Have you or a loved one suffered from a heart attack? Did the doctor prescribe cholesterol-lowering drugs upon leaving the hospital? If not, you're not alone.
A new UCLA study shows that nationwide only 32 percent of heart-attack survivors receive cholesterol-lowering medication upon leaving the hospital - despite national treatment guidelines and major clinical trials demonstrating that these medications significantly help lower mortality rates in this high-risk patient population.
The new study, published in the Dec. 19 edition of Circulation, the journal of the American Heart Association, also revealed that younger women, the elderly and those undergoing coronary artery bypass surgery are less likely to receive cholesterol-lowering medication at time of discharge from the hospital.
"The study points to the need for additional educational programs for physicians and nurses as well as hospital-based treatment programs to help ensure that patients receive these life-saving medications," said Dr. Gregg Fonarow, principal investigator, UCLA associate professor of medicine and director, Ahmanson-UCLA Cardiomyopathy Center.
The UCLA study evaluated records of 138,000 heart-attack patients seen in 1,470 hospitals across the country. This is the first nationwide study to assess lipid-lowering medication use at time of hospital discharge in this patient population. Two-thirds of heart-attack patients did not receive cholesterol-lowering medication upon leaving the hospital. And less than half of the heart-attack patients with a history of coronary artery disease, prior coronary artery bypass surgery or diabetes were treated.
Women were also less likely to be prescribed this medication than men. Younger women, ages 55 and below, in particular, were less likely to be prescribed cholesterol-lowering medication than men in the same age group upon leaving the hospital.
Patients treated at a teaching hospital were 26 percent more likely to receive cholesterol-lowering medication upon discharge than patients treated at a community hospital. Patients receiving care in a hospital on the East Coast were slightly less likely to be treated.
Heart-attack patients with only Medicare coverage were less likely to receive cholesterol-lowering drugs than patients with Medicare-HMO, who usually have some form of prescription drug coverage.
Patients discharged on other cardiovascular therapies such as aspirin, beta blockers or ACE inhibitors were more likely to be discharged on a cholesterol-lowering medication. Likewise, current smokers treated by physicians and nurses who provided smoking-cessation counseling during hospitalization were more likely to be discharged on cholesterol-lowering medications.
"A number of clinical, demographic, hospital and process-of-care factors seem to influence whether physicians prescribed cholesterol-lowering medication to their heart-attack patients or not," Fonarow said. "We now have the opportunity to try and improve care for this large, high-risk patient population."
Fonarow adds that the next step will involve applying hospital-based treatment programs and physician education across the country to help the nation meet the treatment needs of these patients. A hospital-based cardiac discharge program developed at UCLA (CHAMP Cardiac Hospitalization Atherosclerosis Management Program) has improved the use of cholesterol-lowering medications to over 90 percent of UCLA patients. Each year, more than 1 million Americans suffer a heart attack.
According to Fonarow, cholesterol-lowering medications help patients control coronary atherosclerosis by reducing plaque production and inflammation - essential in patients who have suffered a heart attack. Although these medications lower the risk of a recurrent heart attack by 23 percent to 42 percent, the study shows that a large number of patients are still not being treated with this life-saving therapy.
"If you or a loved one has suffered a heart attack or has coronary artery disease, it's important to check with your physician to see if you could be a candidate for cholesterol-lowering medication," Fonarow said.
The study was performed with the National Registry of Myocardial Infarction 3 Registry, which is supported by Genentech Inc. Dr. William French at Harbor-UCLA Medical Center was co-author of the study.