Sins of omission: When physicians fail to prescribe
May 1, 1999
Sins of omission: When physicians fail to prescribe
Only 31% of congestive heart failure patients nationwide are on ACE inhibitors, although clinical guidelines advocate its use as an initial therapy.1 Nationally, only 11% to 25% of people with hypertension have their blood pressure controlled within normal range.2 Beta-blocker use was documented in only 21% of office visits of patients with coronary artery disease who had no strong contraindications.3 As few as 21% of eligible patients receive prescriptions for beta-blockers following hospital discharge for a heart attack.4 In one study, physicians failed to intensify drug therapy despite elevated blood pressure readings in three-quarters of office visits by hypertensive male patients.5References
1. Stafford RS, Saglam D, Blumenthal D. National patterns of angiotensin-converting enzyme inhibitor use in congestive heart failure. Arch Intern Med 1997; 157:2,460-2,464.
2. Joint National Committee. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1993; 153:154-183.
3. Wang TJ, Stafford RS. National patterns and predictors of beta-blocker use in patients with coronary artery disease. Arch Intern Med 1998; 158:1,901-1,906.
4. Marciniak TA, Ellerbeck EF, Radford MG, et al. Improving the quality of care for Medicare patients with acute myocardial infarction: Results from the Cooperative Cardiovascular Project. JAMA 1998; 279:1,351-1,357.
5. Bosker G. Cocktails for cardioprotection. Physician’s Therapeutics and Drug Alert 1999; 4:Supplement.