Heart Plan may Reduce Death Risk for Elderly

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Heart Plan may Reduce Death Risk for Elderly

By Steve Sternberg, USA Today

March 11, 2004

By following a few simple guidelines, doctors can reduce elderly heart patients' risk of dying by 25%, says a study out Wednesday.

The study demonstrates that getting doctors to adopt standard practices for patient care — an approach some have derided as "cookbook" medicine — saves lives, says Kim Eagle, of the University of Michigan-Ann Arbor , who presented his findings at the American College of Cardiology meeting here.

"I'm getting on a flight today and I really hope the pilot goes through his checklist, because I want to live," Eagle said. "In medicine, it's the same thing."

The checklist in this case was developed by the American College of Cardiology program called "Guidelines Applied in Practice."

Participating hospitals were given pocket guidelines for doctors and nurses, regular performance reports and an all-important "patient discharge contract," to assure that patients were not only given appropriate instructions but followed them.

The study involved nearly 3,000 Medicare patients at 33 hospitals in southeast Michigan , including several in such cities as Flint , Saginaw and Detroit .

The patients were elderly, with a median age of 76, almost half were women, and many had medical problems, including previous heart attacks, diabetes and heart failure. Many had had angioplasty or bypass operations.

Prompting doctors to follow the guidelines had a dramatic impact on patient care, Eagle said. By the study's end, 30% of doctors and patients completed discharge contracts, compared with 2% at the start. Use of the "Fab Four" heart medications — aspirin, cholesterol-lowering drugs and the twin blood pressure reducers called ace inhibitors and beta blockers — rose significantly.

Hospitalized patients' overall death rates dropped by 21%. By 30 days after discharge, the death rates fell by 26%, and at one year, they dropped by 22%.

Eagle says the study's message is clear: "In the helter-skelter modern medical environment, you really need a system."

The impact of this approach, if expanded throughout the USA , would be profound, he added.

Darren McGuire, director of Parkland Cardiology Clinics at The University of Texas Southwestern Medical Center in Dallas , agreed.

"These seem like really small absolute numbers," McGuire said, "but add them together across the country and they would affect really large numbers of people."