I have read with interest the article by Monane et al1 on noncompliance with heart failure therapy in the elderly. Several issues, however, need to be addressed. First, the definition of noncompliance needs explanation. The authors defined noncompliance in terms of the number of days in a 12-month period following newly prescribed digoxin in which no heart failure medication was available to the patient. How could a patient who stopped taking digoxin but took a diuretic or an angiotensin-converting enzyme inhibitor be classified as compliant, despite the fact, as stated by the authors, that these two agents were more commonly employed for the management of hypertension? Was this definition stated prior to analysis or after finding a very low compliance rate?
The second point is the very high noncompliance rate (only 10% of the population filled enough prescriptions to acquire the amount of drug prescribed). Considering the various explanations given