Some Heart Patients Did Not Get the Rx They Might Need

ACEI or ARB therapy prescribed to four out of five patients with acute coronary syndrome

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) ACEIs and ARBs are medications that help lower the risk of death in high-risk patients who have had a heart attack. But many of these high-risk patients may not be getting these beneficial medications.

A recent study by the American Heart Association investigated whether hospital patients with acute coronary syndrome were receiving ACEI or ARB prescriptions before being discharged.

The researchers found that one in five eligible patients did not receive a prescription.

The authors of this study suggested that some patients who could benefit from ACEIs or ARBs may not be receiving the medication.

"Ask your doctor about recommended treatments if you have acute coronary syndrome."

Deepak L. Bhatt, MD, MPH, of the Brigham and Women's Hospital Heart and Vascular Center, led this study.

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are recommended by the American College of Cardiology and the American Heart Association (AHA) for patients recovering from acute coronary syndrome, especially those who have low heart function, diabetes or hypertension.

ACEIs and ARBs work by lowering blood pressure and preventing blood vessel constriction.

Acute coronary syndrome is commonly referred to as a heart attack, and represents any situation where the blood flow to the heart is being blocked. Symptoms can include chest pain or pressure, pain in one or both arms and the jaw, nausea and sweating, among others.

According to Dr. Bhatt and team, although ACEI/ARB therapy is recommended for people with acute coronary syndrome, many patients do not receive a prescription for the medications after being diagnosed.

This study measured how many patients admitted to the hospital with acute coronary syndrome received an ACEI/ARB therapy prescription when they were discharged.

The researchers observed 80,241 patients admitted with acute coronary syndrome at 311 hospitals over a period of four years.

Of the 60,847 patients who had more serious symptoms, 49,682 received an ACEI/ARB prescription.

In other words, 19.3 percent of patients with symptoms of acute coronary syndrome did not receive a prescription for AHA-recommended medications by the time they were discharged.

Patients who had undergone coronary artery bypass surgery were significantly less likely than average to receive an ACEI/ARB prescription.

The researchers concluded that one of every five eligible patients who were hospitalized for acute coronary syndrome did not receive recommended medications at discharge.

"This study emphasizes that we still have room for improvement in terms of how we put the recommendations of guidelines into practice," said Linda Gillam, MD, MPH, the Dorothy and Lloyd Huck chair of cardiovascular medicine for Atlantic Health System.

"Patients who have suffered myocardial infarction (heart attack) or unstable angina should ask their doctors if they are candidates for these medications. However,  we must not lose track of the fact that every patient is unique and these medications may not be appropriate for all patients with these clinical conditions," Dr. Gillam told dailyRx News.

The authors of this study acknowledged that their research had limitations. For example, some of the patients may have had undocumented intolerance to the medications.

Dr. Bhatt and colleagues suggested that medical professionals should ensure that appropriate therapy is given to these patients when they are discharged from the hospital.

This study was published in Circulation: Cardiovascular Quality and Outcomes on February 24.

The research was funded by the American Heart Association. Some of the researchers reported financial ties to medical organizations and pharmaceutical companies.

Review Date: 
February 21, 2014
Last Updated:
February 27, 2014