Newby LK, Allen LaPointe NM, Chen AY, et al. Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease. Circulation2006;113:203-212

Smith SC Jr. Evidence-based medicine making the grade. Miles to go before we rest. Circulation . 2006;113:178-179

Long-term compliance with CAD meds “poor” Lisa Nainggolan Heartwire January 9, 2006

The Study

31,750 patients who had undergone a cardiac procedure (e.g., a coronary artery bypass) reported their use of aspirin, beta blockers, and lipid-lowering drugs in annual surveys between 1995 and 2002. This group was divided into those with heart failure and those without.

Nearly half the Coronary Artery Disease (CAD) patients in the seven-year study admitted they did not consistently take beta blockers, lipid-lowering therapy, and other medications.

Older patients, those with heart failure, smokers, and diabetics were least likely to consistently take medication.

The researchers found the use of all drugs and combinations increased year to year, but consistent use lagged. In 2002, for example, 83 percent of patients reported using aspirin, 61 percent used beta-blockers, 63 percent lipid-lowering drugs, 54 percent aspirin and beta-blockers and 39 percent, used all three. Consistent use, however, was lower. Aspirin was 71 percent, beta-blockers; 46 percent; lipid-lowering or cholesterol-lowering drugs, 44 percent; aspirin and beta-blockers 36 percent and all three, 21 percent. Thirty-nine percent of patients without heart failure reported using ACE inhibitors in 2002. However, only 20 percent reported consistent ACE inhibitor use. Of those with heart failure, 51 percent reported ACE inhibitor use in 2002. Consistent use, however, was reported by only 39 percent.

In the accompanying editorial, Dr Sidney Smith writes that the study “is of particular interest because it provides information on the use of medical therapies over time and examines consistency of use long term and its relationship to mortality.” Dr. Smith goes on to conclude

Commentary

It’s become a ritualized refrain for me to open my commentary on these studies with something along the lines of “It is not surprising to learn that compliance with _______ treatment is low.”

And, indeed, in the case of medications used to treat cardiovascular disease, there is little unusual about the adherence rates. Evidence of the efficacy of the medication, on the other hand, may be somewhat more established than for some other classes.

The study also makes the somewhat unusual but helpful step of differentiating between inconsistent and consistent use of the drugs.

Perhaps the question becomes at what point are there enough studies indicating insufficient compliance with enough different treatment regimens to compel us (i.e., the stakeholders: patients, the clinical community, healthcare payers, government) to join our energies and efforts in producing and executing a workable compliance enhancement program.

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