November 12, 1997 in Nation/World

Heart Attack Victims Often Aren’t Given Proven Treatments Studies: Women, Minorities, Elderly Least Likely To Get Therapies

Richard A. Knox The Boston Globe
 

As many as 32,000 U.S. heart attack victims die every year because hospitals don’t give them proven therapies, from an aspirin tablet costing pennies to a $2,300 dose of clot-busting drug, a New York researcher said Tuesday.

“These effective drugs are just not used routinely,” Dr. Richard Greene of the Columbia-Presbyterian Medical Center said at the American Heart Association’s annual meeting, which is being held in Orlando.

Another study, which looked at nearly 85,000 heart attack cases, confirmed that tens of thousands do not get effective treatments to unclog coronary arteries. These include clot-busting drugs, an artery-clearing procedure called angioplasty, and coronary bypass surgery.

All 85,000 heart attack victims were clearly eligible for artery-clearing treatments, according to accepted guidelines. But more than 20,000 did not get them.

Least likely to get the proven therapies were women, minorities, patients older than 75 years, those with a prior stroke or heart attack, and those suffering the most severe heart attacks, said Dr. Hal V. Barron of the University of California at San Francisco and the biotech firm Genentech, which makes a leading clot-busting drug.

The studies are part of a mounting body of evidence that many Americans suffering from heart attack, stroke, high blood pressure, heart failure, and high cholesterol are not getting tried-and-true treatments known to prevent disease and death. Several such reports emerged at this year’s Heart Association sessions, the world’s largest scientific meeting with 37,000 participants.

Part of the problem, experts say, is that there is a big difference between the quality of treatment provided at specialized centers conversant with up-to-date care standards and what is done in many community hospitals.

Mortality rates for heart failure, the most expensive and fastest-growing heart disease problem, are “monstrously higher” in community settings than in specialized centers, observed Dr. Jay Cohn of the University of Minnesota, a leading heart failure specialist.

“Treatment gets done in a haphazard way,” said Dr. Michael Bristow of the University of Colorado, a specialist in heart failure. “Proven treatments don’t get done, or not in the right dose, or many subtle little maneuvers don’t get done.”

Dr. Sidney Smith of the University of North Carolina, past president of the Heart Association, said all hospitals should develop systems for treating heart attacks based on the most current theories. “Before an airplane leaves the ground, the airline goes through a checklist to make sure it’s not going to crash,” Smith said in an interview. “The same should be true for managing patients.”

Some argue that managed care, with its emphasis on cutting costs, is limiting some patients’ access to the best care. But studies are contradictory on this point.

One Philadelphia study found that people who suffered heart attacks in 1993 had double the mortality rate if they were members of health maintenance organizations, compared to those in traditional insurance plans. But another study of HMO care versus non-HMO care in New York State, conducted by Massachusetts General Hospital researchers, found that heart attack victims had equivalent outcomes in 1995.

Much attention is being focused on heart attack care, since 1.5 million Americans suffer heart attacks each year. Greene and his Columbia University colleagues started with data showing that 30 to 40 percent of heart attack patients don’t receive aspirin - a simple treatment whose effectiveness was shown in the early 1990s.

Similarly, Greene noted, a 1996 study found that only 30 to 50 percent of heart attack victims receive heart-protecting drugs called beta blockers; only 25 to 30 percent get blood pressure-lowering drugs called ACE inhibitors; and only about 15 percent get clot-busting drugs.

By applying data on how much these treatments reduce heart attack deaths, Greene’s group calculated that nearly 6,000 lives could be saved each year if patients were given aspirin upon hospital admission. The cost nationally would be $15,938.

Altogether, wider use of the treatments would save 26,000 to 34,000 lives each year at a cost of about $467 million to $2.5 billion. “In terms of cost per year of life saved, this falls well within what is considered a good societal investment,” Greene said.


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