Monday, February 23, 2009

Patients who delay seeking care for heart attacks fare equally well with cheaper, less invasive option
by Kelly Winget, DCRI Communications

For patients who don't seek treatment for a heart attack until days or even weeks after the initial symptoms, a new study finds that drugs are not only cheaper but offer the same long-term quality of life benefits as using drugs and stents, which are used to open blocked arteries.

The study, led by the DCRI's Daniel Mark, MD, MPH, was published in the February 19 issue of the New England Journal of Medicine.

The study is a new analysis of the Occluded Artery Trial (OAT) that compared drug treatment to using both drugs and stents in patients who waited a prolonged period of time after first experiencing heart attack symptoms to seek treatment. The new analysis focused on the quality of life and medical expenses of patients enrolled in the trial.

Mark suggests that based on the findings, clinicians might not want to consider angioplasty to insert stents as part of the routine care for these patients, as drug treatment is less invasive and costly but still effective.

Ideal treatment for a heart attack is within the first few hours of symptoms first appearing. But up to as many as one-third of patients aren't treated for at least 12 hours. While drugs to break up blood clots are not effective at that point, many patients would still be treated with stents as a way to improve their outcomes.

The original OAT study found that drug treatment alone was just as effective for these patients as treating them with drugs and stents. The new analysis found that patients who received stents initially had lower chest pain and better overall functioning but those benefits didn't last long.

For the new analysis, researchers asked patients about any pain, physical limitations, overall energy, and psychological well-being, among other indicators. Patients were contacted at 4, 12, and 24 months after they were released from the hospital.

The differences in the reported amount of chest pain among patients who received drugs and stents and those who only received drugs were small to begin with and disappeared by the two-year follow-up, according to the study findings.

Researchers also learned that patients who received stents had to stay an average of an extra day in the hospital, compared to patients who only received drug therapy. The patients who received stents also had approximately $7,000 in additional costs that the other patients didn't have.

The study findings indicate that the lower-cost option of treating these patients only with drugs provides the same level of care and overall quality of life.

Other DCRI researchers involved with the study include Wenqin Pan, PhD; Nancy Clapp-Channing, RN, MPH; Kevin Anstrom, PhD; Patricia Cowper, PhD; and Linda Davidson-Ray, MA.

Click here to read the complete findings.