Heart Medications and Adherence
Medication doesn't do much good when it never leaves the bottle. And yet the American Heart Association estimates that 12 percent of all Americans don't take their medication after getting a prescription. Another 12 percent don't fill their prescriptions in the first place. And many more quit getting refills: A study in the Journal of the American Medical Association showed that five years after seniors were prescribed cholesterol-lowering statin drugs, only 26 percent of seniors were still taking them.
Even when patients do try to follow their doctor's instructions, they often miss a dose or take less than their doctor recommends. As the American Heart Association stated in a report for doctors, "The number one problem in treating illness today is the failure of the patient to take prescription medicines correctly."
The high costs of some drugs and less than ideal communication on the part of physicians and pharmacists contribute to the problem as well, experts say. Low income, depression, and the use of multiple prescription drugs are among the reasons that many elderly patients fail to take their statin medications, according to JAMA.
Of course, some types of medications are rarely neglected. People who have migraine attacks, for example, aren't likely to forget to take their painkillers. However, drugs for treating high blood pressure or high cholesterol are especially likely to collect dust in the medicine cabinet, says Nancy Houston Miller, RN, associate director of the Cardiac Rehabilitation Program at Stanford Medical Center. Over the years, she has seen countless patients who put their hearts -- and lives -- at risk by not taking their medications. She also knows that most patients, with a little help and encouragement, can do what it takes to stay healthy.
Unlike painkillers, antidepressants, or many other types of medications, blood pressure and cholesterol drugs don't necessarily make a person "feel" better. After all, both hypertension and high cholesterol are silent conditions. Since the benefits are invisible, patients often lose their motivation to keep taking the pills. As Houston Miller puts it, "They don't get enough feedback."
Fortunately, the right feedback isn't hard to find. Houston Miller urges everyone with high blood pressure to buy a home blood pressure monitor. By checking their pressure every day, patients can tell exactly how well their medicine is working. And at a minimum, patients with high cholesterol should have their levels checked regularly by their doctor, Houston Miller says.
Lower-income people make hard choices
For older people, high medicine costs may interfere with adherence. Although many seniors now have access to some prescription drug benefits through Medicare, low-income seniors may still skip pills or take lower doses than they need because of the cost of the medication. A 2008 survey of 24,234 Medicare beneficiaries found that about 12 percent skipped pills because of cost.
If the cost of medicine is keeping you from taking your pills, talk to your doctor about alternatives. You may be able to take a lower dose or switch to a lower-cost generic.
Even if cost is no object, staying motivated is only half of the battle. Patients who take their pills religiously can also make mistakes, Houston Miller says. They can take the pills at the wrong time of day, they may take the wrong number of pills, or they may take their pills on an empty stomach instead of with a meal (or vice versa). Slip-ups are especially common when patients try to juggle several prescriptions at once. According to the American Heart Association, nearly 60 percent of patients taking five or more medications take them improperly.
If you're having trouble keeping track of your prescriptions, a little preparation goes a long way. The job starts in the doctor's office. Make sure your doctor clearly explains exactly how every drug should be taken, and whether it interacts with any other medication you're taking. If communication isn't your doctor's strong point, ask questions until you're satisfied.
Your doctor also has a lot to learn from you. Be sure to mention every medication you're taking, including herbs and over-the-counter remedies; it helps to put them all in a bag and bring them to your doctor's office so that you can review them together. Many drugs prescribed to protect the heart can interact in harmful ways with other drugs.
For instance, statins, the most commonly prescribed cholesterol-lowering drugs, can clash with certain antifungal drugs, blood thinners, antibiotics, and heartburn medications. The herb gingko, which some people take to increase circulation and help ward off memory loss, has been known to cause a bleeding in the brain leading to a stroke if taken with the blood thinner warfarin. Let both your doctor and pharmacist know exactly what you're taking.
Also, if you don't understand why you're taking a particular drug, be sure to talk with your doctor. Ask for a drug with simple dosage instructions. Be honest if you don't think the drug is helpful, so you and your doctor can agree what is absolutely necessary for you to take. In addition, bring up any cultural beliefs about medicine that your physician may be unaware of. If you're going to be on the same medication for long periods of time, it may be helpful to ask for three months' worth of medication (so you don't have to go to the pharmacy every month), and remember to refill your medication before you run out completely.
More medicine tips
The American Heart Association offers more tips for taking medicine properly:
- Take the medicine at the same time every day. As a reminder, you can combine taking your pills with another daily routine like eating lunch or brushing your teeth.
- Consider using a pill box with a compartment for every day of the week.
- Keep a medicine calendar and note every time you take a medicine.
- Consider asking your spouse or someone else to remind you to take your medication.
With the right approach, you can make sure to get the most out of your heart medication. Your medicine, in turn, will help you get the most out of life.
American Heart Association, Statistics you need to know, 2002
American Heart Association, How do I manage my medicine? 2002
Bayer Institute for Health Care Communication, 400 Morgan Lane, West Haven, Connecticut 06516
Benner, Joshua, Pharm.D, et al. Long-term persistence in use of statin therapy in elderly patients. Journal of the American Medical Association, Vol. 288, No. 4, July 24-31, 2002
Davidson, MH. Strategies to improve adult treatment panel III guideline adherence and patient compliance. The American Journal of Cardiology. March 7, 2002. Vol 89(5a): 8c-22c
Interview with Nancy Houston Miller, RN, associate director of the Cardiac Rehabilitation Program at Stanford Medical Center
Tough Choices: High Medicine Costs Hit Elderly the Hardest, Congressional Record, April 11, 2000
Madden, JM, et al. Cost-related medication nonadherence and spending on basic needs following implementation of Medicare Part D. Journal of the American Medical Association. Apr 2008; 299(16).