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 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!

Long term Medications for patients with Heart attack!

Heart attack is the lay man’s term for a myocardial infarction. Myocardial infarction is nothing but damage to the heart due to blockage of the artery carrying blood to the heart.

So once the individual is stabilized, what are the medications he/she needs to take to improve his symptoms and reduce long term events (events like chest pain or a repeat heart attack)?

 

These are as follows:

 

1. Aspirin: This is blood thinner and prevents clot formation. The dosage recommended is 75 or 150 mg a day. It is preferable to take it after meals to avoid gastric irritation.

 

2. Statin: This is one of the most popular drug and know to reduce repeat heart attacks and long term mortality (death rates). These are anti-cholesterol medicines which reduce the bad fats thereby reducing blockages in the heart. The commonly used drugs here are Atorvastatin, Rosuvastatin and Simvastatin. The goal of therapy is to achieve a LDL-cholesterol value of less than 100 mg/dl.

 

3. Beta-blockers: These drugs reduce the heart rate and the blood pressure. This reduces the blood requirement of the heart and thus improves healing. It also reduces events like sudden cardiac arrest and angina pain. The commonly used drugs are Metoprolol, Bisoprolol, Atenolol and Carvedilol. 

 

4. ACE inhibitors: Again a group of drug know to reduce blood pressure and long term mortality. It should be given to patients with heart pumping less than 40%. It reduces the load on the heart and thus prevents further damage. The commonly used drugs here are Enalapril, Ramipril, Lisinopril etc.

 

All the above drugs should be take only after consultation with your doctor.

Also most of the time, the treatment is Long term! 

Most of the patients tend to discontinue their medications. This is not recommended as the benefits with the drugs are immense. So one should consult his Cardiologist and ensure that they are on the necessary medicines. In case of side-effects, there are good alternatives which should be discussed with the Cardiologist.

 

Take care!