Gaps in Care Can Harm Patients After Heart Attack

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Heart attack patients who wait a long period to have a follow-up medical appointment after leaving the hospital are less likely to take their medications as prescribed, endangering their health.

That’s the finding of a new study of 21,000 Medicare patients over 65 who survived a heart attack.

One heart doctor said timely care is key to a good recovery for these patients.

“Many patients with heart attack are treated with coronary stents, and in those patients, missing their medications for more than a couple of days can be life-threatening,” said Dr. Lawrence Ong, a cardiologist at Southside Hospital in Bay Shore, N.Y.

The new study was led by Dr. Tracy Wang, of Duke Clinical Research Institute in Durham, N.C. The researchers noted that of the estimated 1 million Americans hospitalized with heart attack each year, 470,000 are expected to have another heart attack or serious heart problem.

Patients are typically given medications to reduce this risk. But, many patients stop taking these drugs as prescribed, which puts them at increased risk for hospital readmission and death.

Quick follow-up care after hospital discharge should help patients get the medications they need. But just how timely is that care?

In the new study, Wang’s team found that the median time to the first follow-up visit after a hospital discharge was two weeks, but wide variation was seen between patients.

For example, 26 percent of patients had their first follow-up visit within a week of leaving the hospital, while another 25 percent had that first appointment within one to two weeks.

However, a full third of patients waited two to six weeks for their first appointment, and 16 percent waited even longer than six weeks, the study found.

The percentage of patients who took recommended medications — drugs such as the blood thinner aspirin or a cholesterol-lowering statin — ranged from 63 percent to 69 percent at 90 days and 54 percent to 64 percent at one year after hospital discharge, the study found.

All of those drugs are aimed at helping patients avoid a second heart attack, the experts noted.

The rate of “medication adherence” was similar for patients who had their first follow-up outpatient visit within one to six weeks of leaving the hospital, the study found. However, those who waited more than six weeks for a follow-up visit were less likely to be taking their drugs as required, the researchers reported.

Dr. Hal Chadow is director of cardiology at Brookdale University and Medical Center in New York City. He agreed that timely care after a heart attack can reduce illness and death in patients.

But he also said there are many reasons why a patient might not take their medications. For example, “recent studies have shown that 1 in 5 Americans are unable to afford their medications,” Chadow noted. Many patients may also be in “denial” about whether failing to look after their health as directed could have serious consequences, he said.

Many others have a “lack of education regarding their underlying condition and the important role that medications play in reducing recurrent events,” Chadow said.

The study was published online March 23 in the journal JAMA Cardiology.

More information

The U.S. National Heart, Lung, and Blood Institute has more about life after a heart attack.

Source: HealthDay

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