-1079]

The current prospective cohort study was conducted at outpatient clinics of a major hospital in Vietnam from November 2022 to June 2023. Researchers recruited consecutive older patients with CHD and followed them for 6 months.

Medication adherence was defined using the five-item Medication Adherence Report Scale (MARS-5). The impact of medication adherence on hospitalization due to CVD and all-cause hospitalization was assessed using multivariable logistic regression models.

“Healthcare providers should consider incorporating adherence assessment into the long-term care for older patients with CHD,” according to the researchers.