Concern too many won't take heart pills
Half of middle-aged people who have experienced heart problems don't take their medication, putting them at further risk, says a Nelson doctor.
Nelson Hospital cardiologist Dr Andrew Hamer, at a Hospital Advisory Committee meeting last week, said only about half of patients took their pills after a heart event in the under-60 age groups.
A heart event can include a heart attack, stroke or other serious heart issue.
A recent study in New Zealand by School of Population Health at Auckland University and the Health Research Council had shown low levels on post-medication compliance, Dr Hamer said after the meeting.
"[The level's] around 60 per cent of people taking the recommended medication. It's probably similar to the international rate: It's too low."
Nelson Marlborough, and the South Island, fared better than the North Island with compliance in general.
There were, however, "little pockets" of problems in the region, Dr Hamer said.
For those patients on all three cardiovascular drugs, Nelson Marlborough had the sixth highest compliance rate, at 61.4 per cent.
Ideally, Dr Hamer said they would like to see 80 per cent of people being compliant with their medications. There were some people who could not take medications, so there would never be 100 per cent compliance.
"We know in New Zealand the two biggest things we can do to reduce hospital presentations [for heart events] are stopping smoking and taking appropriate meds after a heart event."
The problem medicine seemed to be the statins, a cholesterol lowering medication, he said, which was particularly concerning.
"This tablet has twice the benefit of the others, [such as] aspirin and blood pressure pills."
Higher compliance would make a huge difference to demand on cardiology services in New Zealand, he said.
By looking at the data it became clear one of the main predictors of whether a patient would take their medication was age. For 50-59-year-olds the compliance level was 59.3 per cent, while those aged 70-79 had a compliance level of 63 per cent.
Being Maori or coming from a low socio-economic background did not influence it so much, Dr Hamer said.
"It's because you were younger when you had the event. For some reason 50-year-olds don't want to take pills."
Those in their 70s were much more comfortable taking medication after an event, he said.
Dr Hamer said GPs had said younger people did not like to be patients, which was one reason why they would not take medication.
"They want to be people living a normal life."
Dr Hamer said there was also a perception that the younger non-compliers thought of themselves as "fixed" after treatment.
The research data showed simply that 50-year-olds were bigger risk takers than 70-year-olds. "Maybe they feel somewhat indestructible."
Medical professionals needed to think about ways to increase compliance, he said.
A study presented at the recent American Heart Association meeting trialled the use of a polypill, where all the medications were included in one pill.
The result was an increase in compliance from 60 per cent to 80 per cent, he said.
"It's very exciting. I don't think it's appropriate for everyone. I do think there's a place for it for people who struggle with compliance."
Dr Hamer said another issue with compliance was that the small percentage of people who were unable to take statins, or had a bad reaction, were very vocal and this encouraged others to stop taking the medication.
If there was one thing he could do he would ask for as many people, who have not had issues with statins, to ring up talkback radio shows to encourage others who needed them to take them.
AT A GLANCE
Overall cardiovascular medication compliance levels for patients on all three cardiovascular drugs:
Highest – West Coast, 65%.
Sixth – Nelson Marlborough, 61%.
Lowest – Northland, 55%.
In Nelson Marlborough there was a significant difference in compliance levels between age groups.
50-59-year-olds compliance: 59%.
70-79-year-olds compliance: 63%
Source: Health Quality and Safety Commission
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