Moreover, drug cost did not appear to be a major determinant of non-adherence since all of the participants had insurance coverage, according to the report in the American Heart Journal.

"The focus has been on making sure that (heart attack) patients leave the hospital with a prescription for beta-blockers and, in this regard, we've been very successful," lead author Dr. Judith M. Kramer, from Duke University Medical Center in Durham, North Carolina, told Reuters Health. "However, for this therapy to be beneficial, patients must continue to take it for the rest of their lives," so it is important to determine adherence beyond hospital discharge.

"Anecdotally, you find a lot of examples where people say 'I took my medicine, doctor', meaning that they thought they were finished with therapy after completing the prescription given to them at hospital discharge," Kramer said.

These types of stories led the researchers to conduct a formal analysis of long-term beta-blocker use among 17,035 patients who had survived at least 1 year after a heart attack and had insurance coverage, either commercial or Medicare + Choice (M+C).

In the year after hospital discharge, just 45 percent of patients were adherent with beta-blocker therapy, defined as prescription claims covering at least 75 percent of days. Adherence fell most dramatically between 30 and 90 days after hospital discharge.

M+C coverage, residence in the Southeast, and younger age (primarily for women) were all predictive of lower adherence with beta-blocker therapy, the report indicates.

Kramer said that the poor adherence may relate to patients not remembering the instructions given to them at hospital discharge. She added that this is not surprising since patients are typically bombarded with information when leaving the hospital.

In addition, communication issues may play a role if the physician treating the patient in the hospital is not the same one providing follow-up care.

Kramer said that her group is now involved in a trial evaluating an intervention designed to improve long-term adherence with outpatient medications. A key feature of the intervention is having pharmacists take a more proactive role in ensuring that patients are filling recommended prescriptions, she added.

SOURCE: American Heart Journal, September 2006.