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:10/13/2017)... , ... October 13, 2017 , ... Apple Rehab ... services, staged a mock evacuation of the facility as part of a disaster drill ... Department, Echo Hose EMS and Shelton City Emergency Manager, as well as the ...
(Date:10/13/2017)... ... October 13, 2017 , ... The Visiting Nurse Association (VNA) of Somerset ... of specialty vendors and unique items from across the nation, this holiday-themed event will ... services offered by the VNA. The boutique will be open Saturday, November 4 ...
(Date:10/13/2017)... ... , ... Global Healthcare Management’s 4th Annual Kids Fun Run brought out many ... event, sponsored by Global Healthcare Management’s CEO, Jon Letko, is aimed at getting kids ... of all ages; it is a non-competitive, non-timed event, which is all about having ...
(Date:10/13/2017)... ... October 13, 2017 , ... ... viewers the lowdown on sciatica in a new episode of "Success Files," which ... current events and innovation and investigates each subject in-depth with passion and integrity. ...
(Date:10/13/2017)... ... ... Journey: From the Mountains to the Mission Field”: the story of a missionary couple ... From the Mountains to the Mission Field” is the creation of published author, Carole ... and currently teaches a class of ladies at her church, which she has taught ...
Breaking Medicine News(10 mins):
(Date:9/27/2017)... and NEW YORK , Sept. 27, 2017 ... mobile health and big data solutions, today announced that its MyDario product ... check your local TV listings for when The Dr. Oz Show airs ... The ... this month. ...
(Date:9/23/2017)... Sept. 22, 2017 Janssen Biotech, Inc. (Janssen) ... letter from the U.S. Food and Drug Administration (FDA) ... sirukumab for the treatment of moderately to severely active ... clinical data are needed to further evaluate the safety ... active RA. ...
(Date:9/19/2017)... HistoSonics, Inc., a venture-backed medical device company developing a non-invasive, robotically assisted, platform therapy that ... developments today:   ... ... Tom Tefft ... Veteran medical device executive Josh Stopek , PhD, who has led R&D and ...
Breaking Medicine Technology: