Noninitiation of Discharge Medications After Revascularization

BACKGROUND: Timely initiation of medication therapy after a cardiovascular event is vital to achieve optimal patient outcomes, yet there is a lack of insight on the frequency and predictors of discharge medications that are delayed or never initiated. OBJECTIVES: To (a) describe how frequently patients do not fill newly prescribed discharge medications within 30 days after revascularization and (b) identify predictors of patients who did not fill their new medications. METHODS: A single-center, retrospective analysis was conducted of patients discharged after percutaneous coronary intervention or coronary artery bypass grafting. Discharge prescriptions were linked to pharmacy claims data to identify medications that were not filled within 30 days of discharge. RESULTS: 1,206 patients and their 5,253 discharge medications were included for study. More than one third of patients did not fill at least 1 discharge medication within 30 days (466/1,206, 38.6%); nearly 1 in 10 (116/1,206, 9.6%) did not fill any of their discharge prescriptions. Significant predictors of nonadherence included longer length of stay and higher number of prescribed discharge medications (both P values < 0.05). The largest classes of unfilled medications included insulin, factor Xa inhibitors, and narcotic analgesics. CONCLUSIONS: Noninitiation is a common issue among patients after cardiac revascularization. These patients may be at a higher risk of not filling their medications if they experience longer lengths of stay or are prescribed a higher number of medications at discharge.