Managing Chronic Heart Disease: Tips for Patients

By James E. Calvin, MD

Over the last three decades, the management of acute heart disease such as heart attack has come a long way. When I graduated from high school, the mortality rate for a heart attack was in excess of 30 percent. By current statistics, the mortality rate for a ST-segment elevation myocardial infarction (the kind we rush to the cath lab in order to place a stent) is 5 to 7 percent, and for the less severe form, so called non-ST segment elevation myocardial infarction, this mortality is now less than 4 percent.

However, the emergence of chronic heart failure, chronic arrhythmias and lifelong prevention of coronary disease really requires a sustaining partnership between a proactive physician and a well-informed and motivated patient.

A recent study that I presented at an international meeting determined that patients were receiving appropriate recommended therapies for heart failure and taking them as directed only a third of the time. This observation is a stark reality that points out the need to not only enhance physician clinical decision-making but also patient education.

Why Some Patients Don’t Take Medication

Why might patients not take the medication that they have been prescribed? There appear to be lots of reasons. One important reason is the patient’s knowledge about why the medications are important and how they improve patient’s symptoms is not adequate.

A great deal of research has been conducted or is currently being conducted to try to improve patient’s awareness of why their medications are important for them to take as prescribed. There are several patient education manuals available online from the American Heart Association’s Heart Hub and the American College of Cardiology (Cardiosmart).

Second, medications are expensive, and patients on fixed incomes may spread out their medications in order to be able to manage their own household budget. Many pharmaceuticals do offer programs to help discount the cost of medications. It is important for patients to bring the subject up with their physicians even if the physicians do not bring it up on their own.

Third, often medications have adverse effects, and patients stop taking the medications because of a side effect. It is very important that the patient make the physician aware of when a side effect is occurring so that the medication might be replaced by another. Finally, patients sometimes stop taking their medications because they are feeling better. Unfortunately, feeling better does not necessarily mean being cured, and cessation of medications often will result in the return of heart symptoms.

Tips for Patients

As a patient myself, I have struggled to remember my medicines, and I have found the following tips to be helpful:

1) The pill organizer is a great help. By organizing your medications on a weekly if not monthly basis, one can anticipate when refills need to be done. I also find sometimes that I can’t remember if I took my pills or not, and checking the pill case is a good way to know whether or not I’ve taken my medicines that day.

2) Ask the physician about taking medications that only need to be taken once daily. Organizing your medications around meals is helpful. I have always found that trying to remember to take medications in the middle of a work day, however, is the most difficult and the most likely to be forgotten.

3)  I try to keep my medications in sight in the morning so that I have a visual prompt to remind me to take them. It’s fascinating to me, but simple things such as these tips can help enormously in enhancing my own adherence to my regimen.

I hope these tips help you with taking your medications on time. Next, I’d like to spend a little time on diet.

James E. Calvin, MD, is director of the Section of Cardiology at Rush University Medical Center.

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