In the last couple of decades we have witnessed the explosion of cardiovascular (CV) therapies. These treatments now account for the majority of the daily prescriptions issued by physicians. The ageing of the population has led to CV diseases becoming major contributors to morbidity and mortality throughout the world. However, in real life we are facing a major issue concerning the patient’s adherence to and the persistence with therapy. Why should we worry about it? Well, for several reasons that affect the individual patient and society as a whole.
- The full benefit of therapy is seen with optimal adherence and persistence (80%), as usually occurs in controlled trials. In the area of chronic therapy, adherence is often in the range ≤60%. We know that this is a suboptimal treatment that, in turn, reduces clinical benefit.
- The incidence of side effects decreases less than the clinical benefit gained, as side effects usually occur in the early stages of treatment.
- The cost of therapy is certainly important, but the loss of clinical benefit is overwhelming (i.e. in poorly compliant patients the cost of incident disease is much higher than the cost of treatment).
- The poorly compliant patient (<40% drug consumption) sees no benefit from the treatment but the cost of the drug is an expenditure that should be accounted for.
In Europe many of the medicines used in the chronic therapy of CV disease are reimbursed. The time is ripe to call for a joint effort to avoid unnecessary expenses related to poor compliance. How can this be achieved? There are several possibilities, but a system of rewards accompanied by good auditing, as is currently in place in the UK, could be the way forward. Patients should also be encouraged to improve their compliance, perhaps with better information or a system of rewards.
Determining the ideal path to optimal compliance will also depend on national rules and the outcome of in-depth discussion and agreement among the different stakeholders (doctors, payers, patients, pharmaceutical industries, etc.). It is necessary to move forward to achieve the most from therapies that are highly effective.
These challenges of patient compliance are among the many that we face in our field. This issue of European Cardiology again seeks to provide a comprehensive update on developments in cardiology, providing the time-pressured reader with salient review, not simply in our own individual specialities, but across the entire CV spectrum.