Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Poor compliance increases mortality

Discontinuation rates of statins in clinical practice are known to be high. Several studies in the USA, UK and Australia have shown that approximately half of all patients who are prescribed statins are non-compliant at 6 months and this continued to increase with about 30-40% of patients remaining compliant at one year.

A recent paper in the Archives of Internal Medicine has assessed the impact of non-compliance on mortality.

The study enrolled 1,521 patients who had recently had a myocardial infarction and were subsequently discharged with a prescription for aspirin, statin and beta-blocker. The patients were assessed for compliance to these prescribed medicines a month after discharge and data were collected for mortality up to 12 months.

At 1 month:

  • 12.1% had stopped all three medicines
  • 3.7% had stopped two of the three medicines
  • 17.9% had stopped one of the medicines
  • 66.3% were still taking all three

One-year survival in the group who took all three medicines was 97.7%, this dropped to 88.5% in those who stopped all three medicines.

Action: The consequence of non-compliance to prescribed medication is an increased risk of mortality. Clinicians should always consider compliance when reviewing patients but especially in those who are failing to reach blood pressure and lipid targets.

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