Many Americans are faced with serious cardiovascular problems. Nearly 17 million Americans have been diagnosed with coronary artery disease (CAD), and millions more are at risk of developing CAD. The disease predisposes people to heart attacks and stroke. Damage to the coronary and carotid arteries raises the risk of compromised vital blood flow to the heart muscle and brain. About 900,000 people suffer heart attacks each year and another 800,000 have a stroke. And for many of those with CAD, the very first sign of serious disease is sudden death with no prior warning.
The American Heart Association (AHA) and the American College of Cardiology (ACC) have developed treatment programs for both hospitalized patients and outpatients to help assure that their risk factors are being properly treated. Many studies have shown that optimal therapy can make a difference in recovery from a heart attack or preventing an attack from occurring in the first place.
The AHA’s decade-old “Get with the Guidelines” program for hospitals have increased the likelihood that patients will be discharged with the proper medications. Awareness of and adherence to hospital guidelines has helped to improve patient survival. The 1,500 or so hospitals participating in the ACC program have demonstrated 94% compliance with the proper discharge medications compared to only 78% before the ACC’s hospital-based National Cardiovascular Data Registry was started. The registry highlights the importance of time-critical interventions for patients arriving at the hospital with heart attacks. Of the more than 1,000 hospitals participating in the registry program, over 85% administer life-saving medical interventions within 90 minutes of arriving in the ER, compared to just 40% six years ago.
As successful as these initiatives have been at reducing hospital deaths and complications from heart attacks, the vast majority of CAD is treated in the doctor’s office. There’s little good data about compliance with national guidelines in the office setting. We do know that only about one-third of patients at high risk of heart attack being treated for high LDL (“bad”) cholesterol achieve the targeted level of 100. Only 45% of high-risk individuals gain control of their blood pressure to recommended levels below 140/90. Patients are similarly deficient in their exercise regimens and 20% still smoke.
The outpatient initiative led by the ACC is called the Pinnacle Registry. Nearly 200 cardiology practices have signed on to participate by sharing clinical data. The hope is that regular feedback will raise awareness of guidelines and help doctors and patients follow regimens known to reduce their risk of heart attack and stroke.See All House Calls by Dr. Geehr.