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Posted on 12.20.00
Duke CERTs: Why Aren't Patients Taking Medicines That Can Save Their Lives
By Nancy Allen LaPointe
The Duke CERTs is trying to find out why people with certain types of heart disease aren't taking the medicines that can help them.
Aspirin, for example, is inexpensive and is available over-the-counter. It greatly reduces the risk of death, heart attack, and stroke in people with coronary artery disease (CAD, or blockage of the blood vessels that supply blood to the heart). But many people with CAD don't take aspirin or don't take it regularly.
"Physicians and patients may simply be forgetting this simple treatment, which is available everywhere," says Dr. Robert Califf, director of the CERTs Coordinating Center.
Similarly, another class of drugs, the beta blockers, recently has been shown to help people with congestive heart failure (CHF). In CHF, the heart muscle becomes weaker, so that the heart is less able to do its job pumping blood to various parts of the body. Unlike aspirin, though, these drugs are more expensive, require a prescription, and until recently were thought to be harmful for people with CHF, which may be limiting their use.
The first step toward answering the question was to find out how many and how often people with CAD take aspirin, and those with CHF take beta blockers. The Duke CERTs used data from the Duke Databank for Cardiovascular Disease, the largest and oldest cardiovascular database in the world, to get this information.
The results confirmed what many had feared: 13% of the people with CAD were not taking aspirin, and 55% of the people with CHF were not taking a beta-blocker. More important, the people with CAD who were not taking aspirin were almost twice as likely to die within 1 year as those who were taking the medicine. For people with CHF who were not taking a beta blocker, it was only slightly better; they had 1.5 times the risk of dying compared with people who were taking the medicine.
Clearly, not all of the people who should be taking these medicines for their heart disease are actually doing so, and they are paying a high price.
The Duke CERTs is now investigating ways to get the right life-saving medicines to the right people. Once we learn more about why physicians may not be prescribing these drugs, and why people may not be taking them, we can design programs to overcome these barriers and save lives.