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THE POTENTIAL EXPANSION OF A POLYPILL IN AN INDIGENT HEART FAILURE DISEASE MANAGEMENT PROGRAM

Chabert Medical Center, Houma, LA

PURPOSE: Cardiovascular disease (CVD) remains the leading cause of mortality in the U.S. and Europe and is a growing concern globally. CVD can be avoided or delayed with proper diet, lifestyle changes and medications. Randomized trials demonstrate that drugs which lower LDL cholesterol, blood pressure and platelet function reduce the incidence of ischemic heart disease (IHD) events and stroke. A meta-analysis quantified the efficacy of a proposed formulation of a polypill using a statin, three antihypertensive drugs, aspirin and folic acid. This polypill could potentially reduce IHD events by 88% and stroke by 80%. We sought to quantify how many patients would qualify as candidates for various combinations of a polypill in a heart failure disease management program (HFDMP)for indigent patients.

METHODS: Chabert HFDMP, in rural South Louisiana, maintains a real-time prospective database. Patients with an EF < 40%, NYHA class I-IV and a LDL recorded were included in this study. Statin drug therapy was not recorded, therefore patients eligible for statin therapy with an LDL > 100 were included.

RESULTS: Of the 635 patients who were on an ace inhibitor, beta blocker, diuretic, aspirin or had a LDL > 100, 144 (22.7%) were on 5 medications, 275 (43.3%) were on 4 drugs, 166 (26.1%) were on 3 drugs, 40 (6.3%) on two drugs and 10 (1.6%) on one drug. Table I. Summarizes the use of medications including 92.1% ace inhibitors, 95.7% beta blockers, 56.4% aspirin, 84.6% diuretics, 50.4% LDL > 100 (statin candidate). Table II. summarizes various combinations of polypills, which theoretically could be used in this population.

CONCLUSION: Indigent patients in a HFDMP are on complicated drug regimens.

CLINICAL IMPLICATIONS: Potential advantages of a fixed-dose polypill include fewer pills, convenience, improved compliance, and lower cost. Disadvantages include loss of flexibility and unclear cause of adverse reactions. A strategy to further study this drug regimen could be a short course individual titration then switch to long-term combination therapy.

DISCLOSURE: Lee Arcement, No Financial Disclosure Information; No Product/Research Disclosure Information