Managing essential medications for cardiac health, including those for hyperlipidemia, high blood pressure, or diabetes, remains a persistent challenge for individuals with cardiovascular disease. Low adherence to prescribed medications for secondary prevention of cardiovascular events is linked with increased healthcare utilization, higher costs, and a greater risk of all-cause mortality compared to patients who reliably follow their medication regimens (Hood, Giazzon, Seamon, et al., 2018; Kumbhani, Steg, Cannon, et al., 2013; Simon, Kini, Levy, Ho, 2021; Wolfe, Mitchell, & Brown, 2021). A core component of cardiac rehabilitation (CR) is to assess, monitor, and educate patients on medications they are prescribed to help in reducing cardiovascular disease risk factors, such as hypertension, dyslipidemia, and diabetes (Brown, Pack, Aberegg, et al., 2024). However, there is still much to learn about the variability in medication adherence among those participating in or eligible for CR, as well as the range of strategies currently used by CR programs to assist patients in this goal.
Exploring Medication Management Opportunities and Gaps in Michigan’s CR Programs
To advance support for medication management within CR programs, the Michigan Cardiac Rehabilitation network (MiCR) recently launched a related strategic initiative. As Mike Thompson, PhD, MPH, Co-Director of MiCR, explained,
“By examining how CR programs currently help patients understand and adhere to their medication regimens, and identifying opportunities to strengthen this support, MiCR hopes to improve outcomes for patients with heart disease throughout the state.”
Laying the Groundwork
MiCR’s efforts began during its annual meeting in November at Corewell Health East in Troy, MI. There, the MiCR team facilitated an interactive breakout session (Figure 1), guiding participants through a discussion of professional roles, responsibilities, and strategies relevant to medication management in CR. Dozens of attendees, including CR staff and program directors, collaborated in small groups to share perspectives on both the challenges and solutions involved in supporting medication adherence for CR patients.
Figure 1. MiCR Co-Director Mike Thompson facilitating a medication management discussion activity at MiCR’s fall in-person meeting
Participants provided insights into which types of cardiac-related medications should be prioritized for active management in CR programs, as well as which professional roles are best suited to common medication management tasks. These initial questions sparked lively, open-ended discussions about the complexities of managing medications in the CR setting.
The overwhelming consensus among participants was that CR programs should be responsible for actively managing medications for blood pressure control, secondary coronary artery disease prevention, hyperlipidemia, and heart failure (Figure 2). In contrast, opinions were more varied when it came to obesity medications, and many participants noted that the rapidly changing landscape in obesity medications has left many feeling unprepared to support patients in this area.
Figure 2. Perceptions of Responsibility for Management of Medication Types in Cardiac Rehabilitation Programs Among MiCR Meeting Participants (N=39)
There was also strong agreement about professional responsibilities; more than 80% of respondents felt that nurses or exercise physiologists ought to lead medication education, and over 90% believed they should handle medication reconciliation (Figure 3). Meanwhile, 86% agreed that pharmacists play a critical role in providing pharmacy consultations.
Figure 3. Perceptions of Responsibility for Medication Management Strategies in Cardiac Rehabilitation Programs Among MiCR Meeting Participants, by Role
Small group discussions also focused on barriers to effective medication management in CR, as well as ideas for improvement. Participants highlighted issues such as limited access to nurses and pharmacists, time constraints, inconsistent communication, and uncertainty around the best approaches for certain medication categories. Proposed solutions included strengthening communication between CR staff, prescribers, and patients; integrating pharmacist expertise into CR teams; and increasing the standardization of educational materials, processes, and professional responsibilities.
Looking Ahead
The MiCR Medication Management initiative is poised to take its assessment further with a two-fold approach. First, it will utilize medical insurance claims data from MiCR partner Michigan Value Collaborative (MVC) to analyze medication use patterns among cardiac patients who do or do not participate in CR. Second, MiCR will conduct in-depth interviews with CR professionals, including nurses, exercise physiologists, medical directors, and pharmacists, to identify areas for future improvement.
Are you interested in joining MiCR’s mission to enhance medication management for cardiac rehabilitation patients in Michigan? If you are a nurse, exercise physiologist, medical director, or pharmacist working with CR patients, we invite you to sign up here to be contacted for a brief 30-minute Zoom interview.
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