CLEVELAND, Nov. 2 /PRNewswire/ -- Earlier and more aggressive treatment for patients at high risk of heart attack can reduce their chances of dying during hospitalization, but such treatment often is underutilized, new Cleveland Clinic-led research shows.
According to the research, performing cardiac catheterizations on high- risk patients seeking treatment for acute coronary syndromes -- conditions ranging from heart-disease-related chest pain to heart attack -- within 48 hours of their seeking help can significantly reduce their risk of in-hospital mortality. Cardiac catheterization is a minimally invasive procedure used to diagnose or treat heart problems, and often serves as a prelude to angioplasty/stenting or bypass surgery.
“Our research suggests that the sickest patients experience a reduction in mortality if they undergo cardiac catheterization within two days as opposed to being treated with medications alone, yet these patients often are overlooked for this early invasive management,” said Cleveland Clinic cardiologist Deepak L. Bhatt, M.D., who directed the research as part of the ongoing CRUSADE Quality Improvement Initiative. “With acute coronary syndromes affecting millions of people, the medical profession needs to ensure these more effective treatments are provided to high-risk patients in order to improve outcomes and save lives.”
This CRUSADE study analysis included 17,926 patients with high-risk acute coronary syndromes treated at 248 U.S. hospitals between March 2000 and September 2002. Each of the hospitals participating in the study had diagnostic cardiac catheterization facilities as well as the capability to perform angioplasty, stenting and/or coronary artery bypass grafting. Of those patients included in the final analysis, 62.2 percent underwent cardiac catheterization at some point during their hospitalization and 44.8 percent underwent cardiac catheterization within 48 hours of their initial presentation -- rates much lower than current guidelines would support.
Patients who had catheterization tended to be younger, white males. They also were more likely to be admitted to a cardiology service (as opposed to a general medical service). In addition, patients without kidney failure and without heart failure or signs of heart failure upon presentation were most likely to receive early invasive management.
Patients with these additional health concerns, or comorbidities, did not receive cardiac catheterization as frequently, even though this research and previous research indicates such high-risk patients would benefit from the more aggressive treatment. The CRUSADE initiative will seek to modify current practice through this type of research and feedback, as well as through other educational efforts, Dr. Bhatt said.
Complete results from this current research will be published Nov. 3 in the Journal of the American Medical Association.
The Cleveland Clinic Foundation, located in Cleveland, Ohio, is a not-for- profit multispecialty academic medical center that integrates clinical and hospital care with research and education. The Cleveland Clinic was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. U.S. News & World Report consistently names The Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Approximately 1,200 full-time salaried physicians at The Cleveland Clinic and Cleveland Clinic Florida represent more than 100 medical specialties and subspecialties. In 2003, patients came for treatment from every state and from nearly 90 countries. The Cleveland Clinic website address is http://www.clevelandclinic.org/ .
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