Heart patients often stop their medication

You've survived a heart attack and made it out of the hospital. Wouldn't you stick to the medication you've been prescribed? A surprising number of people do not, apparently.

As many as 20 percent of patients hospitalized with a heart attack or heart-related chest pains stop taking prescribed medication within six months, researchers report in the American Journal of Medicine.

"We need to understand why patients are stopping their medications," lead investigator Dr. Kim A. Eagle told Reuters Health.

Numerous clinical trials have shown that drugs such as aspirin, beta-blockers, cholesterol-lowering "statins" and angiotensin-converting enzyme (ACE) inhibitors can prevent a second heart attack or recurrence of serious episodes of angina.

"These particular therapies are known to prolong life in appropriate candidates, so stopping them without a sound medical reason can be detrimental to patient outcomes," said Eagle, of the University of Michigan Cardiovascular Center in Ann Arbor.

To investigate patients' adherence to their treatment regimen, Eagle and colleagues studied 21,408 patients discharged from 104 institutions after a heart attack or severe angina. Details were available for 13,830 patients from 5 to 12 months after discharge.

By six months, 8 percent of those prescribed aspirin had discontinued treatment; 12 percent of the patients prescribed beta-blockers had stopped; 13 percent of those on statin drugs quit therapy; and 20 percent of patients prescribed ACE inhibitors stopped taking them.

Younger patients were more likely to stick to aspirin and beta-blocker therapy than older patients. Care by a cardiologist also improved compliance with aspirin therapy. Being male and previously having had heart failure increased ACE inhibitor adherence, the team found.

"How patients receive and then are maintained on the right medications is complicated and highly variable," Eagle said.

"Until the health professions are able to properly tease out the barriers - and there are many - we are not going to achieve the degree of secondary prevention that we know is possible," he concluded.

SOURCE: American Journal of Medicine, July 15, 2004.