Most stent patients fail to get best medicines, study finds

Most heart disease patients fail to get the best mix of life-saving medications before they land in the hospital needing intervention for clogged arteries, and one-third aren't given the proper drugs after, researchers said.

The number of people getting optimal medical therapy hasn't changed significantly since 2007, when a landmark study found that the right combination of drugs prevents heart attacks and deaths as effectively as procedures to restore cardiac blood flow.

The findings in the Journal of the American Medical Association show doctors haven't translated those results into better patient care, the researchers said.

Doctors should prescribe medication to lower blood pressure, cut cholesterol and prevent clots before patients need procedures to prop open arteries, said lead researcher William Borden, a cardiologist at New York-Presbyterian Hospital/Weill Cornell Medical Center's Perelman Heart Institute. After the procedure, which may include stents, the medicine gives patients the best shot at heart health, he said.

"There are multiple medications that have individually been shown to decrease rates of heart attack and increase survival," Borden said in a telephone interview. "While no one wants to be on medicine, it is better than having a heart attack or dying from heart disease."

The study of about 500,000 patients undergoing procedures to clear clogged arteries found 44 percent were receiving the best drug regimen. After the surgery, doctors prescribed the recommended medications, including blood thinners like Plavix from Sanofi and Bristol-Myers Squibb Co., cholesterol-lowering drugs such as Pfizer Inc.'s Lipitor and generic hypertension pills called beta blockers, for 65 percent of their patients, the study found.

The reason for the results aren't clear, said Christopher White, director of cardiology at Ochsner Medical Center in New Orleans and president of the Society for Cardiovascular Angiography and Interventions. The use of angioplasty, the procedure to clear clogged arteries, has decreased, and many doctors are practicing with the study results in mind, he said.

The findings, based on the National Cardiovascular Data Registry, may not take into account the reasons doctors have for not prescribing a medication, he said in a telephone interview. If a doctor tells a patient to stop a medication because they have a reaction to it, for example, the physician may not put the reasons in the database, he said.

Other doctors may not be pushing optimal medical therapy because patients don't feel sick and resist taking more drugs, he said in a telephone interview. The results of the earlier trial, dubbed Courage, should be used as a guideline rather than a law, he said. The question of what exact pills patients need isn't clear and the answer will vary depending on the patient, he said.

It is critically important that patients take the right medicines to keep heart disease from worsening, said Judith Hochman, director of cardiovascular clinical research at New York University School of Medicine, who wasn't involved in the research. If patients have a reaction to one medication, there are other options, she said.

"There may be some misconception on the part of physicians and patients that once you have a procedure it fixes the problem," she said in a telephone interview. "The bottom line is that all of these patients, whether or not they undergo a procedure, need to be on optimal medical therapy. You have to address the underlying disease."

Borden said there are several other potential explanations for the results. Some doctors may not be aware of the ideal drug therapy, others question the findings of previous studies and the health system makes it easier for doctors to order tests and perform procedures than to discuss the proper drug therapy with their patients, he said.

"This is a wake-up call to say that we need to examine how we are providing medical care and look at ways to improve that delivery," he said.