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Heart surgery patients receive less aggressive discharge care

DURHAM, N.C. -- Patients who undergo coronary artery bypass surgery are prescribed life-saving medications at discharge significantly less frequently than heart attack patients who receive less invasive angioplasty procedures, according to a new analysis by researchers at the Duke Clinical Research Institute.

These findings are important, the researchers said, because the drugs in question -- aspirin, ACE inhibitors, beta blockers and statins -- have been proven effective by multi-center clinical trials to reduce repeat cardiac events and death and therefore incorporated in established guidelines for care of heart attack patients. The researchers said much room exists for improving the usage rates of these life-saving drugs among all heart patients, including those who received angioplasty.

For example, the Duke team found that 65 percent of angioplasty patients received ACE inhibitors -- a class of blood vessel-relaxing drugs -- compared to only 44 percent of bypass patients. The cholesterol-lowering statins were prescribed for 76 percent of angioplasty patients and 62 percent of bypass patients.

Additionally, the team found in its analysis of data from a national registry of heart attack patients that those who received surgery were much more likely than angioplasty patients to receive diet modification counseling and referrals to cardiac rehabilitation.

The use of discharge medications and behavior modifications, which includes smoking cessation counseling, are officially recommended by the American Heart Association (AHA) and the American College of Cardiology (ACC) as preventive measures against future heart problems and death.

"In general, discharge care given to angioplasty patients is more aggressive and is more consistent with national guidelines than is the discharge care given to the surgical patients," said Duke cardiologist Christopher Dyke, M.D, who presented the results of the
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Contact: Richard Merritt
Merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
8-Nov-2004


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