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Patients at the academic hospitals were age 64 on average, with 48 percent having two or more other disorders, such as high blood pressure, diabetes, etc. At community hospitals, patients were age 70 on average and 48 percent had two or more other disorders. The VA patients were age 69 on average and were more likely (61 percent) to have other diseases.

Researchers found that VA hospitals were more likely to treat atrial fibrillation patients with warfarin, an anticoagulant recommended in the American Heart Association/American College of Cardiology guidelines. On average the VA hospitals treated 68 percent of these patients with warfarin, while 52.9 percent of patients at academic hospitals and 52.8 percent at community hospitals received it. Atrial fibrillation patients at VA hospitals had more contraindications to warfarin compared with patients at community or academic hospitals. There were no differences in the occurrence of contraindications between community and academic hospitals.

"Surprisingly, neither aspirin nor warfarin was prescribed in 20.6 percent of high-risk patients in all of the hospitals," the researchers said.

Additionally, low molecular weight heparin was used in only about 56 percent of patients with blood clots in the legs or phlebitis, an inflammation of the vessels in the legs. And, only 27 percent of patients were discharged on bridge therapy, in which the guidelines recommend heparin and warfarin together, despite a 4.1-day reduction in stay. About one-third of VA hospitals and less than one-third of academic hospitals discharged patients on bridge therapy, versus community hospitals which discharged patients on bridge therapy in about one-fifth of cases.

The researchers also found that doctors weren't prescribing adequate therapy to prevent blood clots in the legs of high-risk patients undergoing orthopedic surgery for hip and knee replacement. This treatment was absent in 14 percent of ort
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Contact: Carole Bullock
carole.bullock@heart.org
214-706-1279
American Heart Association
17-May-2004