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Medications Keep Heart-Failure Patients Alive

Vigilant use reduces risk of death by nearly 50 percent, researchers report

TUESDAY, Dec. 6, 2005 (HealthDay News) -- Heart failure patients who adhered to their medications reduced their risk of death by almost 50 percent, even when the medication was a placebo, a new study found.

The study authors reason that the strong placebo effect occurred because patients who stay with their medication regimens are more likely to engage in other healthy behaviors that help improve their outcome.

"Adherence to medications is a key and important predictor of mortality for all patients," said lead author Bradi B. Granger, a clinical nurse specialist at Duke University's Heart Center in Durham, N.C.

Other studies have found that only about 50 percent of heart-failure patients adhere to their medications, however. "This study and others point to the same message," Granger said. "Patients who can adhere to their medications the majority of the time have a lower risk of death."

The study findings appear in Tuesday's early online edition of The Lancet.

In the study, called the CHARM trial, Granger's team collected data on 7,599 patients with heart failure. The patients were assigned to receive the angiotensin receptor blocker candesartan or a placebo, and were followed for three years.

Patients who took their medication at least 80 percent of the time were considered to have good adherence, while those who took their medication less than 80 percent of the time were considered to have poor adherence, according to the report.

"Good adherence to medications was associated with a lower risk of death in all patients," Granger said, "both in those patients who were taking the effective medication and also in those in the placebo group."

Patients who adhered to their medications reduced their risk of death by 48 percent and their risk of rehospitalization by 40 percent, compared with patients who did not adhere to their regimen, Granger said.

The best way to keep patients on their medications is through constant reminders, Granger said. "Everybody needs help in being frequently reminded to take their medications," she said. "To the extent that we can help the family get involved, they can help the reminder process."

Granger said it's unclear why people who were receiving a placebo also reduced their risk of death and hospitalization. "It's hard to explain," she said. "All of the variables that contribute to it are a bit of a 'black box.' The next step is to sort out the things in that black box."

"We can only surmise that patients who are good takers of medication also tend to be diligent in taking care of themselves," Granger said.

One expert said these findings are consistent with other studies and highlight the importance of staying on a drug regimen to improve heart failure results.

"This analysis of the CHARM trial patients confirms findings over the past decades, in that patients in cardiovascular clinical trials that are adherent to study medication or adherent to placebo have a substantially lower risk of mortality than patients that are not adherent," said Dr. Gregg C. Fonarow. He is the Eliot Corday Professor of Cardiovascular Medicine and Science at the University of California, Los Angeles, and co-director of the UCLA Preventative Cardiology Program.

"The findings of a strong association between adherence and better outcome are consistent with the aim of approaches to improve adherence for patients with heart failure, including the American Heart Association's Get With the Guidelines heart failure program," Fonarow said.

"Since heart failure is a major cause of death and disability worldwide, there is an urgent need to improve adherence to evidence-based, guideline-recommended therapies," he added.

More information

The American Heart Association can tell you more about heart failure.

SOURCES: Bradi B. Granger, R.N., Ph.D., clinical nurse specialist, Duke University Heart Center, Durham, N.C.; Gregg C. Fonarow, M.D., Eliot Corday professor of cardiovascular medicine and science, and director, Ahmanson-UCLA Cardiomyopathy Center, co-director, UCLA Preventative Cardiology Program, University of California, Los Angeles; Dec. 6, 2005, early online edition The Lancet
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