Heart at­tack pa­tients skip drugs and shun ther­a­pies: Re­port

The New Zealand Herald - - News - Ryan Dunlop New Zealand Med­i­cal Jour­nal

More than one third of Ki­wis who have suf­fered a heart at­tack are not tak­ing med­i­ca­tion to pre­vent heart dis­ease and even less are do­ing rec­om­mended ther­a­pies, car­di­ol­o­gist and pro­fes­sor Ralph Ste­wart says.

In an ar­ti­cle penned by Ste­wart in the he posed the ques­tion “Is gen­eral prac­tice iden­ti­fi­ca­tion of prior car­dio­vas­cu­lar dis­ease at the time of car­dio­vas­cu­lar dis­ease risk as­sess­ment ac­cu­rate and does it mat­ter?”

The re­port found that de­spite strong ev­i­dence and clear guide­lines, a third of New Zealan­ders were not tak­ing drugs that re­duced lev­els of choles­terol in the blood one year af­ter an acute heart at­tack.

“Some peo­ple think tak­ing med­i­ca­tion makes them less healthy and want to re­duce the num­ber of tablets they take, even though for many an in­crease in treat­ment could lower risk fur­ther.

“Over 20 years ad­her­ing to op­ti­mal pre­ven­tive med­i­ca­tion may in­crease the chance of be­ing alive with­out a ma­jor heart at­tack or dis­abling stroke from less than one in three to more than 70 per cent.”

In the last 10 years thou­sands of Ki­wis have had a car­dio­vas­cu­lar risk as­sess­ment com­pleted us­ing sim­ple risk al­go­rithms such as “pre­dict”.

“When com­plet­ing this risk score, the most im­por­tant ‘box’ is ‘prior car­dio­vas­cu­lar dis­ease’ (CVD).

“This iden­ti­fies pa­tients who usu­ally have a much higher risk com­pared to peo­ple with risk fac­tors alone, and who al­most al­ways have a clear in­di­ca­tion for pre­ven­tive med­i­ca­tion.”

Ste­wart said 40 per cent of pa­tients that had been hos­pi­talised for a ma­jor car­dio­vas­cu­lar event had in­di­cated “no” for prior car­dio­vas­cu­lar dis­ease in the GP’s pre­dict risk al­go­rithm.

Even fewer Ki­wis were ad­her­ing to rec­om­mend ther­a­pies, he said.

Side ef­fects from the drugs, real or not, were a com­mon rea­son for a pa­tient to stop tak­ing med­i­ca­tion, the jour­nal said.

Neg­a­tive ex­pec­ta­tions of treat­ment or prog­no­sis from heart med­i­ca­tion was a ma­jor con­trib­u­tor to peo­ple not tak­ing their pills.

Bet­ter ex­e­cu­tion of pre­ven­tion mea­sures fol­low­ing a heart at­tack would “sub­stan­tially de­crease” car­dio­vas­cu­lar mor­bid­ity and mor­tal­ity.

Pho­tos / Co­ra­zon Miller

Tourists and sou­venir sell­ers are guar­an­teed vis­i­tors to Wind­sor this week­end.

Photo / Ja­son Ox­en­ham

Pro­fes­sor Ralph Ste­wart says some think tak­ing pills makes them less healthy.

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