Good Mental Attitude Essential to Successful Treatment

After 5/9/98:
Bob Szafranski
312/558-1770

Embargoed for Release Until After 10 a.m. PDT, Thursday, May 7

GOOD MENTAL ATTITUDE ESSENTIAL TO SUCCESSFUL TREATMENT

SAN DIEGO -- Taking medication regularly may be the key to survival, even if that medication turns out to be a placebo. Those are the findings of a study in which people who consistently took either a heart medication or placebo fared better than those who took them inconsistently, providing further evidence there is a strong mental component to health.

The largest study ever to attempt to analyze the reasons for adherence to therapy was presented today at the 19th Annual Scientific Sessions of the North American Society of Pacing and Electrophysiology (NASPE).

"What you believe has an important influence on your outcome," said Paul Dorian, M.D., associate professor of medicine at the University of Toronto and an electrophysiologist at St. Michael's Hospital, Toronto. "Why that is, we're not quite sure."

Patients who didn't comply with their drug regimen were 2 to 3 times more likely to suffer sudden cardiac death, researchers found.

Of 1,141 post-heart attack patients at 36 hospitals in the Canadian Amiodarone Myocardial Infarction Arrhythmia Trial (CAMIAT), 573 were selected to take the anti-arrhythmic drug amiodarone, and 11 percent did so inconsistently; 568 were to take the placebo, and 15 percent did so inconsistently.

After 2 years, 9.4 percent of the patients who inconsistently took the anti-arrhythmic drug amiodarone had died of sudden cardiac death, compared to 3.1 percent of the patients who took it consistently. In the placebo group, 12 percent of those who took their pills inconsistently died of sudden cardiac death, compared to 5.4 percent of those who took them consistently.

The compliance issue was just one aspect of CAMIAT, which found amiodarone beneficial for combating rhythm disorders in heart attack patients.

Dr. Dorian and his fellow researchers found it difficult to predict who might not comply with a health regimen.

"We assumed people who were distressed, depressed, lacked a social support system, were angry or were cynical would be less likely to take the medication than others, but overall that wasn't true," said Dr. Dorian. Slightly more than half of the study population (650) were studied with respect to psychosocial profiles.

The researchers found there were two small predictors of patients who were less likely to take medication consistently. Those older than 70 years and those involved in fewer social activities were less likely to take their medication regularly.

Neither of those factors were predictive for the patients in the amiodarone group.

Dr. Dorian said to be compliant, patients must be convinced that: the condition is dangerous, the pills are effective and the medication will help them.

"Patients who don't take effective medication are in double jeopardy, not only because they are not taking pills that would be helpful to them, but because pill-taking behavior seems to be protective," he said. "As doctors, we must do whatever we can to encourage our patients to take their medication."

Doctors can improve compliance among their patients through patient education materials, patient reminders -- including follow-up calls and regular visits -- and finding a drug regimen that's easy, for instance, once a day, rather than several times a day, he said.

Co-authors of the paper presented by Dr. Dorian are: Jane Irvine, D.Phil; Miney Paquette M.Sc.; David Newman, M.D.; and Stuart Connolly, M.D.

Based in Natick, Mass., the North American Society of Pacing and Electrophysiology is a professional organization of physicians, scientists and allied professionals throughout the world dedicated to the study and management of cardiac arrhythmias. Its mission is to improve the care of patients by promoting research, education and training, and providing leadership towards optimal policies and standards.

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[Editors note: For more information, contact the NASPE Web site at www.naspe.org