Why Getting Patients to Take Cardiac Medications Is a Challenge

Drugs won't work if patients don't take them.

Heart patients who do not take their medications as directed are likely to get worse. Writing in the Journal of the American College of Cardiology, Keith Ferdinand, MD, of Tulane Heart and Vascular Institute and colleagues reported on the extent of the problem and suggested ways to address it.

“Medical nonadherence, a major problem in cardiovascular disease contributes yearly to approximately 125,000 preventable deaths,” the team wrote, estimating that only half of these patients consistently take their medications as prescribed.

Though it is difficult to quantify the extent of the problem, it is clear the situation needs to be better managed since one study of patients with stable coronary artery disease showed they were 4.4 times more likely to have a stroke and 3.8 times more likely to die when they did not take medications (a behavior that patients self-reported).

Conversely, when post-heart-attack patients were more than 80% compliant with their regimens, there was a lower rate of adverse cardiac events, as well as lower costs to the health system.

The researchers looked at many factors that they thought might be playing a role in why some patients chose not to comply with physicians’ orders.

Those were health care systems-related factors, medical condition factors including mental health problems or substance abuse, the complexity of their regimens, and patient-related factors such as low literacy or deficits in hearing. Socio-economic factors were also considered.

Attempting to refine their findings into usable recommendations for clinicians, the team suggested that doctors engage their patients more directly with “literacy-sensitive information” and that doctors should try web-based portals for communicating relevant information, and use phone reminders. “Develop an office-based strategy to monitor adherence,” they advise.

Another tip: use generic drugs to cut patients’ costs.

Doctors should also “be judicious about poor-quality evidence,” and use the federal Sentinel System to report adverse events with drugs.

Individual physicians and medical practices cannot solve the problem alone, however, and solutions require “the participation of governmental agencies, academia, and organizations devoted to optimizing health care.”

They note that the US Food and Drug Administration (FDA) and other have many activities in place to address the issue.

Among the biggest challenges is finding “alignment between therapeutic evaluation and labeling” of drugs, but the if clinicians and health systems do their part to improve adherence, the change “could ultimately have a major effect on health outcomes.”

The study “Improving Medication Adherence in Cardiometabolic Disease” was posted Jan. 23 online ahead of print in the JACC.