NCPA - National Center for Policy Analysis

Heart Care Treatment Varies

November 26, 2002

Ideally, heart patients should receive the same optimal therapy -- drugs, devices, procedures and operations -- wherever they are treated. But according to studies reported at a recent meeting of the American Heart Association (AHA), they don't.

  • One reason is that some hospitals and doctors are less aggressive than others in carrying them out.
  • Also, even when guideline recommended drugs are prescribed, many patient do not comply with the instructions.
  • Another reason is that guidelines are based on clinical trials in which most participants are middle aged, and that relatively narrow focus can make it hard to extrapolate findings to the elderly and children.

One study found a marked variation in the frequency with which guidelines from the AHA and the American College of Cardiology were used in treating heart attacks at 1,085 hospitals.

  • The death rate before discharge ranged from 17.6 percent in 271 hospitals that lagged most in following the guidelines to 11.9 percent in the 271 that led in following them.
  • Where the guidelines called for ACE inhibitor drugs to reduce the risk of death, their use was 40 percent in the "lagging" hospitals, compared to 70 percent in the "leading" ones.
  • Where cholesterol-lowering drugs were called for in the guidelines, the use was 58 percent in lagging hospitals and 80 percent in leading ones.

That said, experts note, guidelines can not replace physician judgment for many reasons -- not least because elderly patients especially are afflicted with more than one disease.

Source: Lawrence K. Altman, M.D., "'Standard' Heart Treatment Is Hit And Miss," New York Times, November 26, 2002


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