Poor Adherence to Heart Failure Treatment Guidelines
Cardiologists are only partially implementing the European Society of Cardiology’s Chronic Heart Failure Guidelines, according to a new survey, ‘ADDress Your Heart’, presented at Heart Failure 2007.
The survey, which was based on interviews of over 500 cardiologists across Europe, reported that while 98% were aware of chronic heart failure guidelines, it was clear that clinical practice in a primary and secondary care setting generally did not reflect the guidelines. Central to this were time constraints for physician consultancy, variation in patient compliance and the complexity of the guidelines.
Such claims of poor adherence raise serious concerns regarding the potential impact of chronic heart failure: it is estimated that 14 million people in Europe currently suffer from the condition, and that as many as three-quarters of these may die within eight years if untreated. With the burden of chronic heart failure set to increase – the result of an aging population and increased patient survival following heart attacks – the implications of failing to universally implement the guidelines are significant.
Subsequently, the ADDress Your Heart Working Party has identified key steps to maximise guideline adherence, including better facilitation of the integration of healthcare professionals, the introduction of regular audits to monitor patient compliance and increasing accessibility to the guidelines.
“Physicians need simplified heart failure guidance. It is important to take a structured approach to the treatment of heart failure in order to minimise the increasing burden of the condition,” explained Professor Leif Erhardt, Chairman of the Working Party.
Long-term Health of Patients with Silent Ischaemia Improved by Angioplasty
Patients with asymptomatic or ‘silent’ ischaemia benefit more from angioplasty – percutaneous coronary intervention (PCI) – than intensive drug therapy in the long term. Cardiac ischaemia – or oxygen starvation in the heart muscle – indicates a poor prognosis among people who have already experienced a heart attack. Silent ischaemia is so-called because it often occurs without causing the typical symptoms of ischaemia, such as angina. Ischaemia is, however, detectable by electrocardiogram.
In the first study of its kind, the long-term outcomes of patients with silent ischaemia who underwent either PCI or anti-ischaemic drug therapy following a heart attack were compared. Researchers from the Division of Cardiology, Kantonsspital Luzern, Switzerland, studied 200 patients who underwent either PCI or drug therapy between May 1991 and February 1997, with a follow-up in May 2006. Of the patients who received PCI (just under half), one-third had a major cardiac event within the follow-up period compared with over two thirds of the drug therapy patients. Impact on the rate of ischaemia itself was also greater for PCI patients. The study also showed that the longer the follow-up period, the greater the difference between the treatment groups.
Despite advances in optimised drug therapy, these results show that in the long term PCI will benefit heart attack survivors to a greater degree than will drug therapy. These findings may have an impact on future PCI procedures, which could become increasingly ischaemic-targeted in their approach.
Ultrasound Screening Could Prevent Abdominal Aortic Aneurysm Deaths in Men
A significant portion of 65–79-year-old men have abdominal aortic aneurysms that remain undetected, putting them at serious risk of death. Screening men in this age group for aortic aneurysms could therefore save lives.
Aneurysms occur when the wall of an artery is weakened, causing a widening of the artery, which can subsequently rupture. Aneurysms in the aorta are particularly dangerous as there is a very strong possibility that a rupture will be fatal. The prevalence of abdominal aortic aneurysms and the impact of screening were studied by Cochrane researchers, who analysed the results of four trials carried out in the UK, Denmark and Australia. Over 120,000 men and just under 1,000 women were involved. The results showed that screening would be beneficial for men aged between 65 and 79. However, the risks involved in elective aneurysm repair mean that, in practice, screening could ultimately cause fatalities in people who may otherwise have remained healthy, despite living with an aneurysm.
Researchers point out, however, that the significance of their findings will depend on context, and that factors such as life expectancy, likelihood of complications following surgery and quality of life must be taken into account when assessing the overall benefits of abdominal aortic aneurysm screening.
Doctors Proactive in Pre-diagnosis Treatment of Heart Attacks
Doctors are treating patients with a suspected heart attack as aggressively as patients who have been diagnosed with an attack. Researchers from Wake Forest University School of Medicine analysed patient data from over 450 hospitals in 12 countries. They compared the treatment received by patients with different levels of troponin – a protein, and a marker of damage to the heart muscle – in their initial evaluation after arriving at hospital.
Troponin levels become elevated over a six- to eight-hour period after the occurrence of a heart attack, making a definite diagnosis problematic in the first few hours following an attack. The study aimed to determine whether the resulting delay in diagnosis can impact on patient care. Patients were divided into three groups – those who presented with elevated troponin levels and were therefore known to have had a heart attack, those whose troponin levels became elevated within 12 hours and those who showed no elevation. The results showed that for the first two groups, which can be classified as highrisk, treatment options were very similar. Both groups were initially treated with blood-thinning agents such as aspirin, and received similar levels of invasive treatment such as angioplasty and bypass surgery.
This finding is encouraging, as it indicates that doctors are being proactive in their treatment decisions and thus patients are receiving vital treatment even before the presence of a heart attack is confirmed through laboratory tests.
Report Warns of Emerging Global High Blood Pressure Crisis
Increasing prevalence of uncontrolled high blood pressure may lead to a global epidemic of cardiovascular disease, causing a massive burden on health systems and economies across both developed and developing countries. The warning is contained in a report presented to the European Parliament and endorsed or supported by 12 leading medical groups.
Although recognising the significant reductions in cardiovascular disease that have been achieved over the last 40 years, ‘High Blood Pressure and Health Policy: Where We Are and Where We Need to Go Next’, reminds governments and health policy makers not to become complacent about the risks posed by high blood pressure, both to individuals and at a socioeconomic level. While high blood pressure can cause fatal heart attacks, kidney disease and dementia, it remains a modifiable risk factor. The report therefore urges further improvements to be made in education, management strategies and medical collaboration.
From a European perspective, a recent study was highlighted showing that people diagnosed with high blood pressure in North America have better blood pressure control than those in Western Europe. Poor patient adherence to prescribed medication and lifestyle adjustments were identified as the main areas of concern.
Lifestyle Attitudes Mean Europeans Are ‘Gambling’ with Risk of Stroke
A consumer survey conducted by Stroke Alliance for Europe (SAFE) has revealed that many Europeans lack awareness of the risks of stroke and make lifestyle choices that increase the likelihood of suffering a stroke. The survey, ‘Gambling with Stroke’, was based on interviews of over 3,100 people in Germany, Spain, Italy, The Netherlands and the UK. The survey reveals that:
- the general public are less aware of the likelihood of suffering a stroke compared with other conditions such as heart disease and cancer;
- a large majority of respondents with hypertension (87%) were unaware of the link between hypertension and stroke; and
- over 30% of respondents known to suffer from hypertension did not get their blood pressure checked regularly.
The news further vindicates SAFE’s organisation of European Stroke Prevention Day, which aims to raise awareness of the risk of stroke while also highlighting the need for more educational support from health policy makers across Europe.
“We want to encourage people to take action and have their blood pressure measured regularly. Disregarding high blood pressure can have fatal consequences,” commented Arne Hagen, President of SAFE. “The survey shows that people are unnecessarily gambling with the severe, disabling consequences of stroke. By undertaking simple methods of controlling blood pressure it is possible to prevent stroke.”