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Article |

Heart Failure and Noncompliance in the Elderly

Jalal K. Ghali, MD
Arch Intern Med. 1994;154(18):2109-2110. doi:10.1001/archinte.1994.00420180119015.
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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


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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