heart attack, patients are often given four or more medicines and directed to
take them for life. Those medicines only work to prevent another attack if the
patient takes them all consistently and correctly, a new study shows.
really have to take your medications all the time to derive any benefit,"
said Dr Niteesh K Choudhry. He led the study at Brigham and Women's Hospital
in Boston. That may seem obvious. But drugs that appear to work in clinical
trials aren't always as effective in the real world, where nobody is making
sure you take your meds on time, he said.
Heart attack survivors are often prescribed
beta-blockers to slow heart rate, statins to lower cholesterol and other drugs
to keep blood pressure down. In an earlier trial, Choudhry and his co-authors
compared a group of heart attack survivors given free prescriptions to people
who had to pay for their medicines, as most real-world patients do.
trial, people in the free prescription group were about 5% more likely to take their
medications at least 80% of the time, compared to people with copays. But there
was no difference between the groups when it came to later hospital admissions
for heart problems.
For the new
study, the researchers divided people who got free prescriptions into three
smaller groups based on how often they took all their medicines: at least 80% of
the time, 60% to 79% of the time or less than 60% of the time. Study
participants who took their free medicines most often were 24% more likely to
never be readmitted to the hospital for another heart attack or a stroke, chest
pain or heart failure than those in the comparison group with copays.
Those people varied widely in how often they
took their medications. Taking some, but not all, of the medications regularly
was not linked to any benefit, according to results published in the American
Heart Journal. "It's difficult to determine which medications are most
important," Choudhry said.
all appear to be important," he told Reuters Health. "It's not like
patients can take one and not another. "That's too bad, because being
saddled with so many prescriptions can be a drain on patients, he said. That's
why some may not take their medications consistently, even though they help protect
anyone is going to be motivated to take their blood pressure and cholesterol
medications, it will be patients who have just had a heart attack," Dr
Walid Gellad said. Gellad is a physician at the Pittsburgh VA Medical Centre
and Co-Director of the University of Pittsburgh's Centre for Pharmaceutical
Policy and Prescribing.
He was not involved in the new study. There
are lots of reasons people may skip doses, including cost, forgetfulness, side
effects, attitudes and beliefs, the experts agreed.
messages or electronic pill bottles may help remind patients to take their
medications, but that too is unlikely to completely solve the problem. People
who have serious side effects should talk to their doctors and look into
alternative treatments, Choudhry said.
doctors and researchers can improve health by getting people to correctly take
current drugs, not just by developing new drugs. "For patients, providers
and policymakers this is a really critical message," Dr Nihar Desai, a
cardiologist at Yale School of Medicine in New Haven, Connecticut, told Reuters
Health. He also didn't participate in the new research.
we should be investing more in interventions aimed at improving adherence to
currently available therapies rather than finding additional therapies that may
be of only marginal benefit," Desai said.