Summary

After a patient has a heart attack, they are generally prescribed a range of drugs such as beta blockers which will improve their long-term outcome. The problem is that many do not adhere to their treatment schedule. A new study shows that sending out a couple of simple reminder letters increases adherence to beta blockers by 17 percent. This is a low cost way of primary care practices helping support their patients after a heart attack.

Introduction

After a heart attack, there is a great deal you can do to prevent a second occurrence. One of these things is sticking to prescribed medication, which could include beta blockers and statins, which are known to protect the heart and circulation. If all heart attack survivors persisted with their beta blockers, for example, around 45,000 life years would be gained in the United States. Those who discontinue this medication are actually twice as likely to die during the year after their heart attack. Despite this, over half of heart attack survivors don't take their meds as directed, for a variety of reasons ranging from forgetfulness to worry about side effects.

Researchers at the Kaiser Permanente Center for Health Research in Oregon undertook a study in improving adherence to beta blockers using simple reminders. They were supported by the Agency for Healthcare Research and Quality which is the part of the United States Department of Health and Human Services charged with improving the quality, safety, efficiency of healthcare for the population.

What was done

Individuals in a group of 836 patients who had recently had a heart attack and had been prescribed beta blockers were randomly assigned to receive reminders or to have their usual care without a reminder. The material used was designed with the help of patients who had themselves survived a heart attack. It covered issues such as why beta blockers are important after a heart attack, the risks of not taking them, and likely side effects. Two letters were sent, two months apart. The first was a personalized letter and the second had an accompanying brochure. Both contained a wallet card with questions for the doctor and space to list medication and make notes. The researchers checked adherence by using pharmacy records to see how often the participants' beta blocker prescriptions were filled.

What was found

The participants receiving reminders took their beta blockers for more days in the month than those in the control group. This amounted to a 17 percent increase in overall adherence to the medication schedule.

What this study means

This is the first study to assess the effectiveness of a direct-to-patient intervention to increase adherence to beta blockers after heart attack. The researchers believe the results are encouraging. Sending out reminder letters will cost only a few dollars per patient and fits easily into a primary care infrastructure, where letters are being sent out all the time. The reminders help patients overcome some of the reasons for non-adherence, such as lack of ongoing information about their medication and the reasons for continuing to take it. The returns for this simple investment could be huge in terms of lives saved.