Many Heart Attack Patients Don't Get Best Emergency...(oplasty or treatment with fibrinolytic (...),Health

But it's those details that reveal the troubling gap between the number of patients who could have received the treatments, and those who actually did.

"We may never be able to get to 100 percent, but 10 percent of eligible patients going untreated is still too many," says first author Brahmajee Nallamothu, M.D., MPH, assistant professor of cardiovascular medicine at the U-M Medical School. "We hope our study highlights the opportunities to improve care and particularly some of the "at-risk" subgroups still less likely to receive reperfusion therapy despite eligibility, so that we can focus our clinical efforts on them."

Adds senior author Harlan Krumholz, M.D., S.M., "This study has good and bad news. We have definitely made progress in treating appropriate patients, but our findings indicate that we need to improve further to be sure that no patient who could benefit from this treatment is missed." Krumholz is the Harold H. Hines, Jr. Professor of Medicine in the Section of Cardiovascular Medicine and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation.

The study was funded by the National Heart, Lung and Blood Institute of the National Institutes of Health. Genentech, Inc. provided the researchers access to the registry, which it sponsors.

To track the changes in acute (emergency) reperfusion therapy over time, the researchers divided the study data into three time periods: June 1994 through May 1997, June 1997 through May 2000, and June 2000 through May 2003.

The rise in emergency angioplasty was fastest from the first time period to the second; the rate of increase leveled off from the second time period to the third. Correspondingly, the number of patients receiving medication-based reperfusion dropped over the study period.

This is an appropriate shift, says Nallamothu: shifting patients from clot-busting medications to
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SOURCE University of Michigan Health System Copyright©2007 PR Newswire.

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