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One in four patients who suffer a heart attack do not bother filling the prescriptions for medications to treat their underlying heart disease after leaving hospital, according to startling new Canadian research.

They pay a heavy price for ignoring doctors' orders, the study shows, because those who fail to take their meds have an up to 80 per cent higher risk of dying in the year following the initial heart attack.

"The early period after a heart attack is a risky time, and taking these medications is a powerful tool," said Cynthia Jackevicius, a researcher at the Institute for Clinical Evaluative Sciences in Toronto, and lead author of the study.

"But, for a variety of reasons, some patients do not fill the prescriptions for some or all their meds," she said.

The study, published today in the medical journal Circulation, does not probe exactly what those reasons are, but does offer some clues.

For example, the research shows that patients who receive in-hospital counselling after a heart attack are the most likely to purchase their prescription medications.

Those who are treated by a cardiologist also have much higher rates of adherence. And the data show that those who do not fill their prescriptions within a few days of discharge from hospital are unlikely to do so at all.

Dr. Jackevicius said this suggests that more time and effort should be invested in educating patients about why and how to take their medications, and that there should be quick follow-up after discharge from hospital.

The study involved 4,591 patients from 104 acute care hospitals in Ontario who suffered a heart attack between 1999 and 2001.

Among them, they received 12,832 prescriptions for heart drugs such as anticoagulants, beta blockers, statins and angiotensin-converting enzyme (ACE) inhibitors. (Current guidelines call for heart-attack patients to receive all four of these drugs after discharge.) Many patients also received prescriptions for antidepressants, antibiotics and respiratory medications.

All the patients in the study were over the age of 65 and received their drugs at virtually no cost under the Ontario drug plan, so affordability is not believed to be a factor.

Still, researchers found that one in five prescriptions for heart drugs were not filled. (For drug treatment not related directly to the heart attack, the adherence rate was far lower, with two out of three prescriptions not filled.)

Three out of four heart attack patients filled all their prescriptions, and they fared best.

One in 10 did not fill any prescriptions, and they had an 80 per cent greater risk of dying within a year than patients who took all their meds. The balance, about one in six patients, filled their prescriptions selectively, and they saw their risk of dying increase by about 40 per cent.

Jack Tu, the Canada Research Chair in health services research and co-author of the study, said previous research has looked at patients who fail to take drugs as prescribed, but this is the first study to examine how many patients do not even pick up their prescriptions.

"This is an under-recognized phenomenon," he said. "Most doctors just assume patients fill their scripts, but that's not the case for everyone."

Dr. Tu said there is a small minority of patients who simply do not believe in Western medicine and want to take alternative therapies.

But a larger problem is that "not everyone understands the rationale for these medications ... we just aren't doing the education."

Dr. Tu said if government programs are going to invest billions in drug treatments, they should consider investing some of those funds in counselling and training patients.

"If people are not filling their scripts, that has important implications for patient care," he said.