Many heart attack patients don't refill their meds

NEW YORK Thu Oct 4, 2012 2:12pm EDT

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NEW YORK (Reuters Health) - Older people who've suffered a heart attack often don't stick with the drugs their doctor prescribes, although the medications have been proven to save lives, according to a new study.

Seniors filled prescriptions for the clot-buster drug clopidogrel (Plavix) less than half the time on average, for instance. And the less diligent they were at getting their meds, the more likely they were to have health problems and die early, researchers found.

Given that the drugs are known to be helpful, "it should be no surprise that patients who actually don't take their medications for various reasons don't get as much of that benefit," said Dr. Kim Eagle, who heads the Cardiovascular Center at the University of Michigan Health System and was not involved in the study.

After a heart attack, patients are typically prescribed a number of drugs to prevent another one, including a clot-buster, blood pressure drugs, beta-blockers and statins.

Clinical trials have proven that the drugs are effective. Ilene Zuckerman of the University of Maryland School of Pharmacy, who led the new study, said she and her colleagues wanted to see how the medications are used in the real world. Their work was funded by drugmaker GlaxoSmithKline.

The researchers, who published their results in the Journal of the American Geriatrics Society, collected medical and prescription information from more than 9,500 Medicare beneficiaries who had survived a heart attack.

Within one month of leaving the hospital, 59 percent of people filled a prescription for one of two kinds of blood pressure drugs, 51 percent filled a prescription for a beta-blocker, 54 percent for a statin and 46 percent for clopidogrel.

Overall, during the first year and a half following the heart attack, adherence to the drugs ranged from 37 percent to 50 percent.

Zuckerman said she was surprised to see the use of these drugs being so low, knowing that they are a standard part of care for heart attack patients.

Patients who refilled their prescriptions - except for those for beta-blockers, a drug that has become increasingly controversial - were less likely to die early or experience a stroke, heart failure or another heart.

People who filled all or almost all of their statin prescriptions, for instance, saw a 29-percent reduction in the risk of dying early or having another serious health event compared with those who rarely took the drugs.

It's impossible to say for certain that those health benefits can be chalked up to the medicine alone, since people who fill their prescriptions regularly may also be more health conscious overall or have other characteristics that could make a difference.

Still, Zuckerman, who is on a contract with GlaxoSmithKline, said the study confirms the drug benefits seen in clinical trials.

"It suggests that if we could improve the use of these drugs, have people take them more regularly, that we could potentially improve outcomes," she told Reuters Health.

How to do that isn't clear, though.

"There are very few known effective interventions for medication adherence," said Dr. John Rumsfeld, the national director of cardiology for the U.S. Veterans Health Administration, who was not involved in the study.

In addition, it's not entirely clear why patients don't always stick with their medicine.

In some cases, instructions to patients might not be clear or they might lack health insurance or face high copays for drugs. A study out earlier this week, for instance, shows lower copays on certain heart drugs may boost adherence somewhat (see Reuters Health report of October 3, 2012).

In other cases, patients might experience side effects on the drugs. And then there's the role of the patient.

"Both physicians and non-physician care givers, we don't, I think, understand the natural inertia for patients is to stop taking their drugs -whether it's because of co-pays or side effects or 'I just forgot' or 'I don't feel bad, so why do I have to take these five pills,'" said Eagle.

Eagle said that in his experience, people often discontinue a drug because they receive a good bill of health, not understanding that the drugs are important to maintaining that good health.

"We need a system that explicitly asks the question, 'Am I on the right medications, what are they for, do I have refills?'" he added.

Rumsfeld called for more research to help patients stay on prescribed medications. He said doctors are great at helping people survive a heart attack, but not so good at following up after the immediate crisis.

"The vast majority of patients survive heart attacks - it's about stabilization and initiation of key therapies - and I think what we need to now focus on is maintenance and sustainment of treatment over time," he said.

SOURCE: bit.ly/T5mhux Journal of the American Geriatrics Society, online September 24, 2012.

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