Preventive Care

Use of prevention drugs after heart attacks declines steadily after hospital discharge

Quality measures report on how often patients who suffer heart attacks are prescribed two recommended drugs—beta blockers and angiotensin-converting enzyme (ACE) inhibitors—when they are discharged from the hospital. Though the 2007 National Healthcare Quality Report shows that hospitals have improved in prescribing these drugs, a new study finds that patients often do not continue taking them in the 2 years following a heart attack.

Beta blockers work against adrenaline, causing the heart to beat more slowly and improving blood flow. ACE inhibitors help blood vessels relax so the heart does not have to work so hard.

Using medical and pharmaceutical claims from June 1, 2000, to May 31, 2001, researchers from Rutgers University found that patients taking beta blockers and ACE inhibitors steadily abandoned those drugs over time, once they were discharged from the hospital. For instance, 6 percent of patients stopped taking their beta blockers within the first 30 days, 18 percent at 6 months, 28 percent at 1 year, and 47 percent at 2 years. Discontinuation results were similar for ACE inhibitors.

Several factors influenced patients' continuation of the drugs. Women and patients who lived in high-income neighborhoods (more than $60,000 annual median income), had high blood pressure, or had vascular disease were more inclined to continue taking beta blockers. Patients taking ACE inhibitors were more likely to keep taking those drugs if they previously suffered from coronary artery disease or angina. Cost was not presumed to be related to continuation, as most patients paid $5 co-payments for their medications.

Side effects of the drugs, including fatigue and loss of sexual functioning with beta blockers, could contribute to their unpopularity. However, because these drugs decrease the chance of future heart attacks, the authors say more research is warranted to determine why patients stop taking them. Further, because of the widespread abandonment of these drugs, additional quality measures that address drug adherence should be developed. This study was funded in part by the Agency for Healthcare Research and Quality (HS16097 and HS11825).

See "Long-term adherence to evidence based secondary prevention therapies after acute myocardial infarction," by Ayse Akincigil, Ph.D., John R. Bowblis, M.A., Carrie Levin, PH.D., and others in the February 2008 Journal of General Internal Medicine 232(2), pp. 115-121.

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