Improving Patient Compliance with Antiplatelet Medications

Dr. Larry S. Dean is a Professor of Medicine and Surgery at the University of Washington School of Medicine and Director of the University of Washington Regional Heart Center at the University of Washington Academic Medical Center. He served his internship and residency at the University of Washington School of Medicine. He received his cardiology training, including interventional cardiology, at the University of Alabama School of Medicine and he then joined the faculty at the University of Alabama in 1986. Dr. Dean served as Assistant Chief of Staff of University of Alabama Hospital and was also Director of the Cardiac Catheterization Laboratory and Professor of Medicine. He returned to Seattle in 2000. Dr. Dean is board-certified in internal medicine, cardiovascular disease and interventional cardiology. He has been involved and widely published in interventional cardiovascular techniques for more than 20 years. At this year’s Transcatheter Cardiovascular Therapeutics (TCT) meeting, the Stentplus Patient Success Program was introduced. What is the intent of this program? The objective of the Stentplus Program is to improve patient compliance with dual antiplatelet therapy following implantation of a drug-eluting stent (DES). One of the key components of the program is that all patients are eligible to receive the program benefits, regardless of the type of DES they receive. I believe this program will be tremendously beneficial to patients in supporting adherence to antiplatelet medications. Why is antiplatelet therapy following DES implantation so important? Several studies have reinforced the importance of patient compliance with antiplatelet therapies after DES implantation. For example, a study by Antonio Colombo showed that premature discontinuation of antiplatelet medication after DES placement is a predictor of stent thrombosis (Figure 1), so we knew some time ago that antiplatelet therapy was an important aspect in the management of DES patients. Current AHA/ACC/SCAI guidelines stress the importance of dual antiplatelet therapy after placement of a DES, and highlight the need to educate patients about the hazards of stopping their medication early. Why aren’t patients more adherent to physician-prescribed medications? It is multi-factorial, but there are three main reasons for non-compliance to medications. First of all, patients are usually overwhelmed with information and they do not remember everything their physicians tell them, despite our best efforts to educate our patients. This is why it is important to not only have a conversation with the patient but also to provide additional information that reinforces the importance of antiplatelet medications that he or she can refer to after discharge. Forgetfulness is another common reason for non-adherence. Patients either forget to take their medication on a daily basis, or forget to refill their prescriptions. Additionally, some patients may not be able to afford the medication. The Stentplus Program is designed to address each of these reasons for non-compliance. How will the Stentplus Program address patient non-compliance? There are three key aspects of the program, designed to address the multiple factors of non-compliance. First, the program includes patient education materials describing the treatment of CAD, an overview of angioplasty and stenting, and ways for patients to make a positive impact on their disease, including the importance of adhering to antiplatelet drugs. The education materials will be available on a DVD, a written manual and through the Stentplus Program website. Another part of the program includes personalized services to remind patients to take their medications each day and to refill their prescription on a monthly basis. These reminders are especially important to support patients in taking their physician-prescribed medications for the full duration of their script. Finally, the program includes resources that detail available financial assistance programs to make it easier for patients who are not financially able to afford medication to find assistance. Will cath lab staff, such as nurses and technologists, have a role in the Stentplus Program? How about patient family members? Cath lab staff will play an integral role in the success of the program. Everyone who comes in contact with the patient has the opportunity to assist physicians in conveying the importance of taking antiplatelet therapy after a DES procedure. The tools included in the Stentplus Program will help facilitate these most important discussions with patients. The Stentplus Program also encourages family members to play an active role in understanding stenting therapy and providing support to their loved ones. Family members are one of the most powerful allies in patient management. If a patient cannot remember all of the details of a conversation with his or her physician, having a family member or a close friend along on the visit is helpful. How are you planning to incorporate the program into your practice? I plan to provide my DES patients with the Stentplus Program materials. I also plan to pass along program information to referring cardiologists so they can educate patients before they get to the cath lab. Non-invasive cardiologists and primary care physicians typically have more contact with patients than interventional cardiologists, so it is extremely important that they assist in stressing the importance of dual antiplatelet therapy. The Stentplus Patient Success Program is sponsored by Boston Scientific Corporation; reviewed and endorsed by The Society for Cardiovascular Angiography and Interventions. Sponsored by Boston Scientific Corporation

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