Why don't heart patients take their medicine? Study finds forgetfulness at the top of the list

March 09, 2004

NEW ORLEANS -- It's one of the biggest conundrums in medicine: Why don't patients take the medications their doctors prescribe, even when the drugs could save their lives or prevent their conditions from worsening?

A new study from the University of Michigan Cardiovascular Center sheds some light on this problem - by looking at reasons why heart attack and angina patients don't take four key drugs known to cut their symptoms and risk of death.

The study, presented today at the Annual Scientific Session of the American College of Cardiology, finds forgetfulness, carelessness and side effects all play a role.

Even among patients whose doctors are taking part in a program aimed at optimizing the quality of heart care - as these U-M patients were - about half reported some problems sticking to their drug regimens six months after they left the hospital.

"It's crucial that we determine why patients aren't adhering to their medications, because we know that taking these particular four drugs can do so much for them," says senior author Kim A. Eagle, M.D., clinical director of the U-M Cardiovascular Center. "It appears that we need to find better ways of helping patients remember to take their pills, so they and our health care system can get the best result."

The study involved 154 patients who had suffered acute coronary syndromes (heart attack or unstable angina episode) and were hospitalized at the U-M Health System. The vast majority of them were taking some or all of the "Fab Four" classes of drugs for heart patients: anti-platelet medications such as aspirin, ACE inhibitors, beta blockers and lipid-lowering, cholesterol-fighting statin drugs.

The researchers contacted the patients six months after they left the hospital, and asked them about their adherence to their medications using standardized questionnaires. They also asked about their household size and education levels.

In all, 50.4 percent of the patients reported some level of non-adherence to their medication regimen. More than 48 percent said they hadn't stuck to their statins, while 40 percent had trouble keeping up with their ACE inhibitors. Aspirin and beta blocker non-adherence rates were also in the 40 percent range.

When asked why they didn't keep up with their medication schedule, the patients' top reason was that they had forgotten. Carelessness was second, followed by a few patients who said they didn't take some of their drugs when they felt better - or when they felt worse.

About 10 percent of the patients had discontinued one of the drugs all together - and just over half of them reported that their doctors had told them that one or more of the four drugs was "not necessary".

Another 9 percent of the patients who discontinued at least one drug said they had done so because they didn't like the side effects. And just over 5 percent said they couldn't afford to buy the medication, so they stopped taking it. All four of the medications studied are available in inexpensive generic forms; the cost per month could be as low as $50 or much higher, depending on which drugs are prescribed.

The results will be presented at the ACC meeting by U-M Medical School student Anchal Sud.

Eagle and Sud are careful to note that the population of patients studied at U-M is not typical of the nation. More than half of the patients had some college or technical school training or were college graduates. The study population was over 95 percent white, with an average age of 64, and only 11 percent of the participants lived alone.

If adherence is a problem for these patients, treated by quality-oriented physicians, it may be even more so for others, Eagle warns.

"Further studies in broader populations are desperately needed, so we can understand the reasons behind non-adherence in order to improve compliance with medication schedules, and as a result improve patients' health status," he says. "All the studies in the world showing how well these drugs work as preventive agents don't mean anything if patients aren't taking them."

Eagle notes a recent study by U-M researchers which was published in the journal Circulation. It found that acute coronary syndrome patients who took one drug from all four of the "Fab Four" categories had a 90 percent lower risk of dying in the six months after hospitalization than those patients who took none of the drugs.

At the ACC meeting, U-M researchers will present results showing a similarly powerful effect for more than 2,300 patients who had a percutaneous coronary intervention such as an angioplasty or a stent.

In addition to Sud and Eagle, the study's authors include others at the Michigan Cardiovascular Outcomes Research and Reporting Program, including Jianming Fang, M.D.; Eva Kline-Rogers, MS, RN, NP; Steve Erickson; David Armstrong; Krishna Rangarjan; and Rich Otten, M.D.

University of Michigan Health System

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