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Many Stroke Patients Stop Taking Meds, Study Shows

Posted Aug 10 2010 1:37pm
Second report finds many heart failure patients not even prescribed recommended medications

Tuesday, August 10, 2010
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MONDAY, Aug. 9 (HealthDay News) -- Many stroke patients stop taking their medications while many heart failure patients are never prescribed recommended medications in the first place, new research shows.

In one report, researchers found that 25 percent of stroke patients stopped taking one or more of their stroke prevention medications within three months after their stroke.

"Providers should spend more time teaching stroke patients and caregivers when new risk factors are diagnosed and new medications are prescribed, such as blood pressure or cholesterol medications prior to discharge, while keeping the regimen as streamlined as possible," said lead researcher Dr. Cheryl D. Bushnell, an associate professor of neurology and associate director of the Women's Health Center of Excellence at Wake Forest University Health Sciences.

In addition, those patients with more severe disability and those without insurance are at risk of not continuing medications, she said.

"Most importantly, these results show that some patients require more teaching regarding their medications, including why a medication is prescribed and how to refill it," Bushnell said. "Hopefully, we as providers can improve patients' medication compliance through better communication and by being aware of the factors associated with medication discontinuation."

The report is published in the Aug. 9 online edition of the Archives of Neurology.

For the study, Bushnell and colleagues collected data on 2,598 patients who had been seen in 106 U.S. hospitals with a stroke or a transient ischemic attack (TIA).

Among these patients, 75.5 percent consistently took all the medications prescribed by their doctor.

However, 20 percent of patients were only taking at least half of their medications, and 3.5 percent weren't taking any of their medications three months after their stoke, the researchers found.

Patients who kept taking their medications typically did so for a variety of reasons -- they were suffering from other serious health problems, had adequate health insurance, or they had fewer medications and understood why they were taking them, Bushnell's group noted.

"This is something we have known, that long-term compliance is a problem and unless you target it, people sort of fall off the curve," said Dr. Steven R. Levine, vice chair of neurology at State University of New York, Brooklyn, and chief of neurology at University Hospital Brooklyn.

What is needed is more patient education and follow-up programs for stroke patients, he said. "Physicians can put patients in behavioral modification programs, get them to see physician assistance, nurse practitioners, nutritionists, to work on their risk factors," he said.

Patients need more education and better stroke support systems, Levine added.

"There are very few stroke prevention centers, despite stroke being the number one killer and disabler," Levine said.

In the second report, published in the Aug. 9/23 online edition of the Archives of Internal Medicine, researchers from the Stanford University School of Medicine found that doctors are not prescribing two medications known to be effective in managing heart failure as much as they once did.

"We expect that, over time, recommended therapies for conditions such as heart failure will continue to increase," Dr. Dipanjan Banerjee, a clinical instructor in cardiovascular medicine said. Banerjee, along with Dr. Randall Stafford, an associate professor of medicine, conducted the study.

However, they found while the use of medications such as ACE inhibitors and beta blockers was increasing, the increase was not to the level where it should be, Banerjee added.

"What is concerning to us, when we took another look at the data, [was] we saw there was a plateau and, in some cases, a decrease in the use of these medications," he said.

The team found that use of the ACE inhibitors and angiotensin receptor blockers increased from 34 percent in 1994 to 45 percent in 2002, but decreased to 32 percent by 2009.

With beta blockers, use went from 11 percent in 1998 to 44 percent in 2006, but dropped to 37 percent by 2009.

This suggests doctors may be getting tired of prescribing the same old drugs, which are available as generics, in favor of newer, more expensive ones, Banerjee said.

Dr. Gregg C. Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center at the University of California, Los Angeles, said that "heart failure results in substantial mortality, morbidity and costs. It is thus essential that evidence-based, guideline-recommended therapies be provided to all heart failure patients who are eligible."

This study suggests that from 1994 to 2009, there has been very little improvement in the use of medical therapies demonstrated to improve outcomes in outpatients with heart failure and substantial opportunities to improve heart failure care, he explained.

"However, it is important to note the limitation that these heart failure medications are only demonstrated to benefit about 50 percent of heart failure patients, whereas the data reported in this study are all patients with heart failure," Fonarow said.

The results of a recent study suggest that new evidence-based approaches can result in substantial improvements in the use of drugs, such as ACE inhibitors, angiotensin receptor blockers, beta blockers, aldosterone antagonists and other therapies for heart failure, he said.

"Thus, an important and highly effective solution to the heart failure treatment gaps highlighted in this present study has been identified," Fonarow said.

SOURCES: Cheryl D. Bushnell, M.D., M.H.S., associate professor, neurology, and associate director, Women's Health Center of Excellence, Wake Forest University Health Sciences, Winston-Salem, N.C.; Dipanjan Banerjee, M.D., clinical instructor, cardiovascular medicine, Stanford University School of Medicine, Palo Alto, Calif.; Steven R. Levine, M.D., professor and vice chair, neurology, State University of New York, Brooklyn, and chief, neurology, University Hospital Brooklyn; Gregg C. Fonarow, M.D., professor, medicine, and director, Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles; Aug. 9, 2010, Archives of Neurology, online; Aug. 9/23, 2010, Archives of Internal Medicine, online


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