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People Often Forgo Using Lifesaving Beta Blockers Despite Health Insurance

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Duke Health News 919-660-1306

DURHAM, N.C. -- Fewer than half of the patients who were
prescribed beta blocker drugs following a heart attack and who
had some prescription drug coverage were regularly taking them
during the first year after leaving the hospital, according to
a Duke University Medical Center analysis of more than 17,000
patients nationwide.

This low rate of adherence is disturbing, since numerous
large-scale clinical trials have proven that beta blockers can
reduce the risk of future heart attacks, the researchers said.
They said the finding also suggests that cost may not be the
only issue that influences whether heart attack patients
continue to take the drugs.

Beta blockers blunt the normal stimulatory effects of the
hormones epinephrine and norepinephrine on the heart, thereby
reducing stress on the heart. The drugs also limit the increase
in heart rate and reduce the heart's need for oxygen when
people exert themselves.

In the study, the researchers found that only 45 percent of
heart attack patients regularly took beta blockers during the
first year after leaving the hospital. The biggest percent drop
in adherence occurred during the initial months after
discharge, suggesting that physicians need to step up efforts
during this period to improve usage rates, the researchers
said.

In particular, younger women with commercial insurance were
less likely to continue taking beta blockers following a heart
attack, compared to men their age and to older women, the study
found.

"In the population of patients we studied with health
insurance and prescription drug coverage, we found adherence to
beta blockers during the first year following a heart attack to
be quite poor, indicating that factors other than the cost of
the medicine are important to long-term adherence," said study
leader Judith Kramer, M.D., an associate professor at the Duke
University Medical Center and principal investigator of the
Duke Center for Education and Research on Therapeutics (CERTS)
at the Duke Clinical Research Institute.

The researchers published the findings in the September 2006
issue of the American Heart Journal. The study was funded by
the Council for Affordable Quality Healthcare, a coalition of
more than two dozen of the nation's largest health plans and
networks representing more than 100 million Americans.

According to Kramer, physicians working in hospitals have
improved their prescribing of medicines, such as beta blockers,
proven by clinical trials to be effective in forestalling heart
attacks. After patients are discharged, however, they face
myriad medical and social challenges that can affect whether
they continue to take their medicines over the long term.

"Once discharged, they can return home to a different and
complex set of issues," she said. "Patients often do not
realize, or it is not made clear to them, that beta blockers
must be taken for the rest of their lives."

The solution for addressing this poor rate of adherence
lies, at least in part, with the health care delivery system,
Kramer said.

"Strategies to maintain adherence must focus not only on
community physicians to maintain prescribing, but also on
patients and their families," she said. "And as our results
suggest, these strategies need to begin within the first month
or two after hospital discharge."

For their analysis, the researchers used data collected by
the Council for Affordable Quality Healthcare to complement a
cardiovascular quality initiative. Each participating health
plan had submitted its data in the aggregate to the
council.

"This study strongly demonstrates the value of aggregating
claims data to generate a more complete picture of compliance
challenges," said Robin J. Thomashauer, the council's executive
director. "We hope the findings encourage health plans, health
care providers and other stakeholders in the health care
industry to collaborate on new approaches for motivating
patients to take their medicine as prescribed."

The researchers used the collective data about prescriptions
from 17,035 patients. For patients who had survived one year
after their heart attack, the researchers used prescription
claims to estimate patients' regular usage of beta blockers for
one, three, six, nine and 12 month intervals following hospital
discharge.

"Adherence is very important, since patients need to take
the drugs for the rest of their lives in order to get the
benefits," Kramer said.

The National Committee for Quality Assurance, an
organization that accredits commercial health insurance plans,
recently began using six-month adherence to beta blockers after
a heart attack as one measure in assessing how effectively the
health plans are serving their members. The group has adopted
the Council for Affordable Quality Healthcare's methodology for
collecting data.

Other members of the research team included, from Duke,
Bradley Hammill, Kevin Anstrom, Nancy Allen LaPointe and Eric
Peterson, and, from the Council for Affordable Quality
Healthcare, Donald Fetterolf, Richard Snyder, John Charde and
Barbara Hoffman.

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