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Do Doctors Sometimes Fail Their Heart
Failure Patients?
Inotropic drugs
make you feel better, but do you live longer? New study seeks answers.
Aug. 21,
2003 - What's the best way to manage a patient who's dying of heart
failure? And just how do physicians make decisions about this
ever-growing population of patients, particularly those in the end
stages of the disease?
These are
two questions that a cardiologist at Saint Louis University is seeking
to answer as part of research sponsored by the National Institutes of
Aging. The project, funded by a $721,000 grant from the NIA, begins
this summer and will continue for four years.
"Congestive heart failure is a disease of increasing prevalence,
accounting for high morbidity and mortality," said lead researcher
Paul J. Hauptman, M.D., a cardiologist at Saint Louis University
School of Medicine. "This is a disease of the elderly, so as baby
boomers age we need to start understanding more about how physicians
in multiple specialty areas actually treat these patients. Ultimately,
we want to figure out how to best take care of patients with end-stage
heart failure."
The risk
of heart failure, which affects 2 to 3 million Americans, is more
common among elderly patients and increases with age. About 5 percent
of those who are 75 have the condition, compared to 1 percent of those
age 50.
Dr.
Hauptman's study has two major parts:
The study
evaluates a medical therapy, the infusion of inotropic drugs,
which is associated with high costs, unproven clinical efficacy and
the potential to shorten survival while achieving palliation. "This
therapy makes patients feel better, but it's unclear whether it helps
them live longer," Hauptman said.
Researchers will use administrative and clinical data from several
Medicare databases for the period 1997 to 2001. The population of
older Medicare beneficiaries receiving and the physicians prescribing
this therapy will be described and contrasted with the demographics
and outcomes of older patients hospitalized for heart failure but not
receiving the drugs.
The data
will be used so doctors can better predict how inotrope use affects
mortality and other factors in this high-risk group.
The second
part involves a survey of 1,200 cardiologists, geriatricians,
internists and family/general practitioners from across the country to
assess how their knowledge and attitudes influence their practices in
treating end-stage heart failure patients. Approximately one-third of
the physicians will be known prescribers of inotropic drugs.
"We plan
to investigate how physicians make decisions and the degree to which
the care of the end-stage patient is influenced by physician
specialty, volume or other factors," Hauptman said.
"When
complete, these studies will form a framework for physicians to use
when selecting care options, including palliation, for older heart
failure patients near the end of life," he said.
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