Doctors Not Following Heart Treatment Guidelines

Physicians sending patients home from the hospital seem to be ignoring a simple, easily accessible, and inexpensive medication for cardiac patients. According to the Associated Press (AP), although a program to increase physician awareness of program guidelines that include spironolactone exists, many <"">doctors do not follow suggested treatment protocols.

Only about one-third of over 12,000 patients who were eligible for the medication received it at over 200 facilities enrolled in the American Heart Association’s “Get with the Guidelines” program, which is voluntary, said the AP. It remains unclear as to why so many doctors are not following the program; however, authors of a study conducted on the matter cited a lack of advertising, for one, said the AP. The study appears in today’s Journal of the American Medical Association.

Spironolactone was the main medication studied. The drug is a water pill that assists in stopping the kidneys from taking in too much salt; excess salt can lead to too much fluid in the body, a problem for the heart. Fluid can accumulate in lungs, blood, and bodily tissue in heart failure because the heart is unable to operate efficiently, the AP explained. Use of spironolactone has been found to minimize hospital stays and fatalities, said the AP.

According to WebMD the existing guidelines specifically recommend aldosterone antagonists (AAs)—such as spironolactone—to cardiac patients suffering from moderate to severe heart failure. Spironolactone is the generic name for the brands Aldactone and Inspira. The hormone aldosterone, said WebMD, is released during heart failure, causing salt and fluid retention and exacerbating shortness of breath and edema (swelling). AAs block aldosterone’s adverse effects and are a long-recognized component in the treatment of heart failure, said WebMD.

The findings were released by Cleveland Clinic researcher Nancy M. Albert, PhD, RN, and colleagues, said WebMD. The team looked at some 43,625 AA-eligible heart failure patients released from 241 U.S. hospitals from 2005 through 2007. “Less than one-third of eligible patients hospitalized for heart failure … received heart failure guideline-recommended aldosterone antagonist therapy,” Albert and colleagues wrote in the study, quoted WebMD.

Spironolactone can overwork the kidneys when prescribed inappropriately, which can lead to dangerous, sometimes life-threatening, reactions, which is why some physicians may not prescribe the medication, noted the AP. Although, according to the study, such inappropriate use—for instance, prescribing the medication to patients with kidney problems—was not widespread, said the AP.

Given that the majority—two-thirds—of patients in significant heart failure are not prescribed an AA, a therapy known to reduce fatalities, said WebMD, it does not make sense that the medication is not prescribed more often. Outdated guidelines using the “should be considered” rather than “is recommended,” and an exaggerated concern over the kidney function effects, could be to blame, reported WebMD, citing the study. Also, said the team, physicians might not understand that the drug’s use in heart failure might be overshadowed by its use as a diuretic, said WebMD.

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