DALLAS, September 1 -- An ounce of prevention may be worth a pound of cure, but many people with heart disease may not even get that much, say researchers in a report in today's Circulation: Journal of the American Heart Association. Researchers evaluated the hospital charts of 225 cardiac care unit patients to determine how physicians at an academic hospital followed the latest National Cholesterol Education Program (NCEP) guidelines. The guidelines were created to help physicians screen those at high risk for heart attack and who may benefit from cholesterol-lowering medication. Researchers also examined whether doctors evaluated patients for major risk factors such as cigarette use, prior heart attack and family history of heart disease.
The scientists found that a surprisingly small percentage of patients were screened for some of the most important risk factors. Moreover, even fewer were provided with adequate follow-up treatment. Researchers also found that physicians followed NCEP guidelines incorrectly half of the time when evaluating the need for drug treatment for high cholesterol.
"There is a significant gap between the guidelines produced by experts and what the real world clinical practice of physicians shows," says the study's lead author, Joseph P. Frolkis, M.D., Ph.D., staff physician, Cleveland Clinic Foundation in Cleveland, Ohio. "It's true for cancer guidelines. It's true for diabetes guidelines. It's true for heart disease guidelines."
Of the eight possible risk factors listed in the 1993 NCEP guidelines -- personal history of heart disease or atherosclerosis, high blood pressure, diabetes, cigarette use, family history of premature heart attack, and menopausal status and status of hormone replacement therapy for women -- medical professionals screened, on average, for 2.4 risk factors.
Interns performed best, a finding Frolkis says is expected since they are
supposed to take the most thorough history from patients. But e
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Contact: Brian Henry
brianh@heart.org
(214) 706-1135
American Heart Association
31-Aug-1998