Some Heart Drugs Aren't Properly Prescribed

Statins and diuretics underused, two studies found

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By
HealthDay Reporter

TUESDAY, April 20, 2004 (HealthDayNews) -- Many doctors aren't properly prescribing drugs for two major coronary risks -- high blood pressure and high cholesterol -- increasing cost and health risks for patients, separate studies find.

A Canadian study indicated physicians aren't using cholesterol-lowering statins as often as they should to help high-risk patients.

The other study found Americans with high blood pressure are paying about $1.2 billion a year more they should because doctors are avoiding lower-cost medications that are just as effective as the high-priced drugs they prescribe.

In both cases, patients can help themselves by learning more about their heart problems and participating in decisions about their medication, the researchers said.

The studies appear in the April 21 issue of the Journal of the American Medical Association.

The Canadian study of nearly 400,000 elderly patients found that "as the risk of future events rises and the severity of risk factors rise, physicians become less aggressive in prescribing statins," said study leader Dr. David A. Alter, a scientist at the Institute for Clinical Evaluative Sciences in Toronto.

The reason is "a misconception about preventative therapy when patients are severely ill," Alter said. "Physicians tend to underestimate the benefits of statins and overestimate their potential harm."

While the study was limited to patients aged 66 and older, the finding also applies to younger people with severe cardiovascular conditions, he said. And, he added, what is true in Canada is almost certainly true in the United States.

Only one-quarter of the patients in the study were taking statins, although many more would benefit from them, Alter said. There also was a steady decrease in the percentage of patients being prescribed the drugs that paralleled their risk of death.

"With every increase in risk, the aggressiveness of treatment decreases," he said.

Patients can take part in the decision on when to prescribe statins in two ways, Alter said. They can ask their physician if the drugs are needed, and they can assure the doctor they will take them as prescribed.

"There is always a concern that patients will not comply with the therapy," Alter said. "It is part of a patient's responsibility to ensure that they will be compliant, to help the doctor be sure that noncompliance is not going to be an issue."

The blood pressure study looked at medication use by more than 133,000 patients in a Pennsylvania state drug-assistance program. It found doctors are prescribing calcium channel blocker drugs more than they should, and thiazide diuretics less than they should, said study author Dr. Michael A. Fischer, an associate physician at Brigham and Women's Hospital in Boston.

That finding was based on the recommendations of a nationally recognized panel of experts that are promulgated by the American Heart Association and other major organizations, Fisher said.

Both calcium channel blockers and thiazide diuretics are available in generic form. Thiazide diuretics usually cost less, in part because doctors tend to prescribe the more expensive, long-lasting versions of calcium channel blockers, Fischer said.

The reasons for the difference between the recommended and actual prescribing patterns are not entirely clear, but "my personal belief is that pharmaceutical company marketing plays a role in this," Fischer said.

Blood-pressure prescriptions should be based on individual patient profiles, he said, and a patient can help in the decision.

"Asking the doctor about it is a terrific idea," Fischer said. "It is a chance for a patient to help find out if another drug might be more beneficial."

More information

The American Heart Association has more on statins, while the National Library of Medicine has more on thiazide diuretics.

SOURCES: David A. Alter, M.D., Ph.D, scientist, Institute for Clinical Evaluative Studies, Toronto; Michael A. Fischer, M.D., associate phyician, Brigham and Women's Hospital, Boston; April 21, 2004, Journal of the American Medical Association

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