Heart drug use has increased, but still suboptimal

NEW YORK (Reuters Health) – Patients with coronary artery
disease (CAD) are now more likely to use evidence-based
therapies than they were a few years ago, but room for
improvement still exists, new research indicates. In
particular, efforts are needed to increase patients’ long-term
adherence to treatment.

Between 1995 and 2002, the percentage of CAD patients using
agents with a proven survival benefit increased each year.
However, the report shows that many patients are still not
using these drugs on a consistent basis. For example, just 71
percent of patients used aspirin consistently.

“It is eye-opening to be reminded how much work we still
have to do when in this day and age, only 71 percent of heart
patients are taking aspirin,” lead author Dr. L. Kristin Newby,
from the Duke Clinical Research Institute in Durham, North
Carolina, said in a statement. “For a drug that is
well-understood, inexpensive, easily available and fairly
well-tolerated, we should see rates in the upper 90 percent.”

The findings, which appear in the online issue of the
medical journal Circulation, are based on a study of more than
30,000 CAD patients in the Duke Databank for Cardiovascular
Disease. Of the subjects, nearly 9000 had heart failure.

As noted, the use of secondary prevention therapies
increased each year from 1995 to 2002. In 2002, use of such
therapies ranged from 83 percent for aspirin monotherapy to 39
percent for aspirin in combination with beta-blockers and
lipid-lowering therapy. Rates of consistent use were lower.

In 2002, rates of overall and consistent use of
angiotensin-converting enzyme (ACE) inhibitors, such as
Accupril and Vasotec, in patients with heart failure were 51
percent and 39 percent, respectively. In those without heart
failure, the corresponding rates were 39 percent and 20
percent.

With the exception of ACE inhibitor use by patients without
heart failure, consistent use of the evidence-based therapies
yielded a survival benefit, the report indicates.

“We as physicians have spent a great deal of time studying
how best to treat our patients while in the hospital, so now we
need to focus on better understanding the barriers to improved
compliance outside of acute medical settings,” Newby
emphasized.

In a related editorial, Dr. Sidney C. Smith, from the
University of North Carolina at Chapel Hill, comments that
while the findings indicate progress has been made, “most
patients still do not receive the comprehensive medical
therapies that can dramatically improve cardiovascular
outcomes. If we are to recognize the true potential of these
therapies, we must…provide the necessary focus and resources
to see that remaining gaps in therapy are eliminated for all
sociodemographic groups.”

SOURCE: Circulation, January 9, 2006.