They determined that the use of optimal medical therapy in all patients between 2005 and 2009 was 44.2 percent before PCI, and 65 percent upon discharge after patients received their stent. Before results of COURAGE were known, medical therapy was used before PCI in 43.5 percent of patients, and after COURAGE was published, the rate rose to 44.7 percent. After PCI, at discharge, medical therapy was prescribed to 63.5 percent of patients before COURAGE was published, and 66 percent after.
That means that the wide publicity that followed publication of the study resulted in a net benefit of 1.2 percent increase in use of optimal medical therapy before a stent was inserted, and 2.5 percent after the procedure, says Dr. Borden. "While this is a statistically significant result given that thousands of patients were included in the study, it is not clinically significant," he says.
"I was surprised," Dr. Borden adds. "I thought there would be more of an improvement in medical therapy over time, but we have seen this difficulty in translating clinical trial evidence into practice before."
The authors say the possible reasons for this failure include a "knowledge gap" on the part of physicians and the fact that the health care workers treating PCI patients (referring primary care physicians, general cardiologists, interventional cardiologists and nurses) may not be working together as part of a team.
"Patients who receive a stent are often in the hospital for less than 24 hours. The interventional cardiologist who implants the stent may, or may not, be following the pa
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New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College