Life-saving drug saves dollars in heart attacks
Thrombolysis as good as angioplasty, study finds
Can a medical therapy save money and save lives in heart attack cases?
The answer is "Yes," according to a study reported in the New England Journal of Medicine. When patients suffer an acute myocardial infarction (AMI), thrombolytic (clot-dissolving) medication is as effective as primary coronary angioplasty in saving lives at community hospitals, researchers reported.
That finding, combined with other similar reports, may influence physicians to use the more cost-effective, less invasive approach in those first crucial hours after a patient’s heart attack, experts say. On average, thrombolysis costs $3,000 less per patient than angioplasty, and nearly 200,000 patients are eligible for thrombolysis each year.1
While some randomized trials have demonstrated better outcomes from primary angioplasty, they were conducted in hospitals that perform high volumes of that procedure. Researchers wanted to know how treatment choice affects outcome in a community setting, says Nathan R. Every, MD, MPH, a cardiologist at the Seattle Veterans Affairs Medical Center and assistant professor at the University of Washington in Seattle.
"In the lower volume angioplasty hospitals, the results [from angioplasty] are good, but not as good as the randomized trial," Every says.
Every and his colleagues analyzed mortality rates and resource use of 1,050 primary angioplasty patients and 2,095 patients given thrombolytic therapy at 19 Seattle hospitals from 1988 to 1994. They found no significant difference in mortality during hospitalization or up to three years after discharge for the two groups.
However, after three years of follow-up, patients who had thrombolytic therapy were less likely to have subsequent tests and treatments. They received 30% fewer coronary angiograms and 15% fewer coronary angioplasties, according to the study, which was funded by the federal Agency for Health Care Policy and Research (AHCPR) in Rockville, MD as a part of a cardiac treatment research project.
Hospitals and physicians may use this information when they make policy decisions about how to treat heart attack patients, Every says. For example, if a hospital doesn’t have a primary angioplasty program, it shouldn’t feel compelled to create one to provide better outcomes, he says. "The results of thrombolysis are equivalent," he says.
You might not need angioplasty program
However, he also cautions cost issues should be evaluated on a hospital-by-hospital basis. Angioplasties would be a less expensive alternative on a per-patient basis at hospitals with a high volume, he notes. "Every hospital will have to decide what is most cost-effective for them," he says.
"It’s possible to be an excellent angioplasty or thrombolytic center, but it’s hard to do both well," Every notes. He advises you to "pick a treatment strategy and stick with it and make sure it works."
The Seattle study highlights the effectiveness of thrombolytic therapy in appropriate patients. An estimated 25% to 33% of AMI patients are candidates for thrombolytic therapy, but research shows that only 18% of patients receive it.
"There was a surprisingly low percentage of appropriate utilization in a whole variety of [AMI] drugs," says Barbara J. McNeil, MD, PhD, Ridley Watts professor of health care policy at Harvard Medical School in Boston and principal investigator of the Patient Outcomes Research Team on Acute Myocardial Infarction for the AHCPR.
McNeil and her colleagues are now repeating research on the use of drug therapy with heart attack patients to determine if physicians have altered their treatment in response to prior studies. "There was a big push to get physicians more aware of the value of these drugs," she says.
Reference
1. Every NR et al. A comparison of thrombolytic therapy with primary coronary angioplasty for acute mypcardial infarction.
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