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Many Heart Failure Patients Don't Get What They Need

Appropriate therapies, counseling vary from hospital to hospital

SUNDAY, Nov. 9, 2003 (HealthDayNews) -- As many as a third of all heart failure patients in the United States don't get all of the therapies and counseling they should, new research says.

The study, to be presented Nov. 10 at the American Heart Association's annual conference in Orlando, Fla., found significant variations in care from hospital to hospital.

"It actually does matter what hospital you're treated at. There's a very large treatment gap," says study author Dr. Gregg Fonarow, the Eliot Corday chairman of cardiovascular medicine and science at the University of California, Los Angeles.

"Certain hospitals were able to provide [care that met the study criteria] in 100 percent of patients and other hospitals were much less likely to provide the recommended care," Fonarow says.

The good news: Because some hospitals provided the necessary care, that means the problem can be fixed and other hospitals can improve their performance by adopting quality-care initiatives, Fonarow says.

About 400,000 new cases of heart failure are diagnosed in the United States each year, and between 2 million and 3 million Americans already have the condition. Heart failure -- the heart's inability to pump enough blood through the body -- is directly responsible for 39,000 deaths annually and is a contributing factor in the deaths of another 225,000 Americans, according to the National Heart, Lung, and Blood Institute.

Fonarow and his colleagues gathered information on more than 30,000 people with heart failure for the study. The data came from a national registry, called ADHERE, of more than 100,000 people diagnosed with heart failure from 250 hospitals across the country.

The average age of the study participants was 72 and slightly more than half were female.

The researchers looked at four important areas of care: receiving a complete set of discharge instructions; having the heart's pumping ability measured; receiving a prescription for an ACE inhibitor (a medication that may help prolong life by keeping blood vessels from narrowing), unless there was a medical reason not to prescribe it; and for smokers, receiving counseling on quitting smoking.

The researchers found that nearly a third of people who should have received ACE inhibitors didn't. Sixty-nine percent of current or recent smokers weren't counseled on smoking cessation. In 18 percent of the people with heart failure, left ventricular function -- an important measure of the heart's pumping ability -- wasn't assessed.

Seventy-two percent of hospital patients were discharged without receiving a full set of discharge instructions. Discharge instructions contain information about what medications should be taken and when; when to schedule follow-up appointments; signs and symptoms of worsening heart failure; and information on what type of exercise to do and a low-salt diet.

"This provides clear, scientific evidence that there are treatment gaps," Fonarow says. He adds that if hospitals can improve the quality of care they provide, they can reduce a patient's risk of re-hospitalization and markedly improve survival rates.

Another study, appearing in this week's Morbidity and Mortality Weekly Report from the U.S. Centers for Disease Control and Prevention, also found heart care lacking.

This study found heart attack patients often weren't referred to cardiac rehabilitation programs. Such programs are designed to increase exercise tolerance, lower cholesterol, help people quit smoking, reduce cardiac symptoms and improve well-being.

Yet, slightly less than 30 percent of people who have had a heart attack have participated in cardiac rehabilitation. This study also suggests the implementation of policies to ensure patients have access to these potentially life-prolonging programs.

Fonarow says the "take-home message" for health-care providers from his study is that they "should be participating in a quality assurance program."

He notes that hospitals don't even have to try to come up with a quality assurance plan on their own. There are already ready-to-implement plans designed by the ADHERE registry or the American Heart Association.

Dr. James Goldstein, a cardiologist at William Beaumont Hospital in Royal Oak, Mich., says his hospital implemented a quality assurance program long ago to make sure "we dot all the 'I's and cross all the 'T's."

He points out the problem isn't just a cardiology problem.

"Trying to give the best medical care is a challenge for every specialty," says Goldstein, who adds that medicine has become increasingly complicated.

Both Goldstein and Fonarow say it's a good idea for patients to educate themselves about their disease and the treatments available.

More information

To learn more about heart failure, visit the National Heart, Lung, and Blood Institute or the American Heart Association.

SOURCES: Gregg Fonarow, M.D., Eliot Corday chairman of cardiovascular medicine and science, University of California, Los Angeles; James Goldstein, M.D., cardiologist, William Beaumont Hospital, Royal Oak, Mich.; Nov. 10, 2003, presentation, American Heart Association Scientific Sessions 2003, Orlando, Fla.
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