NEW YORK - Although it is
well established that the long-term use of beta-blocker drugs, such as Tenormin
and Lopressor, can improve survival and other outcomes after a heart attack,
most patients stop taking them after just a few months, new research indicates.
Moreover, drug cost did not appear to be a major determinant of non-adherence
since all of the participants had insurance coverage, according to the report in
the American Heart Journal.
"The focus has been on making sure that (heart attack) patients leave the
hospital with a prescription for beta-blockers and, in this regard, we've been
very successful," lead author Dr. Judith M. Kramer, from Duke University Medical
Center in Durham, North Carolina, told Reuters Health. "However, for this
therapy to be beneficial, patients must continue to take it for the rest of
their lives," so it is important to determine adherence beyond hospital
discharge.
"Anecdotally, you find a lot of examples where people say 'I took my
medicine, doctor', meaning that they thought they were finished with therapy
after completing the prescription given to them at hospital discharge," Kramer
said.
These types of stories led the researchers to conduct a formal analysis of
long-term beta-blocker use among 17,035 patients who had survived at least 1
year after a heart attack and had insurance coverage, either commercial or
Medicare + Choice (M+C).
In the year after hospital discharge, just 45 percent of patients were
adherent with beta-blocker therapy, defined as prescription claims covering at
least 75 percent of days. Adherence fell most dramatically between 30 and 90
days after hospital discharge.
M+C coverage, residence in the Southeast, and younger age (primarily for
women) were all predictive of lower adherence with beta-blocker therapy, the
report indicates.
Kramer said that the poor adherence may relate to patients not remembering
the instructions given to them at hospital discharge. She added that this is not
surprising since patients are typically bombarded with information when leaving
the hospital.
In addition, communication issues may play a role if the physician treating
the patient in the hospital is not the same one providing follow-up care.
Kramer said that her group is now involved in a trial evaluating an
intervention designed to improve long-term adherence with outpatient
medications. A key feature of the intervention is having pharmacists take a more
proactive role in ensuring that patients are filling recommended prescriptions,
she added.
SOURCE: American Heart Journal, September 2006.
