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Many High-Risk Patients Going Without Anti-Clotting Drugs

Study also finds regional differences across U.S.

FRIDAy, May 11, 2007 (HealthDay News) -- Although well-known medicines can curb a dangerous cardiovascular condition called atherothrombosis, at least 20 percent of people who could benefit from the drugs are still not getting them, a new study finds.

Atherothrombosis occurs when blood collects in the arteries, raising clotting risks. The condition can be well-managed with a range of drugs that include statins, antiplatelets, beta blockers and angiotensin-converting enzyme (ACE) inhibitors.

But doctors from the University of California, San Francisco, say hospital outpatient facilities aren't keeping track of patients who need the preventive medicines.

"There is a need for implementing systems for improving care in out-patient practice," said Dr. Gregg Fonarow, a professor of cardiology at the University of California in San Francisco. "A large number of patients have stroke and cardiovascular deaths that could have been prevented."

Getting the right meds may also depend on where in the United States you live, he added. Patients in the Northeast received more of the clot-preventing drugs than those living in other parts of the country, despite the existence of clear guidelines supporting their use.

"The extent of regional variations is surprising," Fonarow said. "The current thinking is that the guidelines are distributed widely and that doctors in all regions would be treating patients in a similar fashion."

He was presented the findings Thursday at the American Heart Association's Annual Scientific Forum, in Washington, D.C.

For the study, Fonarow and his colleagues studied data from 26,000 U.S. patients enrolled in the Reduction of Atherothrombosis for Continued Health (REACH) trial, an ongoing international study of more than 68,000 patients with atherothrombosis managed in primary-care offices in 45 countries.

Depending upon a patient's condition, doctors can prescribe drugs -- along with a healthy lifestyle and diet -- to significantly reduce the risk of recurrence or onset of atherothrombosis-linked events, such as stroke and cardiovascular disease.

But Fonarow and his colleagues found that only three-quarters of such patients across the country were taking antiplatelets, which prevent blood clots, or statins, which reduce cholesterol. Approximately half were taking beta blockers and ACE inhibitors, which reduce blood pressure and lessen heart disease risk.

Patients in the Northeast were prescribed recommended drugs at a slightly higher rate than were patients in other areas of the country, the team found.

In the Northeast, 55 percent of patients with atherothromobosis were taking at least three of the four drugs recommended for managing their diseases, compared to 52 percent in the Midwest, 51 percent in the West and 50 percent in the South.

These regional percentage differences may seem relatively small, Fonarow said, but they represent hundreds of thousands of patients.

"Even small differences [in percentages] have important consequences," he said.

Patients with symptoms were 50 percent more likely to receive preventive care than patients with risk factors but no symptoms of atherothrombosis, the study found.

There are many possible reasons that these patients aren't getting the drugs they need, Fonarow said, including changing physicians, prescription changes, or the introduction of new drugs that patients don't know about.

"Half to three-quarters of patients are getting treatment, but there is still room for improvement," he said, "and this type of data is helpful for identifying that there is an issue with gaps in the outpatient population."

Dr. Alan Kadish, associate director of the Bluhm Cardiovascular Institute at Northwestern University Medical Center in Chicago, said he was disappointed by the findings.

"In a registry like this the numbers will never be 100 percent, but we have to do a better job translating medical advances, like better drugs, into practice," he said.

More information

Find out more about preventing strokes at the American Stroke Association.

SOURCES: Gregg C. Fonarow, M.D., professor, cardiology, University of California, San Francisco; Alan Kadish, M.D. associate director, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago; May 10, 2007, presentation, American Heart Association's Annual Scientific Forum, Washington, D.C.
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