With shorter inpatient stays, medication dosing adjustments formerly followed in hospital often fall by the wayside.
For nearly 40 years a class of drugs known as beta blockers have been proven to increase patients’ survival prospects following a heart attack by decreasing the cardiac workload and oxygen demand on the heart.
In a breakthrough study published recently by American Heart Journal,(1) a major U.S. cardiovascular research consortium reports that the majority of patients are frequently not receiving a large enough dose of these drugs, which can put their recovery from heart attacks and overall health in peril.
Less than Half of Beneficial Dose
“Only 46% of patients studied were taking 50% or more of the target dose of beta blockers shown to be beneficial in clinical trials,” said Northwestern University cardiologist Jeffrey J. Goldberger, MD, lead author of the report.
• “Furthermore, 76% of patients were still being treated with the same amount of medication given at discharge,” he said.
• “This means that for the vast majority of patients, there wasn’t even an attempt to increase their dose.”
Patients not getting the right amount of beta blockers is a problem nationwide, Dr. Goldberger added. “Beta blockers work to keep patients alive after a heart attack, so proper dosing of beta blockers can save many lives.”
Northwestern Memorial Hospital was one of 19 sites that participated in the PACEmaker and Beta-blocker Therapy Post-Myocardial Infarction (PACEMI) Trial Registry.
• Nearly 2,000 patients, who had been treated for a heart attack, were enrolled across the sites.
• The study participants were prescribed very low doses at discharge, in part to assess how their bodies were likely to react to the drug.
• The researchers then followed up with these patients three weeks later, to determine if their personal physicians had adjusted the dosage amount.
“One of the reasons for the low dosage at discharge from the hospital can be attributed to patients’ shorter length of hospital stay,” said Dr. Goldberger.
• “Better communication between patients and their personal physicians would help ensure patients are receiving the appropriate dose of beta blockers more quickly,” he adds.
• “Patients can be in and out of the hospital within two days after a heart attack, and this short amount of time doesn’t allow for us to increase their medication to the target dose while they are still here.”
• And unfortunately, there is not yet a system in place for what should happen as an outpatient that used to happen as an inpatient. “Patients might see one doctor in the hospital but a different one in the office, and those two might not be conferring on the appropriate amount of beta blockers the patient should be taking,” said Dr. Goldberger.
These findings make it clear, he adds, that patients and their personal physicians need to work together and have better communication.
“Patients also need to schedule an initial doctor’s appointment following their discharge within two weeks, so that doctors can adjust the amount of medication in a timely fashion,” said Dr. Goldberger.
“I would expect 70% to 80% of patients to achieve 50% or more of the target dose.”
1. Goldberger JJ, “Beta-Blocker use following myocardial infarction: Low prevalence of evidence-based dosing,” American Heart Journal, Sep 2010; vol 160(3), pp 435-442
Source: Modification of Northwestern Memorial Hospital news release, Oct 14, 2010