From Mr M. H. Espley, MRPharmS
SIR,—The Times of August 31 carried an article concerning the first big investigation into the care of 120,000 patients who arrived at National Health Service hospitals with serious pain. The conclusion was that they were just as likely to die after being sent home as those with a major heart attack. Doctors were surprised to find that 15,000 patients died or had a major heart attack six months after discharge.The article says that research showed that British people with heart disease were far more likely to be denied life saving treatment than patients in most Western countries, owing to a lack of heart doctors and specialist equipment. The investigation results, presented at the European Society of Cardiology in Amsterdam, indicated that of the 1,046 patients who presented at British hospitals with unstable angina, one in six patients never got aspirin and a third were not given heparin. After six months, a quarter were no longer taking aspirin.
The report says that cardiologists recommend that patients with dangerously high levels of cholesterol be treated with drugs after a coronary event to bring their levels down. However, only a minority of these patients were taking the drugs at the six-month follow up and many were getting the drugs in doses too small to lower their cholesterol.
As a community pharmacist, I frequently find that patients have not been advised to take their statins in the evening, at dinner or at bedtime. I frequently find that they are taking the medicine in the morning. Most HMG-CoA reductase inhibitors have a relatively short half-life but can be given once daily in the evening, since HMG-CoA reductase has a strong circadian variation and is most active at night.1 It seems to me that the role of pharmacists in helping to ensure that patients obtain the maximum benefit from their medication is an important one.
Malcolm Espley Chester
References
1. Stein et al. J Cardiovasc Pharmacol Ther 1997;2:7-16.