Many myocardial infarction (MI) survivors remain under a doctor’s care, taking medicine and living with dietary and exercise prescriptions for the rest of their lives.

Stress management, which may also include use of medications and/or counselling, is also an important component of follow-up care. Not following the doctor’s guidance is a huge problem. At first glance, adherence to the medical regimen seems to be a patient problem; but there are many barriers to following doctors’ orders. Some of them external and some internal.

EXTERNAL BARRIERS

Medication regimens and cost

MI survivors generally have to take multiple medications, particularly if they have other conditions such as atherosclerosis, high blood pressure or diabetes, which contributed to the heart attack. The more complicated the drug or lifestyle prescription, the easier it is to miss doses, miss refills, or just simply be overwhelmed.

Solutions

Create a medication map. A medication map is a schedule covering the whole day that plots when you take what medicine, the dose, and any other instructions such as whether or not to take with food. It organises all your medication in one place so you see at a glance what, when and how much.

Schedule a “brown bag” session with your doctor or pharmacist. Put all your prescription and non-prescription medications in a bag and take them to your doctor’s office or pharmacy. They may find overlapping or duplicate prescriptions from different doctors.

This would also be a good time to make a medication map. Periodic medication reviews allow you to ask if simpler, less- expensive or otherwise better alternatives are available.

Cost

Prescriptions can be expensive and even patients with good insurance may find that their out of pocket costs are more than they can afford. Patients on fixed incomes may think they have to choose between their prescriptions and other necessities.

In an effort to stretch their medicine, they may reduce the amount they take or the frequency, hoping it will still be effective. But a medicine not taken as directed can’t work as expected. If you’re having challenges affording your prescriptions, speak to your health care team about it. they may be able to help you chose medications that are affordable and within your health plan.

INTERNAL BARRIERS

Denial

For many people, taking a prescription reminds them that they are sick, and they prefer not to be reminded. Or they may not feel better or even feel worse taking blood pressure medication, so they figure why bother?

Solutions

Though MI survivors may find these prescriptions difficult to accept, much less embrace, the medicines and lifestyle recommendations from the doctor are designed to reduce the risk of another life-threatening event. Talking with a professional counsellor may also help with moving beyond feelings of denial. Enlisting the support of family and friends to help keep on track with meds and to encourage and participate in healthy behaviours, like eating right and making time for physical activity, can be helpful for all involved.

Thought process challenges

Seniors with high blood pressure or diabetes must monitor those conditions closely. If they’re also experiencing dementia or memory loss, it can interfere with their ability to keep track of these conditions.

Solutions

Thought process challenges may be difficult to compensate for. Medication maps and simplified drug regimens are helpful. Family support is important, but professional caregiving services may be necessary in dealing with this barrier.

Caregiver creativity can help. For instance, they may mask the medication by putting it in food or drink. For patients who do well with a smartphone or tablet device, there are also apps that can alert a patient at the right time with the name of the medicine to be taken and instructions for using it.

Lack of knowledge

Some survivors don’t understand the underlying condition that may have caused the MI and aren’t ready for the amount and complexity of information that comes with their diagnosis. That information is often given at hospital discharge, a time when patients may find it hard to focus on what is being said.

Solutions

Ask someone on your health care team, whether it’s your doctor, nurse practitioner or a clinical nurse specialist, about anything and everything that you’re not sure you understand. Ask if they have any printed material for patients that explains your condition(s) or a list of credible, layperson-friendly websites you can visit.

The Heart Foundation of Jamaica and Heart Smart Centre websites are great places to start. If you have more questions after exploring print materials or the Internet, write them down and discuss them with your health care provider. If you are unsure about medication, ask questions of your nurse, doctor or pharmacist.

Life goes by and other priorities arise

It seems like taking a few pills every day would be easy to do, but sometimes things that should be easy simply aren’t, especially if there are no immediate repercussions for not taking medicine, eating the wrong foods, or not exercising.

At first, your medication may be the highest priority, but as you get further from the event, other priorities pop up and demand attention. A prescription bottle gets pushed behind something else and, without a symptom to signal that

something is wrong, might be forgotten for days or weeks.

Solutions

You can’t make something a habit until you’ve made it a priority, so make taking your medicine as important as brushing your teeth. Most people don’t wait until someone tells them they have bad breath before using a toothbrush. Don’t wait for your body to tell you that you need to take your medication. Making a written commitment can help. If yours is a complicated treatment plan, ask your doctor, nurse practitioner or a clinical nurse specialist if it can be simplified.

Use a weekly pill box where a week’s worth of pills can be allotted. Cue pill taking with some other activity, like eating. Find a smartphone app that lets you schedule

automatic reminders. Ask your family to help you remember.

Fear and side effects

Some people fear being defined by their condition, and taking medicine reminds them of it. Others are simply afraid to put foreign substances into their bodies, fearing there will be unknown consequences or that they will become addicted.

Solutions

Many fears are unfounded. Talk with your health care provider about any fears or concerns; they may have information that will put you at ease.

If you experience side effects, report them and talk with the doctor about other possible ways of taking the medicine — perhaps with food, or changing the frequency or dosage?

There have been great advances in cardiac care. The cocktail of medications we have now are a great advance, and cardiac rehab is a tremendous tool. The collection of all of these advances have translated to a really dramatic reduction in the mortality from heart attacks.

Dr Claudine Lewis is an adult cardiologist and medical director at Heart Smart Centre in Montego Bay. She is also a cardiologist at the Cornwall Regional Hospital and an associate lecturer with he University of the West Indies. Questions may be sent to questions@heartsmartcentre.com and for additional information call 684-9989 or visit the website www.heartsmartcentre.com.