Docs Not Giving Best Post-MI Prevention Care?

Its a worrying finding for patients.

A significant percentage of patients with coronary artery disease (CAD) still aren’t being prescribed the recommended secondary prevention drugs that could save their lives, a new analysis confirmed.

About a third of CAD patients enrolled in a national registry were not taking a combination of beta-blockers, statins, and ACE inhibitors/angiotensin receptor blockers (ACEI/ARBs) after having a heart attack or undergoing percutaneous coronary intervention (Angioplasty/ PCI) or coronary artery bypass grafting (CABG/ bypass surgery).

And compliance with the secondary prevention drug recommendations varied greatly from practice to practice, researcher Thomas M. Maddox, MD, of the VA Eastern Colorado Health Care System in Denver, and colleagues, wrote online Oct. 30 in the Journal of the American College of Cardiology.

 

The researchers examined data from the American College of Cardiology’s PINNACLE Registry, which is the first national, prospective, outpatient-based cardiac quality improvement registry of patients being treated in cardiology practices in the U.S.

Patients treated at 58 PINNACLE practices between July of 2008 and December of 2010 were included in the analysis.

Among 156,145 coronary artery disease (CAD) patients treated at 58 participating practices, 66.5% were taking beta-blockers, statins, and ACE inhibitors/angiotensin receptor blockers on their first post-event visit, and only slightly more (69.7%) had been prescribed these recommended medications a year later.

 

This is worrying that one-third of the patients are not getting the necessary drugs to  prolong survival.  This is despite the fact that most of the doctors have now access to latest medical information and guidelines due to availability of smart phones and internet access. If this is the situation in the western world, it would be worse in the developing countries.

In an editorial published with the analysis, L. Kristin Newby, MD, of Duke University, wrote that efforts to increase the use of optimal drugs for secondary prevention should focus not only on cardiologists but also family practice physicians, internists, gynecologists, and advanced practice providers such as nurse practitioners and physician’s assistants.

 

via Docs Not Giving Best Post-MI Prevention Care?.

Drugs for Angina or cardiac pain!

Angina pectoris, which is more commonly known as angina, is severe chest pain caused by a lack of blood (ischemia) in the heart muscle.

The commonest cause of angina is blocks in the coronary arteries which cause obstruction to the blood flow.

The common drugs which are used to treat angina are as follow:

1. Beta-Blockers: This is a class of drug which reduces the heart rate. Thereby, they reduce the oxygen requirement of the heart. This causes relief in angina. 

The drugs approved for this condition are Metoprolol,  Bisoprolol, Atenolol, Nebivolol and Carvedilol. These drugs are started in normal doses and then increased till the time patient is free of his symptoms. Majority of the patients tolerate them well. They need to be monitored for the side effects like bronchospasm and slow heart rate. 

If a patient is unable to tolerate the beta-blockers, the alternative group of drug which can be prescribed is called Calcium channel blockers. Some of the drugs used are Diltiazem and Verapamil. They can be used in patients with lung problems as they have no effects on lung function unlike beta-blockers.

2. Aspirin: the commonest drug prescribed to all cardiac patients. This is an anti-platelet drug and thus prevents clot formation in the arteries. It is given in a dose of 75-150 mg a day. It should be consumed after food to avoid gastric irritation.

3. Statins: These are drugs which reduce cholesterol and triglyceride levels. The prevent the formation of plaques or blocks in the coronary arteries. They also reduce the incidence of heart attacks in the patients. The common ones used are Atrovastatin, Rosuvastatin, Simvastatin etc. They are to be taken after dinner for maximum effect.

4. Nitrates: There are drugs which cause dilatation of the coronary arteries and are very helpful in relieving angina. They can be taken by keeping the tablet below the tongue (Tab Sorbitrate) or consumed with glass of water. They are also available as oral sprays or skin patches. They can cause headache or giddiness as their side-effect.

Most of the patients with angina can be easily controlled with drugs and can be symptom-free (pain free). The non-medical options are angioplasty or bypass surgery which can be reserved for patients with intractable symptoms.

Drugs for the weak heart!

ImageWeak Heart is a condition caused by weakness of the heart muscle where in the heart is unable to pump blood to meet the daily requirement of the body.

This condition in medical terms is called Cardiomyopathy or Left ventricular (LV) dysfunction.

This condition causes breathless on exertion initially and then breathlessnes at rest in the late stages. One is unable to sleep supine at night due to the breathlessness. It may be associated with cough and swelling of the feet. This clinical condition is called Heart Failure.

The condition is diagnosed by carrying out an Ultrasound of the heart to know its pumping function. This test is also called 2D-Echocardiography.

 

There are some important medications which patients need to take:

1. Diuretics: These are drugs given either orally or intravenously. These act on the kidneys by flushing water and electrolytes from the body. By flushing out water from the body, these drugs reduce the congestion in the lungs and thereby reduce breathlessness. They also cause reduction in the swelling in the feet. This causes increase in the urine output. Thus, these drugs are advised to be taken in the mornings. 

The common ones used are Furosemide, Spironolactone, Amiloride, Triamterene etc.

These can cause electrolyte imbalance and dehydration and so the therapy need to be monitored.

These drugs are recommended to patients in heart failure who are breathless and develop swelling of the feet. They relieve patients of their symptoms but are not found to reduce the  long term mortality.

 

2. ACE Inhibitors. This is a class of drug which acts by blocking the conversion of angiotensin I to angiotensin II. They, therefore, lower arterial resistance and increase venous capacity; increase cardiac output. They reduce the cardiac mortality in the long run and are recommended in all patients with heart failure and LV dysfunction.

The common ones used are Enalapril, Captopril, Ramipril and Perindopril. These drugs can cause increased potassium levels in the blood and can cause dry cough in come patients. If a patient in unable to tolerate the drug due to dry cough, they can be substituted with ARBs. ARBs (angiotensin receptor blockers) are similar drugs but tend to be more expensive.

They are recommended for all patients with LV dysfunction and/or heart failure as they reduce long term mortality.

 

3. Beta-Blockers: This is a class of drug which reduces sympathetic over-activity. Thereby, they reduce the heart rate and blood pressure, thus giving the heart much needed rest to recover. 

The drugs approved for this condition are Metoprolol,  Bisoprolol and Carvedilol. These drugs need to be started in very small doses and then increased carefully as some of the patient may encounter worsening of their symptoms. Majority of the patients tolerate them well. They need to be monitored for the side effects like bronchospasm and slow heart rate.

They are recommended for all patients with LV dysfunction and/or heart failure as they reduce long term mortality.

Now you know what to take if someone suffers from LV dysfunction or heart failure. 

Take care!