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Heart-Failure Patients Need
Better Prompts From Doctors By Otesa Middleton, Dow Jones Newswires Doctors and nurses need checklists and other tools to jog their memories so they will remember to give heart-failure patients potentially life-saving drugs and information when discharged from the hospital, according to a new study. When heart failure patients leave the Another study found that the American Heart Association's initiative called Get With the Guidelines Coronary Artery Disease, helps healthcare teams incorporate such reminders into their practice. "We need to do a better job," said Dr. Gregg C. Fonarow, who led the first study that found how many hospitals were lacking. "There is a lot more that can be done before heart failure patients leave the hospital to improve the quality of patients' lives and make sure they continue to do well." Heart failure, which strikes some five million Dr. Fonarow's study looked at the first group of people enrolled in a 100,000-patient registry sponsored by Scios Inc. at 250 hospitals nationwide. Data from Dr. Fonarow's study included the registry's first 33,046 patients, and was presented here Sunday at the American Heart Association annual scientific meeting. Of the patients who were ideal candidates to receive the popular class of blood-pressure lowering agents called ACE inhibitors, 31% didn't get the drugs. "ACE inhibitor treatment is most important," Dr. Fonarow said in an interview. "It is a proven medication to improve survival." A whopping 72% didn't get complete discharge instructions including information on physical activity, eating a low-sodium diet, how to take their medicines and what dangerous health signs to look for. Also, 69% of smokers weren't giving counseling on quitting. Dr. Fonarow, who teaches in cardiovascular medicine and
science at the Giving healthcare providers preprinted order sets, discharge checklists and patient education materials improve the treatment rates, Dr. Fonarow said. Although, overall, hospitals appear lacking in giving heart failure patients all the weapons they need to survive heart failure, certain hospitals in the study had 100% compliance with guidelines. "It is completely doable," Dr. Fonarow said. Based on the preliminary analysis of subpopulations in the study, Dr. Fonarow said it appeared as if the gaps in treatment hold true regardless of location, race, gender, age or health insurance status. There are several reasons hospitals have failed to uniformly follow the guidelines that have been pushed by the American Heart Association, Dr. Fonarow said. "In some cases the workers are swamped. And some doctors and nurses may not be aware of the national guidelines," he said. "And not all patients are cared for by cardiologists and primary care physicians may not be focused on these complex issues." "As a country we need to have Medicare and other insurance companies pay those hospitals and physicians that do it right more to provide incentives," Dr. Fonarow proposed. "Right now there isn't economic incentive to do this." The second study, which looked at the impact of the American Heart Association's Get with the Guidelines program examined 27,825 patients and found improvement in hospitals that had the low-cost program in place to remind healthcare providers. When the study started just 57.2% of patients who smoked received counseling to quit. Hospitals that used the guidelines program for a year saw that rise to 81.6%.
Copyright
© 2002 Global Action on Aging |
