Educating Your Patients

At the time of discharge from the hospital, your patients with ACS may be feeling overwhelmed and not ready to ask questions about their treatment plan. Therefore, educating your patients about their medications is especially critical.

Studies have shown that many patients don’t have a good understanding of their treatment plans and medications as they leave the hospital.1,2 This may lead to patients not filling their prescriptions postdischarge.

The bottom line is that the health information patients receive at discharge is critical to their understanding of their outpatient care plan.

Why educating your patients is important

A considerable number of patients with acute coronary syndrome (ACS) did not fill their oral antiplatelets (OAPs) within 30 days of discharge, and of those patients who did, a large portion did not remain persistent on OAP therapy.3

Despite guideline recommendations for duration of therapy, nearly 7 out of 10 ACS patients failed to fill their OAP prescriptions postdischarge by 12 months.3

OAP refill rates up to 12 months3

Persistency of Patients with ACS on OAP Therapy

Patients with ACS on OAP Treatment chart

*Patients who filled their original retail OAP prescription within 30 days post discharge.
†Patients who refilled their retail OAP prescription before their current supply had depleted (permissible gap of 50% of supply).

Persistency rates are estimates based on retail prescription fill rates and may be higher or lower. Patients were considered to have discontinued therapy if they switched to another OAP molecule, a mail‐order pharmacy, or a pharmacy outside of the database. Persistency could be overestimated by nonadherent patients.

A retrospective cohort study of new‐to‐therapy ACS patients (excluding patients who underwent coronary artery bypass graft [CABG] surgery) who received an OAP on the last day of hospital stay (n=5,115) from September 2013 to December 2013. The prescription activity of 3,583 patients who filled their first prescription within 30 days post‐discharge were tracked from hospital discharge to the retail setting. From that, 2,162 were included in the persistency analysis. The prescription activity for those patients was tracked through 1 year of therapy. Data were obtained from linked IMS databases (insured and cash‐paying patients).

Education and communication are critical to patients at discharge

More than one-third of patients surveyed following discharge did not know the name, purpose, or correct dosage of their new medications. Health information that patients receive at discharge is critical to the success of their outpatient care plan.‡2

IMPORTANT SAFETY INFORMATION FOR BRILINTA® (ticagrelor) 60-mg AND 90-mg TABLETS
WARNING: (A) BLEEDING RISK, (B) ASPIRIN DOSE AND BRILINTA EFFECTIVENESS

A. BLEEDING RISK
  • BRILINTA, like other antiplatelet agents, can cause significant, sometimes fatal bleeding
  • Do not use BRILINTA in patients with active pathological bleeding or a history of intracranial hemorrhage
  • Do not start BRILINTA in patients undergoing urgent coronary artery bypass graft surgery
1975408-3218312 Last Updated 10/16

IMPORTANT SAFETY INFORMATION FOR BRILINTA® (ticagrelor) 60-mg AND 90-mg TABLETS

WARNING: (A) BLEEDING RISK, (B) ASPIRIN DOSE AND BRILINTA EFFECTIVENESS A. BLEEDING RISK

  • BRILINTA, like other antiplatelet agents, can cause significant, sometimes fatal bleeding
  • Do not use BRILINTA in patients with active pathological bleeding or a history of intracranial hemorrhage
  • Do not start BRILINTA in patients undergoing urgent coronary artery bypass graft surgery 
  • If possible, manage bleeding without discontinuing BRILINTA. Stopping BRILINTA increases the risk of subsequent cardiovascular events

B. ASPIRIN DOSE AND BRILINTA EFFECTIVENESS

  • Maintenance doses of aspirin above 100 mg reduce the effectiveness of BRILINTA and should be avoided

CONTRAINDICATIONS

  • BRILINTA is contraindicated in patients with a history of intracranial hemorrhage or active pathological bleeding such as peptic ulcer or intracranial hemorrhage. BRILINTA is also contraindicated in patients with hypersensitivity (eg, angioedema) to ticagrelor or any component of the product

WARNINGS AND PRECAUTIONS

  • Dyspnea was reported in about 14% of patients treated with BRILINTA, more frequently than in patients treated with control agents. Dyspnea resulting from BRILINTA is often self-limiting
  • Discontinuation of BRILINTA will increase the risk of MI, stroke, and death. When possible, interrupt therapy with BRILINTA for 5 days prior to surgery that has a major risk of bleeding. If BRILINTA must be temporarily discontinued, restart as soon as possible
  • Ticagrelor can cause ventricular pauses. Bradyarrhythmias including AV block have been reported in the post-marketing setting. PLATO and PEGASUS excluded patients at increased risk of bradyarrhythmias not protected by a pacemaker, and they may be at increased risk of developing bradyarrhythmias with ticagrelor
  • Avoid use of BRILINTA in patients with severe hepatic impairment. Severe hepatic impairment is likely to increase serum concentration of ticagrelor and there are no studies of BRILINTA in these patients

ADVERSE REACTIONS

  • The most common adverse reactions associated with the use of BRILINTA included bleeding and dyspnea: In PLATO, for BRILINTA vs clopidogrel, non-CABG PLATO-defined major bleeding (3.9% vs 3.3%) and dyspnea (14% vs 8%); in PEGASUS, BRILINTA vs aspirin alone, TIMI Total Major bleeding (1.7% vs 0.8%) and dyspnea (14% vs 6%)

DRUG INTERACTIONS

  • Avoid use with strong CYP3A inhibitors and strong CYP3A inducers. BRILINTA is metabolized by CYP3A4/5. Strong inhibitors substantially increase ticagrelor exposure and so increase the risk of adverse events. Strong inducers substantially reduce ticagrelor exposure and so decrease the efficacy of ticagrelor
  • Patients receiving more than 40 mg per day of simvastatin or lovastatin may be at increased risk of statin-related adverse events
  • Monitor digoxin levels with initiation of, or change in, BRILINTA therapy

INDICATIONS

BRILINTA is indicated to reduce the rate of cardiovascular death, myocardial infarction (MI), and stroke in patients with acute coronary syndrome (ACS) or a history of myocardial infarction. For at least the first 12 months following ACS, it is superior to clopidogrel.

BRILINTA also reduces the rate of stent thrombosis in patients who have been stented for treatment of ACS.

DOSING

In the management of ACS, initiate BRILINTA treatment with a 180-mg loading dose. Administer 90 mg twice daily during the first year after an ACS event. After one year administer 60 mg twice daily. Use BRILINTA with a daily maintenance dose of aspirin of 75-100 mg.

Please read full Prescribing Information , including Boxed WARNINGS, and Medication Guide  .

A patient survey that evaluated patient knowledge of newly prescribed medication after hospital discharge in 100 patients who were discharged with prescriptions for 1 or more new medications from the internal medicine residency service at a community-based teaching hospital from February 1, 2006, through April 25, 2006.

REFERENCES:

  1. Makaryus AN, Friedman EA. Patients’ understanding of their treatment plans and diagnosis at discharge. Mayo Clin Proc. 2005;80(8):991-994.
  2. Maniaci MJ, Heckman MG, Dawson NL. Functional health literacy and understanding of medications at discharge. Mayo Clin Proc. 2008;83(5):554-558.
  3. Data on file, 3121101. AstraZeneca Pharmaceuticals LP.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088.