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More heart deaths?


Sometimes, we just don’t get around to filling that doctor ordered prescription. This could prove deadly to one-quarter of heart attack survivors, significantly increasing their risk of dying in the first year after leaving the hospital, says a new study from Ontario’s Institute for Clinical Evaluative Sciences (ICES).

Lead author and ICES researcher, Dr. Cynthia A. Jackevicius says, “taking medications such as aspirin, beta blockers, statins or ACE inhibitors after having a heart attack is a powerful way to prevent future heart attacks and deaths, now for the first time we have documented these patients’ adherence.” ICES researchers used data from a population-based acute heart attack registry that linked to prescription drug claims, vital statistics, use of physician services and hospital discharge databases.The primary data source for patient information was the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study registry, which included hospital records from 104 acute care hospitals in Ontario from 1999–2001. The primary outcome was one-year mortality.

“We looked at data from 4,591 patients in Canada who had been in the hospital and the 12,832 prescriptions that were written as a result of their having had heart attacks,” said Jackevicius. “From the data, we were able to see what people were supposed to be filling, as far as prescriptions to prevent heart attack, and whether those prescriptions were filled or not.” To analyze drug adherence, researchers linked to the Ontario Drug Benefit prescriptions claims database.

The results:

  • 1 in 5 of all prescriptions were not filled after heart attack patients left the hospital
  • 3 out of 4 patients filled all their prescriptions
  • Patients who filled none of their prescriptions had an 80% higher chance of dying in the year following their heart attacks vs. those who filled all their prescriptions.
  • If some of the prescriptions were filled, patients had a 40% increased chance of dying in their first year vs. if they filled all their prescriptions
  • Patients who were educated in the hospital about their prescriptions were more likely to fill Patients who filled their prescriptions were also more likely to do so within one week of leaving the hospital
  • Summary: 25% of the patients did not fill their prescriptions completely or not at all

“We hope that members of the healthcare team including physicians, nurses and pharmacists will use this information to reinforce their educational efforts aimed at ensuring heart attack patients fill their prescriptions after leaving hospital,” says co-author, ICES senior scientist and Canada Research Chair in Health Services Research, Dr. Jack Tu. “Patients who are unsure about the reasons for their medications should not hesitate to speak to a member of their healthcare team. Healthcare providers should be aware many patients may not fill all their prescriptions after discharge, so strategies such as follow up telephone calls to remind patients to fill prescriptions and take their medications should be considered. Heart attack patients need to know that they will significantly increase their risk of dying if prescriptions aren’t filled, it’s that simple.”

Future research should also explore why patients don’t necessarily fill their prescriptions, Jackevicius said.

The study “Prevalence, predictors and outcomes of primary nonadherence after acute myocardial infarction” is in the February 26 issue of Circulation.

Author affiliations: ICES (Drs. Jackevicius, Tu, Li); (Dr.Jackevicius) University Health Network;(Drs. Jackevicius, Tu ) Faculty of Medicine, University of Toronto; (Dr.Tu) Division of General Internal Medicine and Cardiology, Sunnybrook Health Sciences Centre, Ontario, Canada; (Dr.Jackevicius) Department of Pharmacy Practice, Western University of Health Sciences; California, US.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.



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