Noncompliant Patients

A lot of people with heart disease aren't taking the medications their doctors prescribe for them as often as they should, cardiologists report.

Almost half of the 31,750 people treated at Duke University for major heart problems in a seven-year study acknowledged that they were not taking beta blocker drugs, aspirin and cholesterol-lowering drugs exactly as their doctors had ordered, according to a report in the Jan. 10 issue of Circulation.

In fact, the study showed, the patients who would benefit most from drug therapy -- the elderly, those with heart failure, those with other diseases -- were the least likely to be using them as directed.

The study participants had all undergone at least one heart procedure, such as bypass surgery, or had at least 50 percent blockage of one coronary artery. Yet, while a majority did take the drugs now and then, many did not take them regularly.

For aspirin, presumably the easiest drug to take, 29 percent said they did not consistently use it as ordered. The compliance rate was much lower for other medications: 46 percent said they took beta blockers as ordered, and only 44 percent followed instructions for using lipid-lowering drugs such as statins.

The usage of ACE inhibitor drugs by people with heart failure, the progressive loss of ability to pump blood, were even lower: only 20 percent said they took the medication consistently.

This is rather discouraging. I wonder if the patients really understand how important these medications are to their health, and even survival. Less than 50% compliance is a health crisis in its own right.

What's the solution here? Patient education? Paper checklists? Visiting nurses? Phone call reminders? I think we should all brainstorm here and try to do better; our patients deserve no less from us.