Switching to once-daily evidence-based [beta]-blockers in patients with systolic heart failure or left ventricular dysfunction after myocardial infarction.

To purchase electronic or print reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, [email protected]. ication regimen (Figure 1). Among patients with heart failure and other cardiovascular conditions, such as hypertension, changing regimens from doses taken 2 or 3 times a day to a dose taken once a day increased adherence. In a large meta-analysis, increased treatment adherence improved health outcomes, including survival, readmission rates, blood pressure, cholesterol level , and hemoglobin A1c level. Fewer pills per day may be particularly beneficial for patients after myocardial infarction or for patients with heart failure. Medication adherence was previously thought to be in the domain of the patient, but a recent shift in philosophy advocates forming a partnership between healthcare provider and patient, who enter into a contractual agreement to support selfcare by the patient once the patient is discharged from the hospital. Nancy M. Albert, RN, PhD, CCNS, CCRN, CNA Polypharmacy, the use of multiple medications resulting in complex drug regimens, is increasing among patients with heart failure. Ideally, at discharge from the hospital, each patient should be prescribed evidencebased medications (ie, medications that published evidence indicates are effective for the patient’s condition). The list of such medications is becoming long. According to the National Heart Care Project for 2000-2001, the mean numbers of heart failure medications and doses per day were 7.5 and 11.1, respectively. National guidelines rarely address the problem of polypharmacy for high-risk patients, and they do not consider patients’ adherence, the risk of adverse effects, or pharmacoeconomic considerations. Patients who have had a myocardial infarction, especially those who have concomitant heart failure, are prescribed an equal, if not higher, number of medications than are patients with just heart failure. Perhaps the easiest way to improve clinical and health outcomes is to improve adherence to the drug treatment plan by simplifying the medClinicalArticle