title: Gaps in cardiovascular medication taking: the tip of the iceberg.
abstract: OBJECTIVE
  To search for major gaps in medication-taking behavior predisposing patients to cardiovascular morbidity and mortality.
  
  
  METHODS
  Convenience sample; cohort prospectively followed for < or = 5 months.
  
  
  METHODS
  General internal medicine and cardiology clinics in a university medical center.
  
  
  METHODS
  From among 893 patients, the authors identified 132 eligible individuals and entered 33 subjects (25%) with chronic cardiovascular conditions, 1-3 chronic oral medications for these conditions, overall regimen of < or = 6 drugs, regular visits at 1-3-month intervals, literacy in English, willingness to use electronic monitors, and physician permission to participate.
  
  
  METHODS
  Medication compliance rates and patterns by patient self-report, physician estimates, pill count, and electronic monitoring of pill vial opening.
  
  
  RESULTS
  Despite moderately complex regimens (5.4 +/- 0.5 pills daily; range 1-11), most subjects took most medications according to the prescription: median intervals between pill vial openings were 1.00, 0.50, and 0.43 days for once, twice, and three times daily dosing, respectively. Medication-taking gaps of > or = 2 times the prescribed interdosing interval occurred for 48% of the patients. Patients' dosing patterns often produced "uncovered" intervals (mean duration 3.7 days, range 0-25) with doubtful pharmacologic effectiveness. These lapses were underestimated by patients and poorly perceived by their treating physicians, despite familiarity with their care. Baseline sociodemographic, psychosocial, medical system, or clinical characteristics did not predict the patterns or degrees of medication noncompliance.
  
  
  CONCLUSIONS
  Major treatment gaps occur frequently, even in carefully selected ambulatory populations, and generally escape detection. The compliance patterns and gaps may contribute to reported excesses of cardiovascular morbidity and mortality.
authors.affiliation: Department of Medicine, Stanford University Medical Center, CA 94305-5475.
authors.forename: P
authors.initials: P
authors.lastname: Rudd
authors.forename: J
authors.initials: J
authors.lastname: Ramesh
authors.forename: C
authors.initials: C
authors.lastname: Bryant-Kosling
authors.forename: D
authors.initials: D
authors.lastname: Guerrero
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D012044:Regression Analysis
chemical_list: D002317:Cardiovascular Agents