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| |  Evidence-Based Medicine Underused After Cardiac Device Procedures in Heart Failure Patients: Presented at HFSA By Jill Stein TORONTO -- September 24, 2008 -- Many physicians are not prescribing evidence-based treatments for their heart failure patients during the first 6 months after placement of cardioverter defibrillators and cardiac resynchronisation devices, researchers reported here at the of the Heart Failure Society of America (HFSA) 12th Annual Scientific Meeting. Paul Hauptman, MD, St. Louis University, St. Louis, Missouri, and associates assessed drug prescriptions in patients who had undergone a cardiac device procedure in a large multistate, managed-care database. "Underuse of evidence-based medications for the treatment of heart failure has been documented in both the inpatient and outpatient settings," Dr. Hauptman noted in a presentation on September 23. "While registries and other studies have suggested a gradual improvement in prescribing practices, little is known about the use of beta-blockers, angiotensin-converting enzyme (ACE)-inhibitors, or angiotensin-II receptor blockers (ARBs) in patients before and following cardiac device placement," Dr. Hauptman said. For their analysis, the investigators used administrative claims from a large managed-care organisation within the United States with over 218 million medical claims and 243 million pharmacy claims for 6.1 million individuals over a recent 4-year period. His team was especially interested in beta-blockers because these drugs have been shown to decrease the risk of death and improve survival in patients with heart failure. More days were covered by oral prescriptions for beta-blockers, ACE inhibitors, or ARBs in the 6 months following the device procedure as opposed to the 6 preceding months, although nearly 40% of days remained uncovered by a beta-blocker prescription. More than half of the subjects received 2 months or less of evidence-based beta-blockers before device placement. Use of ACE inhibitors or ARBs paralleled beta-blocker use. That is, the group with the least coverage by beta-blockers had the lowest use of ACE-inhibitors or ARBs. Dr. Hauptman said that the study results may be limited by a lack of data on mortality.
[Presentation title: Underutilization of Evidence-Based Medication in Patients Undergoing Cardiac Device Procedures: Hardware Over Pills? Abstract 301]
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