Heart patients don't stick to drug programs

A new report says that although people with coronary artery disease (CAD) are now more likely to use evidence-based therapies than they were a few years ago, there is still room for improvement.

The report was based on a study of more than 30,000 CAD patients in the Duke Databank for Cardiovascular Disease, almost 9000 of that number had heart failure.

In particular, efforts are needed to increase patients' long-term adherence to treatment.

The report shows that between 1995 and 2002, the percentage of CAD patients using agents with a proven survival benefit increased each year, but many patients are still not using these drugs on a consistent basis.

As an example, just 71 percent of patients used aspirin consistently.

Lead author Dr. L. Kristin Newby, from the Duke Clinical Research Institute in Durham, North Carolina, says that for a drug that is well-understood, inexpensive, easily available and fairly well-tolerated, the rates should be in the upper 90 percent.

The team found that the use of secondary prevention therapies increased each year from 1995 to 2002, when the use of such therapies ranged from 83 percent for aspirin monotherapy to 39 percent for aspirin in combination with beta-blockers and lipid-lowering therapy.

However the rates of consistent use were lower.

In 2002, rates of overall and consistent use of ACE inhibitors, such as Accupril and Vasotec, in patients with heart failure were 51 percent and 39 percent, respectively, while in those without heart failure, the corresponding rates were 39 percent and 20 percent.

Newby says doctors have spent a great deal of time studying how best to treat patients while in the hospital, but now need to focus on how to improve compliance outside of the hospital.

Dr. Sidney C. Smith, from the University of North Carolina at Chapel Hill, says that most patients still do not receive the comprehensive medical therapies that can dramatically improve cardiovascular outcomes.

The findings appear in the online issue of the medical journal Circulation, January 9, 2006.