After the Heart Attack

I have a friend whose heart stopped beating due to a massive heart attack over ten years ago.  His wife found him unresponsive, called 911 and performed CPR on him until the paramedics arrived.  He was taken to the hospital for an extended stay in the intensive care unit where doctors and nurses performed multiple procedures, infused him with many different medications and monitored him constantly in an effort to stabilize his now beating heart.  When discharged from the hospital, my grateful friend did one important thing; he followed his doctor's directions. 

·         First of all, he quit smoking.  He had smoked daily and regularly for many years.  This gentleman has not smoked a cigarette since he left the hospital.

·         He signed up with a health club, and began a regular course of aerobic and resistance training.

·         He followed his doctor's orders about taking his new medications.

Here we are, more than ten years later, and my friend leads a happy and healthy life.  He is somewhere over 70 years old; however, he still exercises daily, travels, hunts, fishes, and is alive to be present for his wife, children and grandchildren.

A study that was just published in the October, 2013 issue of the American Heart Journal reviewed the importance of medication adherence for patients post Myocardial Infarction (heart attack-MI). Unlike most adherence studies, which attempt to answer the question as to why a patient is not taking their medications, this study focused specifically on the clinical outcome of post-heart attack patients compared to how often they took their prescribed medications.

"The results indicated that patients who achieved adherence of 80% or greater to each of their prescribed medications were significantly less likely to experience a major vascular event or undergo revascularization when compared with controls, while non-adherent and partially adherent patients had event rates similar to control patients. Adherent patients were 24% less likely to experience an event compared with control patients."

"The researchers conclude that all recommended therapies are necessary in patients after heart attack and that improved adherence to each drug reduces the risk of subsequent major cardiovascular events. The results of the study highlight the importance of adherence and the need for more interventions to improve adherence among these patients."

After a heart attack patients are sent home with a handful of new medications that they have never taken before.  Many heart attack survivors have never needed to take medications on a daily basis.  Here they are, faced with the task arranging their schedule so they remember to take four or more new medications on a daily basis, sometimes up to three times daily.

Many tools are available to help patients remember to take their medications on a scheduled basis.  Walk into your local community pharmacy and ask them to show you their pill box section, most likely you will see a rack that has over 10-15 different choices of daily or weekly pill containers.  These help patients keep their medications organized in a nice manner.

How do people remember to take their doses?  Like the article we reviewed said, even if you obtain at least 80% adherence to your heart medication you will be increasing your chance for the most favorable outcome of therapy.  I recently reviewed a smart phone app called Medisafe that provides a great dosing reminder tool.  If you have difficulty remembering to take your medications, this is a worthwhile tool.

Lastly, I feel that one area that may be overlooked at times with regards to adherence is medication education.  When a patient receives upwards of four new prescriptions, they need some level of current and ongoing education to help them understand their medications.  Quite often, just the doctor, nurse and pharmacist telling them they need to take their medications is not enough.

This is the section I like to call Motivational Adherence.  Educating a patient about their medications may help a patient to become motivated to participate in their own pharmaceutical care.  When a patient understands what the medication is doing and what effects to look out for, they are then becoming an active participant in their own care, rather than just following directions. 
 
·         Medication education you LISTEN to
·         Where do you get your Medication Education
·         What is Health Literacy
·         Blood Pressure Medication Treatment Options
·         Acute Coronary Syndrome

 
Please comment and let us know what tools you use to remember to take your medications.

Thanks
Steve

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