Heart failure patients for whom drug therapy is essential after release from the hospital are the least likely to get it, a Canadian study has found.
And a likely explanation is that doctors may not be devoting the time that is needed to care for these higher-risk patients, says lead researcher Dr. Douglas S. Lee, a research fellow at the University of Toronto.
In a study of more than 1,400 Ontario residents who were hospitalized for heart failure, those judged to be at the greatest risk of dying within a year after release were significantly less likely to be prescribed front-line medications for the condition.
The risk assessment was based on a number of factors, including age (older people are at higher risk), kidney function and the presence of other medical problems.
Those in the highest risk category had a 50% chance of dying within one year, Lee says. Yet only 60% of them were prescribed ACE inhibitor drugs to treat their condition, compared with 73% of the people in the middle-risk group and 81% of those in the low-risk group.
Similarly, 24% of the high-risk patients were prescribed beta blocker medicines, compared with 33% of those classified as medium risk and 40% of those in the low-risk group.
This pattern continued outside the hospital. Within 90 days of discharge ,61% of the high-risk patients were prescribed ACE inhibitors, while 76% of the middle-risk group and 83% of the low-risk group got the same prescriptions. Posthospital numbers were similar for other heart failure drugs as well, the study found.
The Canadian findings "would likely also be true in the United States," says Lee, who is also a research associate with the Massachusetts-based Framingham Heart Study.
A previous study had also found consistent underuse of medications for heart failure patients. This new study adds support to those findings, says Dr. Frederick Masoudi, associate professor of medicine at the Denver Health Medical Center, and a leader of the earlier study.
"Higher-risk patients are more complicated to treat and probably require a lot more time and a lot more effort. That maybe one of the primary reasons," for the undertreatment, says Lee. In medicine, as in business, time is money, and according to Lee, "Doctors are paid the same amount for treating high-risk and low-risk patients."
Because no other treatment options exist, proper drug therapy is vital for people who have heart failure, in which the heart progressively loses its ability to pump blood.
"The study shows not only that medications are underused, but also a systematic failure of physicians to calibrate their treatment to the underlying risk of the patients," Masoudi says. "The complexity of some of these patients does create additional challenges for the physicians, but the complexity shows the need for understanding the risk of individual patients and calibrating the treatment that will benefit them the most."