Study: Skipping Pills Can Kill

Sept. 14, 2007 — -- Did you take your heart medication today? If you answered no, you could be doubling your risk of heart attack, stroke -- or even death.

Still, about 8 percent of heart patients say they skip their medications more than 25 percent of the time, according to a study published this week in the journal Archives of Internal Medicine. And these patients do much worse.

"I think we know that medication nonadherence is an issue," says Dr. Anil Gehi, a fellow in cardiovascular electrophysiology at Emory University School of Medicine in Atlanta and lead author of the study. "This study helps to clarify the overall importance of it."

The study, which looked at more than 1,000 patients, asked one main question: "How often did you take your medications as the doctor prescribed?" Patients who took their medications less than 75 percent of the time were considered noncompliant.

Researchers studied the patients over three years, and they found that patients who did not take their medications were more than twice as likely to suffer a heart attack, stroke, or death during this time.

Yet Another Bad Heart Habit

According to the study, not taking medications is just as bad as smoking or diabetes when it comes to cardiovascular problems down the road.

And noncompliance could be an even more widespread habit than the recent study indicates.

"Because patients who volunteer for studies are likely to be more health conscious than the population in general, the actual proportion of patients with nonadherence is much larger," says co-author Dr. Mary Whooley, associate professor of medicine at the Veterans Affairs Medical Center and University of California at San Francisco.

"Physicians get reports on the refill rates of patients from pharmacy benefits managers, and it is evident that the rates are much higher than 8 percent," says Dr. Seth D. Bilazarian, a cardiologist at Pentucket Medical Associates in Haverhill, Mass.

"It's a big problem, especially in demographic groups with less education; the [noncompliance] rates are much higher … probably 20 to 30 percent."

The Root of the Problem

Dr. Melvyn Rubenfire, director of preventive cardiology at the University of Michigan, says that there are any number of reasons that heart patients may choose not to take their medications. But the biggest issue is cost.

"[Noncompliance] is more common among the elderly, those with financial issues, less well educated, and men who are widowers," he says. Others may choose to skip their medications because they are concerned about toxicity or side effects.

Some patients may also not understand that skipping their meds can have such a profound effect on their health.

"Preventive strategies don't make people feel better, and they don't feel immediately worse by omitting them," Bilazarian says.

So why is this happening? Bernard Gersh, professor of medicine at Mayo Medical School in Rochester, Minn., said that one part of the problem may lie in a breakdown in communication between doctor and patient.

An "understanding of why drugs are being prescribed, [the] relationship with health care providers, [and] time spent with the patient" can help remedy the problem, Gersh said.

Another interesting finding of the study was that people who did take their medications regularly also tended to do other things right when it came to their health.

"We believe better compliance with medications also tracks with other more favorable behaviors," said Dr. Marc A. Pfeffer, professor of medicine at Brigham and Women's Hospital in Boston. "We found that patients with heart failure that took more of their medications did better -- even those [taking] placebos."

"It might not be just the effect of the medications. It might be a marker of patients that don't pay as much attention to their health," Gehi adds.

Despite all of the data showing the profound effects of medication noncompliance, the most important question remains: How do we fix the problem?

"Better patient education regarding the need for following directions and information [about] side effect" may help improve compliance, says Rubenfire. He adds that getting the message across to patients that while there may be side effects and toxicity associated with their drugs, the benefits of taking their meds may outweigh the risks of skipping them.

As for reducing the financial burden of ongoing prescription drug use, Rubenfire suggests using "generic drugs, combination drugs and once per day [drugs] if possible to reduce doses and numbers of pills."

Compliance 'Not Rocket Science'

The study did have its weaknesses. Whooley said the research does not look at specific medications, and the study population may not have been entirely representative of everyone who takes prescription medications.

"The patients were mostly men, so it's unclear whether the same relationship would be true for women," she says.

But overall, the authors believe the study plays an important role in emphasizing the importance of compliance.

"I think it's a fairly straightforward study with a pretty simple message," said Gehi. "Physicians, patients and the public health sector need to pay more attention to adherence."

"It's not rocket science -- taking the medicines as your doctor tells you to is actually going to prolong your life," says Whooley. "That's the take-home message."