Monday, September 17, 2007

Heart and Soul Study

Below is the Abstract from the Heart and Soul Study I found in The Archives of Internal Medicine current issue. Unfortunately I do not have a subscription, but I can see flaws in this study just looking at the methodology. I support studies like this in finding the root and causes of medication non-adherence, but self reporting has never been an acurate measure. See my comments below.

Nonadherence to physician treatment recommendations is an increasingly recognized cause of adverse outcomes and increased health care costs, particularly among patients with cardiovascular disease. Whether patient self-report can provide an accurate assessment of medication adherence in outpatients with stable coronary heart disease is unknown.

We prospectively evaluated the risk of cardiovascular events associated with self-reported medication nonadherence in 1015 outpatients with established coronary heart disease from the Heart and Soul Study. We asked participants a single question: "In the past month, how often did you take your medications as the doctor prescribed?" Nonadherence was defined as taking medications as prescribed 75% of the time or less. Cardiovascular events (coronary heart disease death, myocardial infarction, or stroke) were identified by review of medical records during 3.9 years of follow-up. We used Cox proportional hazards analysis to determine the risk of adverse cardiovascular events associated with self-reported medication nonadherence.

Of the 1015 participants, 83 (8.2%) reported nonadherence to their medications, and 146 (14.4%) developed cardiovascular events. Nonadherent participants were more likely than adherent participants to develop cardiovascular events during 3.9 years of follow-up (22.9% vs 13.8%, P = .03). Self-reported nonadherence remained independently predictive of adverse cardiovascular events after adjusting for baseline cardiac disease severity, traditional risk factors, and depressive symptoms (hazards ratio, 2.3; 95% confidence interval, 1.3-4.3; P = .006).

In outpatients with stable coronary heart disease, self-reported medication nonadherence is associated with a greater than 2-fold increased rate of subsequent cardiovascular events. A single question about medication adherence may be a simple and effective method to identify patients at higher risk for adverse cardiovascular events.

I don't really like the number 75% as being a proper number for adherence. It should be 100%. Diabetics need to take their pills everyday or suffer problmes with their blood sugar. What if they only chose to take those pills five days a week and skip the weekend? Does that 75% sound OK to you?

Here's a surprising fact: if you do not take your medication, you are more than likely to have a heart attack. The national average for non-adherence is over 50% - it is astounding how they found the minority as the basis for their study. As far as I know, self reporting has never been an acurate gauge for a study.

Everyone feels guilty and will lie regarding non-adherent behavior regarding everything from flossing to diet to heart medication. Here, take these, they will save your life - oh jeez, yeah I know I was supposed to take them, but, you know, I forgot, so now I am in the hospital - but I did tell you I took them.

Patient education is an important factor, as well as side effects and financial costs when dealing with medication non-adherence. But most often, people forget and it is not in their behavior (especially with a new script) to be adherent to medication - although in this case I like compliant because if you do not take that medication, you will return the hospital and die.

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