Abstract
Patient participation in covering the cost associated with medical therapy after acute myocardial infarction (AMI) is a factor that limits the use of evidence-based recommendations in every day patient care. The significance of this factor is further exacerbated when long-term therapy is required.
Nonadherence to recommended guidelines negatively influences patient prognosis. In long-term dual antiplatelet therapy (DAPT), within the scope of secondary prevention following MI, ignoring recommendations for the use of the new P2Y12 inhibitors, prasugrel and ticagrelor (and using clopidogrel), as well as shortening therapy duration to <12 months, can be considered as not complying with the guidelines (especially when there are no contradictions or high bleeding risk).
Recognizing the importance of out-of-pocket costs has led to initiatives that further proved that adherence to therapy increases after elimination of copayment. The ARTEMIS (Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study) trial documented greater compliance with the use of the new P2Y12 inhibitors and longer DAPT duration when out-of-pocket costs were compensated.
The trial also pointed to the complexity of the adherence to therapy issue. Nearly 1 in 3 patients in the intervention arm did not use the copayment reduction option.
The most important initial intervention will remain the decision to discuss the importance of medication adherence with our patients. Dr.
Lozano and colleagues commented on the communication gap that exists between patients and physicians relative to the cost the patient will incur while using a prescribed medication.