More than 1 in 4 hospitals don't comply, says Eric Peterson, a cardiologist at Duke Clinical Research Institute in Raleigh, N.C. Peterson surveyed 430 hospitals for compliance with the guidelines on statins and other medications, such as aspirin and beta blockers. His findings, released at last week's heart meeting, show that 26 percent of the hospitals overall did not comply with the statin guidelines. The rate ranged from an average of 19 percent at the most compliant hospitals to 35 percent at the worst performers.
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Peterson and his fellow analysts then calculated the consequences. "If all hospitals followed the aspirin guidelines," says Peterson, "we figured about 1,000 lives a year would be saved. If 100 percent of hospitals followed the statin guidelines, the number of lives saved would be around 10,000 a year."
Even when statins are handed out and prescriptions written, many patients simply stop taking them. Conventional wisdom among doctors is that for drugs in general, the dropout rate by the end of the first year is 40 to 50 percent. A small survey released at the heart meeting supports that guesstimate.
University of Michigan researchers contacted 154 patients six months after they were discharged from the university's medical center following a heart attack or episode of unstable chest pain. They asked them whether they were still taking the four heart medications--an anticlotting drug, ACE inhibitor, beta blocker, and statin--prescribed for them. About half said they were having trouble with the dosage or timing of at least one drug--nearly half were struggling with the statin--and about 10 percent of the patients had completely stopped taking at least one of the drugs. Cost wasn't the reason. The main factors, the patients reported, were that they forgot or were careless.
Some researchers believe that the results of PROVE-IT and ALLIANCE, besides demonstrating that aggressive statin treatment reduces risk, might offer a serendipitous solution. "Starting at a higher dose is likely to make people more compliant," says LaRosa. Patients on a higher dose will get reinforcement by seeing their LDL number shrink faster and further. And by starting at and staying on a high dose, they won't be inconvenienced by trekking to the pharmacy every time they get bumped up another dose.
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