Wednesday, January 11, 2006

Heart drug use suboptimal

Many patients whose lives may depend on agents like aspirin or on drugs that control heart rate and lower cholesterol stop taking them over time.

Not only that, according to L. Kristin Newby, M.D., and colleagues at the Duke Clinical Research Institute here, doctors often stop prescribing drugs that have proven to be effective for secondary prevention of cardiovascular disease.

The recommended medications were aspirin, beta-blockers, lipid-lowering drugs, and, for those patients with heart failure, ACE inhibitors, the Duke investigators reported in the Jan. 17 issue of Circulation, Journal of the American Heart Association.

Only 71% of heart disease patients consistently take aspirin during seven years of follow-up, and adherence to lipid-lowering therapy and beta blockers is even lower. The evidence for aspirin’s benefit is so robust and the drug is so well tolerated, that Dr. Newby said she would have expected upwards of 90% of patients to be taking the drug.

"Substantial improvements in the care of coronary artery disease patients and in their outcomes could result from efforts focused on improving long-term adherence to proven therapies.”

Doctor-patient relationships should be improved. Merely using reminders to boost patient compliance may not work. Mail and telephone reminders to encourage patients to take their prescription medication as directed may be a pointless exercise, a new study suggests. "Doctor-patient relationships drive compliance, not postal and telephone reminders."

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