Interview with Dr. John Rogers on Prescription Medication Adherence: What it Means for Heart Failure Patients
26 February 2010, 11:00 AM EST
Read more about Dr. John Rogers
Transcript
Winston:
In the healthcare reform debate, I keep hearing that many heart failure patients return to the hospital shortly after they have been discharged. Is this due to not properly taking medication?
Dr. John Rogers:
There are a number of reasons why a heart failure patient may return to the hospital shortly after being discharged. Noncompliance with diet (eating too much salt) or medications certainly accounts for a large number of these patients. In some instances a patient’s heart failure is so bad that they frequently return to the hospital for intravenous medications.
Jimmy:
Between the stress from watching the Super Bowl and eating my wife’s gumbo, I had some chest pain that I assumed was just heartburn. Now I pretty much feel back to normal, but how do you know the difference between heartburn and something more serious?
Dr. John Rogers:
Sometimes it is difficult to tell if a discomfort a person is feeling is from the heart or from the stomach or esophagus (heart burn). Typical heart pain is usually described as a heaviness or pressure like sensation in the center of the chest (like someone pushing or standing on your chest). This discomfort can be very mild or quite severe. Sometimes typical heart pain or pressure will radiate up into the neck/jaw and into the left arm. Occasionally typical heart pain will also involve, shortness of breath, nausea, sweating, lightheadedness or feeling faint. Occasionally a person can have atypical symptoms (some type of discomfort other than the above) and it can still be there heart.
Certainly a good batch of Gumbo and watching your favorite Team (the Saints I assume) battle it out in the Superbowl can cause heartburn from too much stomach acid production HOWEVER it is always a good idea to get yourself checked out if you have had any chest discomfort. I urge you to let your doctor know about your symptoms. Your doctor may recommend for you to have an EKG and/or a stress test just to be sure.
Certainly a good batch of Gumbo and watching your favorite Team (the Saints I assume) battle it out in the Superbowl can cause heartburn from too much stomach acid production HOWEVER it is always a good idea to get yourself checked out if you have had any chest discomfort. I urge you to let your doctor know about your symptoms. Your doctor may recommend for you to have an EKG and/or a stress test just to be sure.
Dwight:
I’ve had a heart arrhythmia since childhood and I’m now 28. I heard in the news that an ablation technique shows better results than some arrhythmia medicines. Is this true for most people with common arrhythmias?
Dr. John Rogers:
Certain heart rhythm problems can be treated and in fact cured by an ablation procedure. In some cases medication can be significantly reduced and even stopped after the ablation. Because each type of heart rhythm problem is very unique and each has different success rtes from ablation I urge you to discuss this with your doctor. The ablation procedure is performed by a highly specialized cardiologist (know as an electrophysiologist) who sub specializes in treating heart rhythm disorders with this type of procedure.
Mary:
I've been taking a low-dose aspirin each day for the past three years. I guess I think of it as a vitamin because it's an over-the-counter drug. My husband thinks I should discuss this with my doctor, but I don't see the need. We agreed to let you be the referee. Is this something I need to raise with my doctor?
Dr. John Rogers:
It is always a good idea to discuss the use of any medication (over the counter, supplement, vitamin or prescription) with your doctor. There are a number of benefits to taking low dose aspirin however taking it daily is not completely without risk. This risk mostly coming form the gastrointestinal tract in the form of irritating the lining of the stomach or esophagus, causing heartburn and even slightly increasing the risk of gastrointestinal bleeding.
In my practice, if there is no history of cardiovascular disease I recommend a low dose aspirin as part of a daily regimen if a patient has one or more risk factors for developing cardiovascular disease (high blood pressure, diabetes, high cholesterol, smoking, family history of cardiovascular disease). This low dose aspirin is in addition to whatever medications they may need to address their other risk factors.
If a person has cardiovascular disease then a low dose or regular strength aspirin will likely certainly be a part of their daily regimen.
AS your “referee” I would suggest you discuss this with your doctor so that he/she may advise you and so that it can be placed in your medical record that you are taking aspirin, an important fact that other health care providers might need to now in the future while caring for you.
In my practice, if there is no history of cardiovascular disease I recommend a low dose aspirin as part of a daily regimen if a patient has one or more risk factors for developing cardiovascular disease (high blood pressure, diabetes, high cholesterol, smoking, family history of cardiovascular disease). This low dose aspirin is in addition to whatever medications they may need to address their other risk factors.
If a person has cardiovascular disease then a low dose or regular strength aspirin will likely certainly be a part of their daily regimen.
AS your “referee” I would suggest you discuss this with your doctor so that he/she may advise you and so that it can be placed in your medical record that you are taking aspirin, an important fact that other health care providers might need to now in the future while caring for you.
Dan:
I only get my blood pressure checked once a year during my annual physical, yet blood pressure is one of the heart numbers that patients are advised to monitor in order to maintain a heart-healthy lifestyle and reduce risks of cardiovascular conditions. Is there a convenient, non-intrusive way that I can more frequently monitor this, aside from the machines at the grocery stores?
