Navigation Links
Less Aggressive Care for More Severe Heart Disease

Paradox found in guidelines study

WEDNESDAY, Aug. 5 (HealthDay News) -- A study assessing the treatment of people hospitalized for heart disease has produced a worrisome finding: Those who need intensive care the most are less likely to get it.

The study of 143,999 people hospitalized between 2000 and 2008 found that those with previously diagnosed atherosclerosis -- hardening of the arteries -- were less likely to undergo artery-opening surgery and get cholesterol-lowering drug therapy than those with no such diagnosis. They also had longer hospital stays and were more likely to die in the hospital.

"We knew that patients with prior disease have worse outcomes, higher mortality and stay in the hospital longer. But we would expect these patients to be getting better therapy," said Dr. Emmanouil S. Brilakis, director of cardiac catheterization laboratories at Veterans Administration North Texas Healthcare System and lead author of a report released in the Aug. 4 issue of Circulation.. "The surprise is that they get less of the therapies recommended in guidelines compared to those who have no prior diagnosis."

The researchers used data from the American Heart Association's "Get With the Guidelines -- Coronary Artery Disease" program. They did find higher compliance with some of the guidelines for those with previous atherosclerosis. For example, 92 percent were given aspirin and a beta blocker drug more than 95 percent of the time, consistent with what was prescribed for all patients.

But while 90 percent of those who had no previous diagnosis of blocked arteries were given counseling on smoking cessation, that counseling was given to 88 percent of those with one blockage, 85 percent of those with two blockages and 79 percent of those with three blockages.

Similarly, cholesterol-lowering drugs were prescribed for 89 percent of those with no previous blockages and just 77 percent of those with three blocked arteries.

Why is this happening?

"We can only make hypotheses," Brilakis said. "Maybe some of these patients are so sick that physicians decide that being aggressive with them would not be the best course of action. Or they have been told many times to do something, and maybe physicians just give up on them."

Or maybe it's a question of money, he added. The incidence of atherosclerosis is highest among people without a lot of money, he said, "and they may not have the same health insurance coverage that other people do."

One problem is that when people think of heart disease, they think only of the heart, said Dr. Adrian F. Hernandez, an assistant professor of medicine at Duke University, and a member of the research team.

"Most people just focus on coronary disease," Hernandez said. "People may not realize the risk that is involved with multiple areas of vascular [blood vessel] disease."

"We need more education in terms of the principles of care for high-risk patients," Hernandez said. "The hope is that by highlighting this issue, we will have greater adherence to the guidelines of care."

The next step is a planned study to pinpoint the reasons for differences in care, Brilakis said. That study will question both physicians and people hospitalized for heart disease about all the factors that can affect treatment decisions, he said.

"We want to get more specific," Brilakis said. "Are patients saying they don't want aggressive treatment? Do they not have enough insurance? Why are physicians reluctant to give aggressive treatment?"

More information

Details of the "Get With the Guidelines" program are described by the American Heart Association.

SOURCES: Emmanouil S. Brilakis, M.D., Ph.D, director, cardiac catheterization laboratories, Veterans Administration North Texas Healthcare System, Dallas; Adrian F. Hernandez, M.D, assistant professor, medicine, Duke University, Durham, N.C.; Aug. 4, 2009, Circulation

Copyright©2009 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. Frequent Prostate Screens Fail to Improve Aggressive Cancer Diagnoses
2. Coalition for Pulmonary Fibrosis Launches Aggressive Ad Campaign Directed at United States Congress
3. AWT Management Announce Aggressive Growth and Acquisition Strategy
4. Novel strategy under study for aggressive leukemia
5. Prostate cancer more likely to return in blacks than whites, but the disease is not more aggressive
6. Mayo Clinic tests novel vaccine for aggressive brain tumors
7. Aggressively Treating Cardiac Risk Factors May Reverse Ischemia
8. Breast cancer is more aggressive in African-American women
9. Gene Variant Tied to More Aggressive Prostate Cancer
10. Study finds gene linked to aggressive prostate cancer
11. Even tiny breast tumors can be aggressive and may require maximum therapy
Post Your Comments:
Related Image:
Less Aggressive Care for More Severe Heart Disease
(Date:6/25/2016)... ... June 25, 2016 , ... First Choice Emergency ... named Dr. Sesan Ogunleye, as the Medical Director of its new Mesquite-Samuell Farm facility. ... Director of our new Mesquite location,” said Dr. James M. Muzzarelli, Executive Medical Director ...
(Date:6/25/2016)... ... June 25, 2016 , ... On Friday, June 10, Van ... Wellness at Work award to iHire in recognition of their exemplary accomplishments in worksite ... 7th annual Maryland Workplace Health & Wellness Symposium at the BWI Marriott in Linthicum ...
(Date:6/24/2016)... , ... June 24, 2016 , ... Those who have ... these feelings, many turn to unhealthy avenues, such as drug or alcohol abuse, as ... Michigan, has released tools for healthy coping following a traumatic event. , Trauma sufferers ...
(Date:6/24/2016)... ... June 24, 2016 , ... The Pulmonary Hypertension Association ... it will receive two significant new grants to support its work to advance ... 25th anniversary by recognizing patients, medical professionals and scientists for their work in ...
(Date:6/24/2016)... ... June 24, 2016 , ... Comfort Keepers® of San Diego, CA is excited ... To Recovery® program to drive cancer patients to and from their cancer treatments. ... highest quality of life and ongoing independence. Getting to and from medical treatments ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)...  Arkis BioSciences, a leading innovator in the ... cerebrospinal fluid treatments, today announced it has secured ... led by Innova Memphis, followed by Angel Capital ... Arkis, new financing will accelerate the commercialization of ... of its in-licensed Endexo® technology. ...
(Date:6/23/2016)... Research and Markets has announced ... Type (Organic Chemical (Sugar, Petrochemical, Glycerin), Inorganic Chemical), Functionality ... - Global Forecast to 2021" report to their ... global pharmaceutical excipients market is projected to reach USD ... in the forecast period 2016 to 2021. ...
(Date:6/23/2016)... , June 23, 2016 ... CAPR ), a biotechnology company focused on the ... announced that patient enrollment in its ongoing randomized ... has exceeded 50% of its 24-patient target. Capricor ... the third quarter of 2016, and to report ...
Breaking Medicine Technology: