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Adherence to a prophylactic medication regimen in patients with symptomatic versus asymptomatic ischemic heart
R M Carney1, K E Freedland, S A Eisen
1Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA.
Insights
Patients with silent ischemic heart disease adhered better to daily low-dose aspirin therapy than those with symptomatic angina pectoris. This finding suggests silent heart disease may not negatively impact medication adherence.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Coronary artery disease (CAD) commonly presents with angina pectoris, but some patients experience asymptomatic (silent) ischemia.
- The impact of silent myocardial ischemia on patient self-management, particularly medication adherence, is understudied.
- Depression, linked to poor adherence, is more prevalent in symptomatic ischemia patients.
Purpose of the Study:
- To investigate and compare the adherence to prophylactic low-dose aspirin therapy in patients with silent myocardial ischemia versus those with symptomatic angina pectoris.
- To evaluate the influence of asymptomatic versus symptomatic ischemic heart disease on patient self-management of medication.
Main Methods:
- A 3-week prospective study involving 37 patients with documented ischemic heart disease and no anginal symptoms (silent ischemia) and 28 patients with daily anginal symptoms.
- Low-dose aspirin was dispensed in an electronic adherence monitor; other medications were in standard bottles.
- Adherence was measured by the electronic monitoring of aspirin removal.
Main Results:
- Patients with silent ischemia demonstrated higher adherence to prescribed low-dose aspirin, taking it on 77.3% of days.
- Symptomatic patients adhered to their aspirin regimen on 62.4% of days.
- Contrary to expectations, silent ischemia did not correlate with poorer medication adherence.
Conclusions:
- Patients with silent ischemic heart disease may adhere as well as, or even better than, symptomatic patients to prophylactic medication regimens.
- These findings challenge assumptions about self-management in asymptomatic cardiovascular disease.
- Further research is needed to explore the factors influencing adherence in silent myocardial ischemia and its clinical implications.
Abstract:
Although angina pectoris is the most common symptom of coronary artery disease, some patients do not experience angina during ischemic episodes. The effects of asymptomatic (silent) heart disease on patient self-management have rarely been studied. Studies of other patient populations with asymptomatic illnesses indicate that patients with silent myocardial ischemia might adhere less well to a prophylactic medication regimen than would those with symptomatic ischemia. Depression, a state associated with poor adherence to medical regimens is more common among patients with symptomatic ischemia. For prevention of thromboembolic events, 37 patients with documented ischemic heart disease who denied having anginal symptoms and 28 patients who reported almost daily symptoms were given a 3-week supply of low-dose aspirin packaged in an unobtrusive electronic adherence monitor. All other medications were provided in standard pill bottles. The symptomatic patients removed their prescribed aspirin on 62.4% of the days; the patients with silent ischemia took their medication on 77.3% of the days. Possible explanations for these results, their clinical implications, and directions for future research are discussed.