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WERBUNG
USA: Katastrophale Fehlversorgung
der Herzpatienten.
Nicht nur in Deutschland werden
zahlreiche Herzpatienten unzureichend behandelt. Auf
der soeben in Orlando, Florida, zu Ende gegangenen
Jahreskongress der American Heart Association (AHA)
erhoben Experten schwere Anklagen gegen ihre Kollegen:
obgleich ACE-Hemmer seit 1995 zur Standardtherapie
der Herzmuskelschwäche (Herzinsuffizienz) gehören,
verlassen 31% der als ideale Kandidaten für diese
Therapie geltenden Patienten das Krankenhaus ohne
eine entsprechende Verordnung.
Etwa 70% erhalten nicht die
in den Therapierichtlinien empfohlenen genauen Anweisungen
für eine optimale Therapie und 69% der unter
einer Herzinsuffizienz leidenden Raucher wurden von
den Ärzten nicht aufgefordert das Rauchen einzustellen.
Es gibt viele ernstzunehmende
Hinweise die die Ansicht einiger Experten unterstützen,
dass die Situation in Deutschland vergleichbar ist
- wenn nicht gar schlimmer. Auch hierzulande erhalten
als Folge der Sparhysterie viele unter Herzinsuffizienz
leidende Patienten keine ACE-Hemmer und nur vergleichsweise
wenige Patienten werden zusätzlich mit den seit
einigen Jahren bei Herzinsuffizienz empfohlenen Betablockern
behandelt. Dadurch werden viele Chancen für eine
Heilung oder zumindest deutliche Linderung der Herzschwäche
sinnlos vertan.
Not All Heart Patients
Get Standard Care. Study Finds Doctors Often Fail
to Give Standard Treatment to Heart Failure Patients
ORLANDO, Fla. Nov. 9 Doctors
have known for a decade that drugs called ACE inhibitors
are a cornerstone of care for congestive heart failure,
yet a nationwide survey released Sunday shows that
nearly one-third of patients are sent home from the
hospital without this lifesaving treatment.
The report documents what many
see as a dangerous reality of modern medicine: Doctors
often fail to offer, or simply don't know about, the
most basic elements of care for the many conditions
they see daily.
Just why doctors do not give
patients the treatments experts universally agree
work best is not always clear, although those who
study situation say the reasons probably range from
forgetfulness and haste to simple ignorance.
In the latest study, Dr.
Gregg Fonarow of the University of California, Los
Angeles, looked at how often patients hospitalized
with heart failure are discharged with four standard
kinds of care. He found they are often missing, although
this varies widely from hospital to hospital.
"There are certain hospitals
in the United States where 100 percent of the patients
get this," he said. "There are others where
patients had a better chance of winning the lottery
than getting the indicated care."
More than 1 million admissions
are made each year to U.S. hospitals for congestive
heart failure, which is becoming even more common
as better treatments that help people survive heart
attacks leave them with damaged heart muscle.
Large studies finished in the
early 1990s convinced specialists that every heart
failure patient with a few clearly defined exceptions
should be on widely available drugs called angiotensin
converting, or ACE, inhibitors. The American
Heart Association and the American College of Cardiology
included the drugs in their formal treatment guidelines
in 1995, and the Joint Commission on Accreditation
of Healthcare Organizations later agreed.
The newest survey found that
31 percent of patients considered ideal candidates
for ACE inhibitors are sent home without them. Even
at elite teaching hospitals affiliated with medical
schools, more than one-quarter are not given them.
The other findings:
72 percent are discharged without
receiving a complete set of discharge instructions,
as guidelines recommend.
69 percent of smokers with heart
failure are never told to quit.
18 percent do not have the pumping
power of their left ventricles measured, a standard
indicator of heart failure.
Fonarow noted that doctors can
bill insurance companies for measuring ventricle strength
but not for writing prescriptions or exhorting patients
to give up smoking.
"I don't think the public
understands the huge degree of variation between hospitals,"
he said. "People think if they go to a good hospital,
they will get all the standard things."
He based his findings on discharge
data on 54,639 heart failure patients at 260 hospitals
between October 2001 and January 2003. The registry
is sponsored by Johnson & Johnson's Scios pharmaceutical
unit, which is developing new heart disease treatments.
Fonarow presented the results at the heart association's
annual scientific meeting in Orlando.
Dr. Richard Pasternak, head
of preventive cardiology at Massachusetts General
Hospital, said he believes doctors are actually more
likely to follow standard procedures than they once
were.
"Things are getting better,"
he said. "The question is why they aren't getting
better faster."
One approach is to set up systems
in hospitals that routinely prompt doctors to offer
all the standard kinds of care when they admit patients
or discharge them. These are like the checklists airline
pilots follow before taking off.
The heart association recently
introduced its "Get with the Guidelines"
program to improve treatment of heart attacks by helping
hospitals establish these checklists.
Dr. Kenneth LaBresh of MassPRO,
the Massachusetts Medical Society's healthcare quality
organization, said the program has already paid off
for the first 123 hospitals to join.
He presented data at the meeting
showing doctors at these hospitals are more likely
to give such accepted treatments for heart attacks
as aspirin, beta blockers and cholesterol drugs.
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