Heart drug use has increased, but still suboptimal

Patients with coronary artery disease (CAD) are now more likely to use evidence-based therapies than they were a few years ago, but room for improvement still exists, new research indicates. In particular, efforts are needed to increase patients' long-term adherence to treatment.

Between 1995 and 2002, the percentage of CAD patients using agents with a proven survival benefit increased each year. However, the report shows that many patients are still not using these drugs on a consistent basis. For example, just 71 percent of patients used aspirin consistently.

"It is eye-opening to be reminded how much work we still have to do when in this day and age, only 71 percent of heart patients are taking aspirin," lead author Dr. L. Kristin Newby, from the Duke Clinical Research Institute in Durham, North Carolina, said in a statement.

"For a drug that is well-understood, inexpensive, easily available and fairly well-tolerated, we should see rates in the upper 90 percent."

The findings, which appear in the online issue of the medical journal Circulation, are based on a study of more than 30,000 CAD patients in the Duke Databank for Cardiovascular Disease. Of the subjects, nearly 9000 had heart failure.

As noted, the use of secondary prevention therapies increased each year from 1995 to 2002. In 2002, use of such therapies ranged from 83 percent for aspirin monotherapy to 39 percent for aspirin in combination with beta-blockers and lipid-lowering therapy. Rates of consistent use were lower.

In 2002, rates of overall and consistent use of angiotensin-converting enzyme (ACE) inhibitors, such as Accupril and Vasotec, in patients with heart failure were 51 percent and 39 percent, respectively. In those without heart failure, the corresponding rates were 39 percent and 20 percent.

With the exception of ACE inhibitor use by patients without heart failure, consistent use of the evidence-based therapies yielded a survival benefit, the report indicates.

"We as physicians have spent a great deal of time studying how best to treat our patients while in the hospital, so now we need to focus on better understanding the barriers to improved compliance outside of acute medical settings," Newby emphasized.

In a related editorial, Dr. Sidney C. Smith, from the University of North Carolina at Chapel Hill, comments that while the findings indicate progress has been made, "most patients still do not receive the comprehensive medical therapies that can dramatically improve cardiovascular outcomes. If we are to recognize the true potential of these therapies, we must...provide the necessary focus and resources to see that remaining gaps in therapy are eliminated for all sociodemographic groups."

SOURCE: Circulation, January 9, 2006.