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    Many Heart Patients Aren’t Taking Needed Drugs

    Study Shows Patients Are Missing Out on Benefits of Preventive Medications

    Drug Therapy Before and After Stents

    Research comparing the impact of different treatments on outcomes in specific patient groups is a major focus of the health care reform bill signed into law by President Obama last year.

    Borden says a major message to policy makers as they fund studies comparing different treatments is that they also need to find better ways to implement findings from these comparative studies.

    “One of the real lessons here is that we need to focus more on making sure that the findings from research studies like this one actually make it to clinical practice,” he says.

    American Heart Association president-elect Gordon F. Tomaselli, MD, tells WebMD that preventive drug treatments are being underprescribed to patients with stable coronary artery disease.

    Tomaselli, who directs the division of cardiology at the Johns Hopkins University School of Medicine in Baltimore, says it is of particular concern that roughly a third of patients in the study were not prescribed the drugs after treatment with stents or angioplasty.

    He adds that the patients included in the COURAGE trial with stable coronary disease make up a minority of patients with heart disease.

    Benefits of Drugs and Heart Procedures

    While the benefits of stents and angioplasty beyond improvement in chest pain symptoms are not clear for these patients, this is not true for patients with less stable, more advanced disease, he says.

    “There are clearly people who have better outcomes with these interventions, and we know who they are,” he says. “They are patients with acute myocardial infarction, ST segment elevation, and other signs of ongoing [heart] muscle injury.”

    Interventional cardiologist Barry Kaplan, MD, points out that these patients also benefit from the drug treatments, but many clinicians fail to recognize this.

    Kaplan is vice chairman of cardiology at North Shore University Hospital in Manhasset, N.Y.

    “Many clinicians think of PCI as a standalone treatment, which is a big misconception,” he says. “The idea that if you fix the blockage, medical treatments are less important couldn’t be more wrong. Fixing the blockage does not negate the responsibility to be vigilant about the need for optimal medical therapy.”

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