Do beta blockers add benefit to other meds?


heart made out of pills

Just under half of participants in a study of heart attack survivors stick to their medicines regimen, a new study has found

The study, which involved Monash University’s Centre for Medicine Use and Safety, found that beta blockers offered no additional survival benefit for heart attack survivors who took their ACE inhibitors and statins as prescribed.

The study, published in the Journal of the American College of Cardiology and conducted in collaboration with the University of North Carolina at Chapel Hill, has challenged the belief that many heart-attack survivors need to take all three medicines to reduce their risk of death, authors say.

It involved more than 90,000 US Medicare patients, aged 65 or older, who had had a heart attack and been prescribed a beta blocker, ACE inhibitor (or an angiotensin receptor blocker) and statin.

Those patients who took only the ACE inhibitor/angiotensin receptor blocker and statin as prescribed were no more likely to die than those who took all three medicines.

“We found that as long as patients took their ACE inhibitors and statins as prescribed, patients appeared to gain no additional survival benefit by being adherent to their beta blocker,” Monash Associate Professor Simon Bell said.

He warned however that patients should not stop taking beta blockers as prescribed, and that pharmacists are “of great value” in helping people take their medicines as directed.

In the past, media reports on the value of medicines to manage heart disease have resulted in patients stopping their medication.

“People are more likely to be adherent to their medicines if they believe in the value of those medicines,” he told the AJP. “Pharmacists have an important role to play in supplying education and support about the role of medicines.”

The research team followed for six months heart attack survivors who filled prescriptions for all three medicines to study how well they adhered to their prescription regimen. The team then followed the patients for up to 18 months to see how many died during that time.

Only about half of the patients (49%) took their medicines as prescribed, the researchers found. Six months after their heart attack, about half the patients in the study had become non-adherent to at least one of their medicines.

For patients who took all three medicines as prescribed, the mortality rate at one year was 9.3%.

For patients who adhered to their ACE inhibitor (or angiotensin receptor blocker) and statin prescription but not their beta blocker, the mortality rate was 9.1%, a statistically insignificant difference.

For patients not taking any of the medicines as prescribed, the mortality rate was 14.3%.

Investigating why people don’t adhere to their medication regimen, even after a significant event like a heart attack, is important, A/Prof Bell says.

“I think we could divide non-adherence into intentional, and non-intentional non-adherence.

“So if the person is intentionally non-adherent, I believe there is great value in pharmacists and doctors explaining the benefit and purpose, and encouraging them, if they do experience adverse events, to speak with a pharmacist or doctor to ensure appropriate management or follow-up.

“If the non-adherence is non-intentional, strategies like simplifying the regimen or perhaps recommending a Dose Administration Aid could be useful.

“It’s important to realise many people, particularly older people, find it challenging to adhere to medicines regimens. Many pharmacists would see this on a daily basis.”

He adds that the interface between care in hospital post heart attack, and care in the community, could also be examined.

“We need to ensure appropriate continuity of care at the point of being in hospital, and when discharged to the community.”

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