|
E-mail this page to a friend!
Heart Patients at Greatest Death Risk Least Likely
to Get Needed Medicine
Sept. 14, 2005 In study results that seem too
strange to be true, researchers have found that even though certain
medications such as ACE inhibitors reduce the risk of death for patients
with heart failure, patients at greatest risk often are not prescribed
these medications, and are less likely to get them than lower risk
patients. It is reported today in the Journal of the American Medical
Association (JAMA).
Heart failure affects more than 5 million people,
mostly senior citizens, in Canada and the United States and is
associated with a high death rate, according to background information
in the article.
Medications shown to reduce the risk of illness and
death from this condition include angiotensin-converting enzyme (ACE)
inhibitors, angiotensin II receptor blockers (ARBs), and beta-adrenoreceptor
antagonists.
These drug classes have been studied extensively
and recommended strongly by disease management guidelines, given their
proven benefit of reducing the risk of death in patients at the highest
risk. It should be expected that these individuals would be more likely
to receive these medications. However, previous studies have suggested
that the opposite may occur in practice.
Douglas S. Lee, M.D., Ph.D., of the University of
Toronto, and colleagues examined the use of drug therapies for heart
failure in relation to predicted 1-year death rates. The patients for
this study were part of the Enhanced Feedback for Effective Cardiac
Treatment (EFFECT) study (1999-2001), which included 9,942 hospitalized
patients with heart failure.
The researchers evaluated 1,418 patients, aged 79
years or younger, with documented left ventricular ejection fraction (a
measure of the heart's pumping ability) of 40 percent or less and with
low-, average-, and high-predicted risk of death within 1 year. All
patients survived to hospital discharge. Administration of ACE
inhibitors, ACE inhibitors or ARBs, and beta-adrenoreceptor antagonists
were evaluated according to predicted risk of death.
The researchers found that at hospital discharge,
prescription rates for patients in the low-, average-, and high-risk
groups were 81 percent, 73 percent, 60 percent, respectively, for ACE
inhibitors; 86 percent, 80 percent, 65 percent, respectively, for ACE
inhibitors or ARBs; and 40 percent, 33 percent, 24 percent,
respectively, for beta-adrenoreceptor antagonists. Within 90 days
following hospital discharge, the prescribing rates were 83 percent, 76
percent, and 61 percent for ACE inhibitors; 89 percent, 83 percent, and
67 percent for ACE inhibitors or ARBs; and 43 percent, 36 percent, and
28 percent for beta-adrenoreceptor antagonists for the three risk
groups, respectively.
|
At
Discharge |
Patients at lowest risk of death
received the most medication?
Click chart for larger view. |
|
|
% ACE Inhibitors |
% ACE or ARBs |
% Beta-andrenoreceptor |
|
Low Risk |
81 |
86 |
40 |
|
Average Risk |
73 |
80 |
33 |
|
High Risk |
60 |
65 |
24 |
|
Within 90
Days |
|
|
% ACE Inhibitors |
% ACE or ARBs |
% Beta-andrenoreceptor |
|
Low Risk |
83 |
89 |
43 |
|
Average Risk |
76 |
83 |
36 |
|
High Risk |
61 |
67 |
28 |
The pattern of lower rates of drug administration
in those patients at increasing risk was maintained up to 1 year
postdischarge.
After accounting for varying survival time and
potential conditions that makes a particular treatment or procedure
inadvisable, low-risk patients were 61 percent more likely to receive
ACE inhibitors or ARBs; and 80 percent more likely to receive beta-adrenoreceptor
antagonists compared with high-risk patients.
A potential explanation for the inverse
relationship between risk and treatment rates could be under
appreciation of the benefits of therapy, particularly in patients with
chronic disease who are at risk of death from noncardiac causes, the
authors write.
Additionally, clinicians may be distracted from
heart failure care in patients with multiple comorbid [coexistence of
two or more often related diseases] conditions. However, despite
excluding patients with several potential life-limiting comorbidities,
the treatment mismatch remained. The possible need for multiple
prescription medications could also be a consideration in withholding
therapy.
In conclusion, the predicted and observed risks of
death in patients with heart failure were inversely associated with
discharge and postdischarge administration of potentially life-saving
drug therapies.
This finding is particularly important because
patients at highest risk of death have great need for effective
treatment. Clinical use of quantitative multifactorial risk profiles or
algorithms that convey information regarding probability of poor
outcomes could be applied to better identify such patients. Further
study is needed to quantify the adverse consequences attributable to the
mismatch between risk and treatment rates and may also identify
potential solutions to correct this undesirable phenomenon, the
researchers write.
Click to More Senior News on the
Front Page
Copyright: SeniorJournal.com |
