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NEW ORLEANS -- A Duke University Medical Center analysis of
a Council for Affordable Quality Healthcare (CAQH) study of
more than 15,000 insured patients has shown that during the
year after suffering a heart attack, less than half of the
patients had been taking beta blockers regularly.

This is a disturbing finding, the researchers said, since
numerous clinical trials have proven the effectiveness of beta
blockers in reducing the risk of future heart attacks and
improving survival.

Duke performed its independent analysis of study data
collected by CAQH, Washington, D.C., a not-for-profit alliance
of more than 20 leading health plans and networks, providing
health-care coverage to more 100 million Americans.

"While many studies have shown improvements in doctors'
frequency of prescribing beta blockers at discharge after heart
attacks, very few studies have looked at the long-term
adherence to the drug," said Judith Kramer, M.D., principal
investigator of the Duke Center for Education and Research on
Therapeutics (CERTS) at the Duke Clinical Research Institute.
"In the study, despite having prescription and commercial
insurance coverage, less than 50 percent of this large
population had been taking beta blockers regularly over the
first year after their heart attack.

"In order for the proven benefits of these drugs to be
realized, we need to focus our efforts on increasing patient
adherence to the therapy," she continued.

Kramer presented the results of her analysis March 9, 2004,
at the annual scientific sessions of the American College of
Cardiology.

Beta blockers are a class of drugs that blunt the
stimulatory effects of epinephrine and norepinephrine, the
so-called "fight-or-flight" hormones. By blocking the effects
of these hormones, beta blockers reduce the stress on the
heart, and during exertion, they limit the increase in heart
rate and so reduce the demand for oxygen.

Numerous studies have shown that approximately 90 percent of
heart attack patients are receiving prescriptions for beta
blockers at discharge from the hospital, the researchers
said.

"CAQH has developed a coordinated effort among multiple
health plans to conduct one of the largest studies to date of
long-term beta blocker adherence," said Donald Fetterolf, M.D.
chair of CAQH Measurement Work Group, medical director of
Highmark BlueCross and BlueShield and co-author of the
study.

"Beyond advancing knowledge and science CAQH will utilize
the information to develop and implement appropriate
interventions to help heart attack survivors achieve the
benefits of this important and life-saving drug," he said.

The researchers identified 15,070 patients in 44 states
where CAQH had both administrative and prescription data. In
terms of insurance type, 73 percent were covered by commercial
insurance plans, while the remaining 27 percent were covered by
the Medicare+Choice plan. The data used was for calendar year
2001.

In the patients who survived one year after their heart
attack, researchers measured the proportion of patients who had
been taking beta blockers for at least 75 percent of the time
for periods of three, six, nine and 12 months after their heart
attack.

"We found a declining proportion of patients were adherent
to beta blockers over time from hospital discharge in all
insurance products and all geographic regions," Kramer
said.

Specifically, 55 percent of patients had been taking beta
blockers regularly during the first three months. However,
looking over the full year after heart attack, only 46 percent
of patients had been taking beta blockers at least 75 percent
of the time.

"For drugs like beta blockers, adherence is very important,
since patients need to take the drug for years after their
heart attack in order to get the benefits," Kramer said.

The researches believe that reasons for the declining
adherence are probably many and complex.

"Many patients do not realize, or were not told, that these
drugs need to be taken for years," Kramer said. "For others, it
could be an economic issue, since many of these patients tend
to be older and take many other prescription medications. We
obviously need to conduct further research to better understand
the reasons why patients stop taking the drugs."

The researchers are now adding data for calendar year 2002,
which they hope will provide additional insights in beta
blocker use in the U.S., particularly how the usage differs by
age and gender.

Kramer's analysis was supported in part by a cooperative
grant from the CERTS program and the Agency for Healthcare
Research and Quality.

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The Centers for Education and Research on Therapeutics
(CERTs) demonstration program is a national initiative to
conduct research and provide education that advances the
optimal use of therapeutics, including drugs, medical devices,
and biological products. The program, which consists of seven
centers and a coordinating center, is administered as a
cooperative agreement by the Agency for Healthcare Research and
Quality (AHRQ), in consultation with the U.S. Food and Drug
Administration (FDA).