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Journalists:
please note that all presentations are embargoed until the
time of their actual presentation at the Late-Breaking Clinical
Trial (LBCT) sessions or ACC press conference, whichever comes
first. The date and time of each official presentation at
an LBCT session is provided at the end of each trial topic
description.
Highlights
from: Critical Analysis of Coronary Artery Bypass Surgery
WEDNESDAY,
MARCH 9, 2005
11:00
a.m.-12:00 p.m.
Quality Programs
Keep Treatments on Track, Boost Patient Survival
(ORLANDO, Fla.)—SQuality improvement
programs increase adherence to treatment guidelines and improve
survival in patients with heart failure, coronary artery disease
and heart attack, according to studies being presented at
the American College of Cardiology’s 54th Annual Scientific
Session in Orlando, Fla., March 6-9, 2005.
Heart failure patients are far more likely
to take medications proven to enhance long-term survival if
physicians prescribe them before the patient goes home from
the hospital, according to a report from the Organized Program
to Initiate Lifesaving Treatment in Hospitalized Patients
with Heart Failure (OPTIMIZE-HF) (Gregg Fonarow, #844-4).
Drawing on a database of more than 4,000 patients from nearly
90 hospitals, researchers found that 95 percent of patients
prescribed beta blockers in the hospital were still taking
them two to three months after hospital discharge, as compared
to 32 percent of patients who did not start therapy in the
hospital. Similarly, 73 percent of patients prescribed angiotensin-converting
enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs)
in the hospital were taking them at follow-up, as compared
to just 19 percent of those who did not start therapy in the
hospital. (Original presentation on Tuesday, March 8, at 10:45
a.m.)
A computerized quality improvement program
that reminds physicians about treatment goals can improve
the number of patients who receive key medications in accordance
with clinical guidelines (James T. Dove, #844-5). A study
conducted at a large midwestern cardiology practice evaluated
the use of aspirin, beta blockers, statins, and ACE inhibitors
or ARBs in patients with coronary artery disease. Through
an electronic medical record, physicians had access to information
on medications, laboratory results, and medical history for
all patients. In about one-tenth of patients, a quality improvement
program also provided access to American College of Cardiology/American
Heart Association treatment guidelines and issued visual alerts
when those guidelines were not being followed. Investigators
found that reminders and alerts substantially improved compliance
with prescription guidelines. (Original presentation on Tuesday,
March 8, at 11:00 a.m.)
A new analysis validates clinical guidelines
that call for treatment within 90 minutes of hospital arrival
in heart attack patients who have angioplasty to open a blocked
coronary artery (William W. O’Neill, #822-5). Researchers
combined data from four clinical trials with a patient enrollment
of more than 1,300. They found that the shorter the “door-to-balloon”
time—the time from arrival at the hospital to inflation
of the angioplasty balloon inside the problem artery—the
lower the rates of cardiovascular complications and death
within 30 days, and the less the damage to the heart muscle.
(Original presentation on Monday, March 7, at 4:30 p.m.)
Therapies that relieve chest pain significantly
improve patients’ mental and physical well-being and
overall quality of life (Patricia A. Cowper, #870-3). Using
standardized questionnaires, researchers evaluated quality
of life in more than 1,600 patients with severe coronary artery
disease. About two-thirds of patients had surgery or catheter-based
coronary intervention, and the remainder were treated medically.
After six months, improvements in quality of life were directly
related to relief of chest pain, regardless of the type of
treatment. (Original presentation on Wednesday, March 9, at
8:30 a.m.)
Patients who take an aspirin a day to keep
heart attack away should be careful about the dose, or face
increased risk of bleeding complications (Victor L. Serebruany,
#870-7). In an analysis of data from 31 clinical trials with
more than 190,000 participants, investigators found that the
bleeding risk was lowest with an aspirin dose of less than
100 mg/day. Increasing the dose to just 100-200 mg/day nearly
quadrupled the overall bleeding risk, and doubled the rate
of hemorrhagic stroke. (Original presentation on Wednesday,
March 9, at 9:30 a.m.)
Physicians are less likely to take advantage
of quality improvement programs when treating women who have
had a heart attack, or acute myocardial infarction (AMI)—but
when they do, long-term survival is markedly better (Sandeep
M. Jani, #844-8). Researchers analyzed the use and effectiveness
of the American College of Cardiology AMI Guidelines Applied
in Practice (GAP) in nearly 1,400 women and 1,500 men. They
found that the tool was used in only 28 percent of women,
as compared to 33 percent of men.
Its use significantly increased the use of
aspirin and beta blockers in both men and women, but the use
of statins and ACE inhibitors improved only in men. Nonetheless,
at one-year follow-up, the risk of death was reduced by 54
percent in women whose care was guided by the GAP program,
a highly significant improvement. The 38 percent reduction
in the risk of death at one year in men fell shy of statistical
significance. (Original presentation on Tuesday, March 8,
at 11:45 a.m.)
Moderator: TBD |
