Many patients worldwide don’t receive generic life-saving heart medicines that are supposedly affordable, a new study reveals.
In poor and middle-income nations, these vital medications are often not widely available or are too expensive. In rich countries, as many as half of patients with a history of heart disease or stroke still don’t receive them, the researchers found.
“Unless both availability and affordability of these medicines are improved, their use is likely to remain low in most of the world,” they added. The study is published Oct. 21 in The Lancet.
Four classes of heart medicines — aspirin, beta blockers, statins and angiotensin-converting-enzyme (ACE) inhibitors — should be available in 80 percent of communities and used by half of eligible patients by 2025, the World Health Organization says.
But compliance currently is far from those targets, the study found.
“Unless governments in most countries, especially low- and middle-income countries, begin initiatives to make these essential heart medicines available and provided free — as is done for HIV — then their use is always going to be far less than optimal,” said study leader Salim Yusuf, director of the Population Health Research Institute at Hamilton Health Sciences and McMaster University in Canada.
“In rich countries, the key question is different — we need health systems in which there are organized approaches to secondary prevention, perhaps run by non-physicians such as trained nurses or other health workers, to improve uptake and adherence,” Yusuf added in a journal news release.
Researchers assessed use of these heart medicines in 2003-13 in 18 countries, including Sweden, United Arab Emirates, Canada, Poland, Turkey, Chile, Malaysia, South Africa, Argentina, Brazil, Colombia, Iran, China, occupied Palestinian territory, Pakistan, Bangladesh, Zimbabwe and India.
The medicines were considered available if in-stock at pharmacies. They were deemed affordable if their combined cost was less than 20 percent of household capacity to pay.
In high-income countries, all four classes of medicines were available in nearly all urban and rural communities, the researchers found. But availability declined along with national wealth.
The drugs were obtainable in only 62 percent of urban and 37 percent of rural communities in lower middle-income countries. And in low-income countries (excluding India) they were available in just 25 percent of urban and 3 percent of rural communities. In India, however, more than 80 percent of communities, urban and rural, had access to the drugs.
While affordability was an issue for less than 1 percent of households in the richest countries, it emerged as a problem for 25 percent in upper middle-income countries and roughly 30 percent in lower middle-income countries. The drugs were potentially unaffordable in about 60 percent of households in low-income countries, including India.
The American Heart Association has more about heart medicines.