ADHERENCE TO A PROPHYLACTIC MEDICATION REGIMEN IN PATIENTS WITH SYMPTOMATIC VERSUS ASYMPTOMATIC ISCHEMIC-HEART-DISEASE

Although angina pectoris is the most common symptom of coronary artery disease, some patients do not experience angina during ischemic episo des. The effects of asymptomatic (silent) heart disease on patient sel f-management have rarely been studied. Studies of other patient popula tions with asymptomatic illnesses indicate that patients with silent m yocardial ischemia might adhere less well to a prophylactic medication regimen than would those with symptomatic ischemia. Depression, a sta te associated with poor adherence to medical regimens, is more common among patients with symptomatic ischemia. For prevention of thromboemb olic events, 37 patients with documented ischemic heart disease who de nied having anginal symptoms and 28 patients who reported almost daily symptoms were given a 3-week supply of low-dose aspirin packaged in a n unobtrusive electronic adherence monitor. All other medications were provided in standard pill bottles. The symptomatic patients removed t heir prescribed aspirin on 62.4% of the days; the patients with silent ischemia took their medication on 77.3% of the days. Possible explana tions for these results, their clinical implications, and directions f or future research are discussed.