News Briefs
April 1, 2000 3 minutes read
News Briefs
Many CHF patients not getting care in guidelines
Patients are not receiving the care recommended in clinical guidelines, according to a recent nationwide study conducted by The Medstat Group, a division of Thomson Health Care in Ann Arbor, MI. Investigators compared care actually received to care recommended for individuals with heart failure as well as asthma and diabetes, and results revealed a significant gap between what is recommended by leading health care organizations and what actually occurs.
• Of nearly 4,000 heart failure patients, only 40% received an echocardiography within three months of their initial diagnosis, despite its recommendation by the Agency for Healthcare Research and Quality.
• Of about 2,500 heart failure patients, only 46% received a chest X-ray — recommended by the American Board of Family Practice — during the 12-month period following diagnosis.
• Of the nearly 16,000 diabetics followed, only about a quarter received an annual eye exam and less than half received an annual total cholesterol test, both of which are recommended by the Alexandria, VA-based American Diabetes Association.
Those rates are significantly below expectations, says Louis H. Diamond, MD, vice president and medical director at The Medstat Group. "While we might not expect 100% of patients to receive the care recommended, we must certainly expect most patients to receive it."
In addition, a review of about 6,500 asthma cases showed that only 27% received an inhaled anti-inflammatory drug as recommended by the National Heart, Lung and Blood Institute.
Depression linked to death among CHF patients
Depressed mood is significantly related to increased mortality risk among people with CHF, according to a new Norwegian report.1 A hospital outpatient cardiology practice conducted the study on two groups of patients — one with severe depression and one without — and found that those with severe depression were approximately four times as likely to die within two years after they entered the study than the other group.
"This study has important implications for the treatment of congestive heart failure patients," reported Terje A. Murberg, MSc, the lead researcher. "The results suggest that health professionals should be especially alert to depression in congestive heart failure patients and should strive to provide appropriate treatment for depression when needed."
Murberg’s co-author, Torbjørn Aarsland, RN, tells CHF Disease Management the best approach for treating these patients. "Appropriate treatment involves primarily psychological therapy aiming at coping and stress management. This type of intervention should be a natural part of the patient follow-up in heart failure. Chemical treatment should be added if warranted based on regular clinical evaluation. In this patient population, no single antidepressant can be favored, this must again be based on the individual status of disease and the risk of side effects."
Participants in the study included 119 clinically stable CHF patients, average age 66, and average time since onset of heart failure, five years. The researchers evaluated each study participant for depressive symptoms, emotional problems related to CHF, patients’ perceptions of their physical limitation and dyspnea, and severity. The results showed that patients who died (20) had significantly higher scores on the self-rating scale used to measure depression than did those who survived. Furthermore, a quarter of the depressed patients died, compared to 11% of the nondepressed patients. (See related articles in CHF Disease Management, February 1999, pp. 18, 19, 21.)
Reference
1. Murberg TA, Bru E, Svebak S, et al. Depressed mood and subjective health symptoms as predictors of mortality in patients with congestive heart failure: A two-year follow-up study. Int J Psychiatry Med 1999; 29:311-326.
AMI guidelines updated on-line
The American College of Cardiology and the American Heart Association have updated their recommendations for the management of patients with acute myocardial infarction (AMI) and have posted them on their Web sites at www.acc.org and www.americanheart.com. The organizations indicate changes to the text with strikeouts and indicate additions with shading. The updated guidelines include these recommendations:
• Glycoprotein IIb/IIIa inhibitors and low-molecular-weight heparins should be used to treat unstable angina and MI without ST-segment elevation.
• Bypass surgery or angioplasty is preferred for the treatment of cardiogenic shock patients under 75.
• Hormone replacement therapy should not be started after AMI but can be continued in women who were receiving it prior to AMI.
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