Dr. John Rogers:
If someone has normal blood pressure the current recommendations are for an annual screen of blood pressure. If someone has high blood pressure they will likely be evaluated numerous times throughout the year. As long as your blood pressure has always been normal the yearly exam should be sufficient. However, if you are at all concerned and want to know your blood pressure or have other risks for developing cardiovascular disease (smoking, diabetes, high cholesterol or a family history of stroke or heart disease then I would recommend getting an automatic blood pressure machine and checking your blood pressure 3 – 4 times a year. These portable blood pressure machines are affordable (generally less than 100$) and very easy to use.
Lorraine:
I take Crestor for cholesterol problems, and I read that the FDA recently approved expanded use of the drug. What other conditions can Crestor be used for, and does that mean it could replace various other drugs?
Dr. John Rogers:
Based on the results of the JUPITER Trial, which involved 18,000 patients the FDA recently voted to expand the indications for the use of CRESTOR. CRESTOR already has an approved indication to lower cholesterol and triglycerides in combination with diet and exercise in patients with high cholesterol and/or triglycerides, and an indication to slow the progression of atherosclerosis.
The new indications include:
Primary Prevention of Cardiovascular Disease
In individuals without clinically evident coronary heart disease but with an increased risk of cardiovascular disease based on age ≥50 years old in men and ≥60 years old in women, hsCRP ≥ 2 mg/L, and the presence of at least one additional cardiovascular disease risk factor such as hypertension, low HDL-C, smoking, or a family history of premature coronary heart disease, CRESTOR is indicated to:
• reduce the risk of stroke
• reduce the risk of myocardial infarction
• reduce the risk of arterial revascularization procedures
This new indication in no way is meant so that Crestor can replace other medications. The exception to this might be if you are on another statin medication and are questioning whether or not you should switch to Crestor. In this case I would ask your doctor.
The new indications include:
Primary Prevention of Cardiovascular Disease
In individuals without clinically evident coronary heart disease but with an increased risk of cardiovascular disease based on age ≥50 years old in men and ≥60 years old in women, hsCRP ≥ 2 mg/L, and the presence of at least one additional cardiovascular disease risk factor such as hypertension, low HDL-C, smoking, or a family history of premature coronary heart disease, CRESTOR is indicated to:
• reduce the risk of stroke
• reduce the risk of myocardial infarction
• reduce the risk of arterial revascularization procedures
This new indication in no way is meant so that Crestor can replace other medications. The exception to this might be if you are on another statin medication and are questioning whether or not you should switch to Crestor. In this case I would ask your doctor.
Barbara:
I’ve read the guidance about “knowing your numbers” and “getting to goal.” I’ve been on a brand name statin for almost two years. It hasn’t made any difference in my cholesterol level. I’ve asked my doctor about changing medication or going to a generic to save some money, but she insists on staying the course. I almost feel like she’s getting some rebate from the drug manufacturer. How do you suggest I talk to her to get a better outcome?
Dr. John Rogers:
I always tell my patients that the best statin drug is the one that works (gets their LDL Cholesterol to goal) and is covered under their insurance. We as physicians who treat high cholesterol have our favorite statin usually, one that we know that most of the time is going to work to lower cholesterol. We may feel that one is stronger than the other or in our experience has been more successful in lowering cholesterol. One of the driving factors in my practice has been cost and which statin is covered under patients insurance. I may have to work with increasing doses or switching to a different statin until I find one that lowers the cholesterol to goal in a given patient.
I will say however, that in my experience, certain name brand statins or combination drugs (statin and another medication combined into one pill) work better than most generics to lower cholesterol.
I would encourage you to make an appointment to discuss this specific issue with your doctor. Let her know that the cost is becoming prohibitive and you wish to switch to another statin.
I will say however, that in my experience, certain name brand statins or combination drugs (statin and another medication combined into one pill) work better than most generics to lower cholesterol.
I would encourage you to make an appointment to discuss this specific issue with your doctor. Let her know that the cost is becoming prohibitive and you wish to switch to another statin.
Ellen:
Does it really make a difference if I occasionally miss a dose of heart disease medication? I’ve been on medications in the past for other conditions, and missing a dose every once in a while didn’t seem to have a negative impact.
Dr. John Rogers:
For the most part it can definitely make a difference if you miss a dose of heart medication. Depending on the medication and the problem being treated (high blood pressure, heart rhythm problems, need for blood thinners) missing one or more doses can lead to problems. Unfortunately doubling up on medications because you missed a dose can also be dangerous. It is always best to consult your physician if you miss a dose or are having trouble remembering certain doses during the day. When discussing this with your physician be certain to ask the question, what do I do if I miss a dose of this medication?
Thank you for joining me today. That concludes this session of SCAA's Ask the Experts with Dr. John Rogers.
