MI patients admitted in hospitals are graded from high risk to low risk, and treated as per the guidelines. But recent studies show that there is a decline in adherence to the quality and performance of treatment in high risk patients. Here is the study.

Team@CMHF

Adherence to guideline-based care remains paradoxically decreased in high-risk myocardial infarction (MI) patients, but has improved in recent years, US researchers report.

Clinicians must bear the risk–treatment paradox in mind when they feel reluctant to initiate or continue therapies in high-risk MI patients, urge Gregg Fonarow, from the University of California Los Angeles, and co-authors.

The analysis, published in the Journal of the American Journal of Cardiology, included 112,848 MI patients who enrolled at 279 hospitals participating in the Get With the Guidelines–Coronary Artery Disease (GWTG–CAD) program, between August 2000 and December 2008.

The researchers used a risk prediction model to stratify these patients into low risk (0–3%; n=36,541), intermediate risk (3–6%; n=36,542), and high risk (>6.5%; 36,541) for in-hospital mortality.

There was a significant increase in adherence to all quality and performance measures from 2002 to 2008. Indeed, the yearly adjusted composite measure increased by 33% for low-risk patients, 30% for intermediate-risk patients, and 30% for high-risk patients during this time period.

Although the adherence to measures remained significantly lower in the high-risk group, the difference between the low- and high-risk groups decreased significantly with each passing year from 2003 (p=0.0002).

“We speculate that certain invasive or aggressive in-hospital therapies may have been withheld from higher-risk patients out of genuine concern of the risk for adverse effects in high-risk patients,” comment the authors.

“It has also been suggested that physicians may be concerned about applying evidence from clinical trials (which may exclude higher-risk patients) to their everyday practice,” they continue.

But, they add, programs such as GWTG–CAD provide “solid science in the form of clearly articulated, easily actionable items that physicians at the bedside can adapt,” and lead to improved adherence to guideline-based care in all risk groups.

“It is premature to declare the end of the risk–treatment paradox,” he concluded.

Ref: http://www.incirculation.net/NewsItem/Adherence-to-guidelines-reduced-in-highrisk-MI-pat.aspx