Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Heart surgery patients receive less aggressive discharge care

08.11.2004


Patients who undergo coronary artery bypass surgery are prescribed life-saving medications at discharge significantly less frequently than heart attack patients who receive less invasive angioplasty procedures, according to a new analysis by researchers at the Duke Clinical Research Institute.



These findings are important, the researchers said, because the drugs in question -- aspirin, ACE inhibitors, beta blockers and statins -- have been proven effective by multi-center clinical trials to reduce repeat cardiac events and death and therefore incorporated in established guidelines for care of heart attack patients. The researchers said much room exists for improving the usage rates of these life-saving drugs among all heart patients, including those who received angioplasty.

For example, the Duke team found that 65 percent of angioplasty patients received ACE inhibitors -- a class of blood vessel-relaxing drugs -- compared to only 44 percent of bypass patients. The cholesterol-lowering statins were prescribed for 76 percent of angioplasty patients and 62 percent of bypass patients.


Additionally, the team found in its analysis of data from a national registry of heart attack patients that those who received surgery were much more likely than angioplasty patients to receive diet modification counseling and referrals to cardiac rehabilitation.

The use of discharge medications and behavior modifications, which includes smoking cessation counseling, are officially recommended by the American Heart Association (AHA) and the American College of Cardiology (ACC) as preventive measures against future heart problems and death. "In general, discharge care given to angioplasty patients is more aggressive and is more consistent with national guidelines than is the discharge care given to the surgical patients," said Duke cardiologist Christopher Dyke, M.D, who presented the results of the Duke analysis Nov. 8, 2004, at the AHA’s annual scientific sessions in New Orleans. "The disparity between the two groups of patients is inappropriately large, with the usage of ACE inhibitors and statins by surgical patients alarmingly low," Dyke continued. "These patients tend to be the sickest heart patients, and may have the most to gain by receiving these proven therapies."

For their analysis, the researchers consulted the nationwide quality improvement initiative named CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC and AHA Guidelines) The registry continually collects data from more than 400 hospitals on outcomes and on the use of proven drugs and procedures used to restore blood flow to the heart.

From this registry, the researchers identified 307 hospitals that had the capability to perform both angioplasty procedures and bypass surgery. Of the more than 64,000 patients entered into the registry from those hospitals since 2002, 33,316 received one of the procedures. One-quarter of those 33,316 patients received bypass surgery.

The gaps between the usage of aspirin, a commonly prescribed blood thinner, and beta-blockers, which blunt the cardiovascular system’s response to stress, were not as wide, but still had clinical significance, Dyke said. "The absolute difference between aspirin use (95 percent vs. 92 percent) may not seem large on a percentage basis, but in a population of more than 33,000, that represents a lot of patients who are not receiving aspirin," Dyke said. The rate of beta blocker usage was 88 percent for angioplasty patients, compared to 83 percent for bypass patients.

Dyke said the surgical patients were much more likely to receive diet modification counseling (86 percent vs. 79 percent) and to be referred to cardiac rehabilitation (72 percent vs. 51 percent). In general, the bypass patients tended to be older and sicker, and for many of them, the need for surgery serves as a "wake-up call" that inspires them to change their life style.

It is at this point in their treatment, when the patient is in the hospital recovering from surgery, that the introduction of these medications should be started or at least discussed, Dyke said. "The time in hospital and at discharge is the best time to start patients on these medications," Dyke said. "Studies consistently show that patients are more likely to continue taking medications initiated while in the hospital than if started later. These patients will also have improved outcomes."

CRUSADE focuses on heart patients with non-ST-segment elevation myocardial infarction (non-STEMI), a categorization of heart attack based on electrocardiogram (ECG) readings. These patients typically arrive at emergency rooms with chest pain, but often will not have telltale signs of a heart attack on the initial ECG. They might be diagnosed with a heart attack only when the results of the blood tests are reported a few hours later.

While patients with acute STEMI are at higher risk of dying within 30 days of their hospital stay, patients with non-STEMI actually have a higher risk of dying six months and one year after initial hospital presentation. It is estimated that about 1.3 million Americans are hospitalized each year with non-STEMI.

CRUSADE continuously gathers data from participating U.S. hospitals on treatments for patients with non-STEMI and provides quarterly feedback to hospitals with the ultimate goal of improving adherence to the ACC/AHA treatment guidelines and patient outcomes.

Richard Merritt | EurekAlert!
Further information:
http://www.mc.duke.edu

More articles from Health and Medicine:

nachricht Millions through license revenues
27.04.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn

nachricht New High-Performance Center Translational Medical Engineering
26.04.2017 | Fraunhofer ITEM

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Fighting drug resistant tuberculosis – InfectoGnostics meets MYCO-NET² partners in Peru

28.04.2017 | Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

 
Latest News

Wireless power can drive tiny electronic devices in the GI tract

28.04.2017 | Medical Engineering

Ice cave in Transylvania yields window into region's past

28.04.2017 | Earth Sciences

Nose2Brain – Better Therapy for Multiple Sclerosis

28.04.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>