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Non-Compliance Can Mean Serious Consequences for Patients with Heart Disease
By Nancy Kennedy

When patients fail to comply with the medication regimen and lifestyle modifications that have been recommended by their healthcare providers, they are sabotaging their own health and recovery and causing frustration for their physicians. Non-compliance can undo the physician’s efforts to help the patient and can cause avoidable and often serious complications that may lead to emergency room visits, hospital re-admission and worsening health.

Alan Bramowitz, M.D., is a board certified cardiologist with Jefferson Cardiology Association who cares for patients with many types of cardiovascular disease. He and his colleagues provide state-of-the-art diagnostic and therapeutic care to their patients, and that includes prescriptions and recommendations for lifestyle changes to support and improve their heart health. Dr. Bramowitz says that he is seeing an increase in non-compliance and this presents challenges to him and other healthcare providers. “Increasingly, I’m seeing patients who have undergone successful treatment for heart disease, including stent placement, angioplasty and open heart surgery. But they have not made the necessary adaptations to improve and maintain their health. Some are smoking again, or gaining weight with unhealthy eating habits; others are not following recommendations for exercising and some are even refusing to take the essential medications that have been prescribed. Some simply drop off, never returning for follow-up medical care. These behaviors defeat the benefits that were achieved through the medical intervention.”

Non-compliance with prescriptions may be a financial matter, Dr. Bramowitz acknowledges, but often it is a matter of personal choice. It’s a dangerous choice –for certain diagnoses, optimal medication management is essential. “Too many patients fail to understand this or simply refuse to comply,” he explains. “In some situations, people take the uninformed advice of family members, neighbors and co-workers, or they find unprofessional advice on Internet sites. The Internet has some good medical web sites, but they are never a substitute for the personal care provided by your physician. Compliance is essential and is the patient’s responsibility.”

“If you are not taking your meds, or you’re taking them incorrectly because you cannot afford them, you should let us know that and we may be able to help with a less expensive prescription,” he says. “It can also be that a patient is seeing multiple doctors and they may not know the patients full history or the recommended regimen. Many people seem to worry a lot about side effects. In fact, side effects are less common than benefits. A pharmacist should not tell patients about side effects when they are not involved clinically with that patient. This can mislead the patient. Even when there are side effects, they can be minor and short-lived. You have to weigh the benefits of the medication versus the side effects.”

To address the problem of non-compliance, Dr. Bramowitz believes that improved doctor-patient communication is key. He urges patients to prepare for appointments by writing down their questions and concerns, and bringing a copy to the physician. He also encourages his patients to bring along an advocate – a family member or friend who can help the patient remember the exact instructions and can reinforce the doctor’s recommendations.

“There is a spectrum. Some patients are quite compliant and follow the recommendations for diet and exercise, smoking cessation and taking medications exactly as prescribed. I know of a forum that took place with ten women who had all experienced cardiac events. All but one of them were omitting their medications, intentionally. Only one was compliant, taking her medications as her cardiologist prescribed them. Ten years later, she is the only one of the group who is still alive.”

Dr. Bramowitz understands that lifestyle change is difficult, and that smoking cessation and weight loss are difficult to achieve and maintain. “My approach is to speak with each patient individually, providing information and emphasizing the importance of adhering to the medication regimen. I try to communicate the goals to the patient and help them understand that this part is their responsibility. If you don’t understand some aspect of your treatment, ask us to explain it. Compliance with medications and lifestyle changes are critically important to your health, safety and well-being.”

To contact Jefferson Cardiology, call (412) 469-1500 or visit the web site, www.jeffersoncardiology.com.

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