Heart Medications: The More You Skip, The More You Risk

Main Category: Heart Disease
Also Included In: Compliance;  Public Health
Article Date: 15 Sep 2007 - 0:00 PDT

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Although it might take some effort to find out why some patients skip taking their medicine, a new study finds that heart patients who most frequently miss a dose are more than twice as likely to suffer heart attack, stroke and death.

The findings are important because they pinpoint the size of the problem, said study co-author Mary Whooley, M.D., associate professor of medicine at the University of California at San Francisco. Just over 8 percent of the 1,015 patients surveyed said they fail to take their medicine at least 25 percent of the time.

"The next step is to figure out how we can change people's behavior," Whooley said. "It is so hard to convince people to lose weight, exercise and take their medicines as they're supposed to. If we could figure out ways to motivate people to change, that would have tremendous public health consequences."

Whooley and colleagues asked coronary heart patients taking part in a national study whether they took their medications over the past month as prescribed. Then they followed the patients for almost four years to see who died and who had survived a heart attack or stroke. The study results appear in the Sept. 10 issue of the Archives of Internal Medicine.

After the researchers adjusted the numbers to account for the effects of factors like depression and severity of illness, those who admitted not taking their medication more than 25 percent of the time were 2.3 times more likely to suffer serious problems including death when compared to the others. Close to 14 percent of patients who more regularly took their medications experienced cardiac events, compared with about 23 percent of those who more frequently skipped doses.

"Honestly, it's not really rocket science," Whooley said. "It's pretty intuitive that if you don't take your medications, you won't do as well."

Why do patients fail to follow their doctor's directions? Samuel Sears, Ph.D., professor of psychology and internal medicine at East Carolina University, said it is often a matter of miscommunication between the doctor and the patient.

Most patients do not intend to disobey doctor's orders, according to Sears. "I put the onus on our health care system and the providers to walk in the patient's moccasins a bit and look at why they can't get it done," he said.

One of his own patients, Sears said, did not follow instructions regarding diabetes medication. It took some questioning to reveal that she was afraid of needles.

While it is possible that other factors could affect the health of those who do not take their medications consistently, it is still important for doctors to ask a "simple question" about whether patients follow medication instructions and to follow up if they don't, said P. Michael Ho, M.D., staff cardiologist at Denver VA Medical Center.

Gehi AK, et al. Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease. Arch Intern Med 167(16), 2007

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