NEW ORLEANS (AP) - Getting doctors to follow their own rules for taking care of heart attack patients appears to pay off by saving more lives. Despite huge improvements in heart care over the past two decades, the flow of these advances into everyday care has often been slow and spotty, varying between parts of the country and even hospitals.
Many studies have shown beyond doubt that a short list of drugs -the so-called "fab four" - can greatly improve survival after heart attacks, the nation's leading killer. Guidelines from professional groups lay out precisely how these medicines should be used. Yet patients often are sent home without them.
Even if doctors know the rules, some chafe at "cookbook medicine," arguing that treatment must be individualized. Others may simply forget to follow all the steps in a busy practice.
Still, experts say some treatments are just so basic that they should be offered to all patients unless there is a specific reason not to.
"We know human behavior in a helter-skelter environment requires reminders," said Dr. Kim Eagle, cardiology chief at the University of Michigan.
His team helped Michigan hospitals set up procedures to make sure doctors and nurses follow the heart attack guidelines of the American College of Cardiology. The idea is to build reminders into every step of care, much like the checklists that pilots follow each time they take off, even though they know them by heart.
In a presentation in New Orleans on Wednesday at the college's annual scientific meeting, Eagle reported that lives were saved. He found that heart attack survival a year following discharge improved about 25 percent after hospitals made the changes.
"The potential impact of similar initiatives, if taken throughout the nation, is clearly profound," he said.
The team compared the care at 33 hospitals on 2,857 elderly patients before and after they made the changes. All the patients were considered good candidates for the standard care.
Prescriptions of the four mainstay drugs - aspirin, beta blockers, cholesterol-lowering statins and ACE inhibitors - significantly rose. For instance, use of beta blockers went from 84 percent of patients to 92 percent.
Doctors at the hospitals use standardized forms for ordering treatment for their heart attack patients. This way, they must check off boxes showing whether they will use the standard drugs.
Medical staff are given pocket guides and checklists, while patients receive information sheets and other data to help them remember what they are supposed to do.
Dr. Robert Califf, director of clinical research at Duke University, said medical schools train doctors to believe they don't need such step-by-step help, that they can rely instead on their understanding of biology to make decisions.
He said fast food restaurants do a much better job of making sure ketchup and a napkin are stuffed into each bag than hospitals do assuring sick people are sent home with the right drugs.
"It's easy to get excited about the next big drug, but if we just used the old drugs better, we could have a bigger effect," he said.
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EDITOR'S NOTE: Medical Editor Daniel Q. Haney is a special correspondent for The Associated Press.
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