Friday, January 14, 2011

MI patients with CKD not taking meds

MI patients with CKD not taking meds

January 14, 2011
Michael O'Riordan

Stanford, CA - An analysis of elderly survivors of MI shows very low rates of adherence to medical therapy for secondary prevention, with more than one-third of patients not taking their ACE inhibitors/angiotensin receptor blockers (ARBs), beta blockers, and statins at one year, and adherence rates falling off further at three years [1]. Patients with baseline kidney dysfunction are even more problematic, report investigators, with these patients less adherent to their medication than those with better kidney function at baseline.

"The results of our analysis have important clinical implications, because elderly patients with kidney dysfunction are at high risk for cardiovascular mortality and may therefore benefit the most from dedicated interventions aimed at improving long-term medication adherence," write Dr Tara Chang (Stanford University School of Medicine, CA) and colleagues in a report published online January 13, 2011 in the Clinical Journal of the American Society of Nephrology.

Previous studies by the group have shown that outpatient use of ACE inhibitors and ARBs within 90 days of hospitalization for MI were lower among patients with chronic kidney disease (CKD). The present study of more than 2100 patients 65 years of age or older enrolled in a pharmacy benefits program extends these results further, they note.

Approximately 70% of patients were adherent to each of the three medication classes (ACE inhibitors/ARBs, beta blockers, and statins) at baseline. Using pharmacy refill data to determine the percentage of days covered, only half of patients were adherent to the medication at 36 months. Adherence was defined as a percentage of days covered >80%.

Stratifying patients by estimated glomerular filtration rate (eGFR), investigators report that long-term ACE-inhibitor/ARB and beta-blocker use adherence differed by kidney function. Among those in the lowest eGFR category, defined as <30 mL/min/1.73 m2, there was a steeper drop off in medication adherence, with similar findings observed among patients taking beta blockers. There was no difference in long-term adherence to statin therapy in patients with different levels of kidney function.

Discussing the possible reasons for the poor adherence among kidney-dysfunction patients, Chang and colleagues point out that CKD patients have higher rates of functional limitations, cognitive impairment, and depression, and these are all associated with lower rates of medication adherence. Also, patients with CKD take, on average, at least eight prescribed medications, with some patients taking as many as 24 drugs, often taking different medications multiple times per day. The group points out that the prescription drug program in the present study paid for all the medications and required only small copayments.

"If long-term medication adherence is to be improved, a multifaceted approach that addresses not only financial assistance, but also a deeper understanding of physical and psychologic barriers to proper medication-taking behavior, is paramount," they conclude.
Article published here.

My comment: Maybe it's the side effects or evidence contrary to what the main stream medical/pharmaceutical communities claim. Those are exactly what it was in my case.

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