Some heart patients not getting treatment: study

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WASHINGTON (Reuters) - Some patients with congestive heart failure are not receiving recommended medicines that could keep them alive longer and out of the hospital, a trend that may be adding to the nation's health costs, U.S. researchers say.A team at Stanford University School of Medicine in a study conducted over 15 years found that patients got prescriptions for drugs that would help their condition in fewer than half of doctor visits, and that number was falling."There are some recommended medications for heart failure that have been proven to be effective against mortality and morbidity, to lower hospitalizations and improve death rates," said Dr. Dipanjan Banerjee, a cardiologist at Stanford who worked on the study released on Monday in the Archives of Internal Medicine."We saw a plateau of those therapies, and in some cases there was a reduction in the use of those therapies later on," Banerjee said in a telephone interview.Congestive heart failure happens when the heart muscle loses its ability to efficiently pump blood through the body, often because of high blood pressure or heart disease.Of people with the condition, 20 percent die within one year, and 80 percent die within eight years. Heart failure accounts for 3 percent of U.S. hospital admissions and is the leading cause of death in the developed world.Doctors have a variety of ways to treat the disease, including drugs that expand blood vessels to allow blood to flow more easily, called ACE inhibitors and ARBs, and drugs that improve the heart's ability to pump blood, called beta blockers.The researchers looked at what the study called a nationally representative database of physician responses to survey questions about the treatment they provide heart patients in an outpatient setting. The study did not specify the sample size.They found that the use of ACE inhibitors and ARBs, which increased to 45 percent in 2002 from 34 percent in 1994, had fallen to 32 percent by 2009 in this group of patients.Use of beta blockers increased to a high of 44 percent in 2006 from a low of 11 percent in 1998, but had fallen to 37 percent in 2009."There tends to be this phenomenon of provider fatigue at some point," Banerjee said. When new medicines first come out, "you see a sudden surge in uptake," he said.Generic drugs are not aggressively promoted by drug companies, which may be another reason awareness of effective drugs falls, Banerjee added.Dr. Sid Smith, a professor at the University of North Carolina School of Medicine and former president of the American Heart Association, said the findings do not reflect his group's experience."Everything that we can see in the heart failure quality improvement efforts using the AHA or ACC (American College of Cardiology) heart failure guidelines suggests that there is an increase in the use of these therapies," Smith said."Heart failure is a very broad term," he said. He cautioned against generalizing from a study where the sample size and underlying condition of the patients were not known.

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