Heart Patients Not Taking Meds As Directed

Nearly half failed to follow doctor's orders, study found

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By Ed Edelson
HealthDay Reporter

MONDAY, Jan. 9, 2006 (HealthDay News) -- A lot of people with heart disease aren't taking the medications their doctors prescribe for them as often as they should, cardiologists report.

Almost half of the 31,750 people treated at Duke University for major heart problems in a seven-year study acknowledged that they were not taking beta blocker drugs, aspirin and cholesterol-lowering drugs exactly as their doctors had ordered, according to a report in the Jan. 10 issue of Circulation.

In fact, the study showed, the patients who would benefit most from drug therapy -- the elderly, those with heart failure, those with other diseases -- were the least likely to be using them as directed.

The study participants had all undergone at least one heart procedure, such as bypass surgery, or had at least 50 percent blockage of one coronary artery. Yet, while a majority did take the drugs now and then, many did not take them regularly.

For aspirin, presumably the easiest drug to take, 29 percent said they did not consistently use it as ordered. The compliance rate was much lower for other medications: 46 percent said they took beta blockers as ordered, and only 44 percent followed instructions for using lipid-lowering drugs such as statins.

The usage of ACE inhibitor drugs by people with heart failure, the progressive loss of ability to pump blood, were even lower: only 20 percent said they took the medication consistently.

"My feeling is that a number of factors are responsible," said study author Dr. Kristin Newby, an associate professor of medicine at Duke. "Cost does play a role in it, but health-care providers are the key part of the issue. That includes physicians, nurses and pharmacists."

Patients sometimes don't realize the importance of taking the drugs, Newby said. While the study was not designed to show the repercussions of not taking drugs as ordered, there were indications that patients who followed instructions on drug therapy had a better survival rate.

"This is consistent with the results we see in randomized trials," she said.

It will take a concerted effort on the part of doctors and other medical professionals to correct the problem, Newby said.

"We have to develop algorithms for checking on medication use," she said. "It means checking every time they come in for a visit, and helping patients and their families understand the importance of taking medicine. It requires doing a lot of little things."

"There were suspicions about inconsistent use of heart drugs," Newby said, "but it's always a surprise when you see numbers like these. The magnitude of the problem is certainly eye-opening, and it should be a wake-up call for us."

There has been some progress toward improving compliance, noted Dr. Sidney Smith, a professor of medicine at the University of North Carolina, but his accompanying editorial in the journal said, "We have miles to go before we sleep."

"We can't afford or justify neglect of this issue," added Smith, a spokesman for the American Heart Association. "We need a major focus in our health-care system to recognize and solve this problem."

More information

Practical advice on following doctor's orders on drugs is available from the American Heart Association.

SOURCES: Kristin Newby, M.D., associate professor, medicine, Duke University, Durham, N.C.; Sidney Smith, M.D., professor of medicine, University of North Carolina, Chapel Hill, and spokesman, American Heart Association; Jan. 10, 2005, Circulation

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