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Less Aggressive Care for More Severe Heart Disease
Date:8/5/2009

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 w
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