Thousands of lives are being lost each year because doctors fail to prescribe an inexpensive, highly effective family of drugs called beta blockers to patients who have suffered heart attacks, researchers said Tuesday.
In some cases, heart attack victims are not receiving the drugs because the patients have other problems, such as lung disease or diabetes, that doctors had previously thought would be exacerbated by beta blockers.
But half of the patients who are considered ideal candidates for the drugs do not receive them, perhaps because physicians--particularly general practitioners--are not aware of their value or are conservative in their prescribing practices, the research shows.
Two new reports published this week in the Journal of the American Medical Assn. and the New England Journal of Medicine, based on studies of more than 200,000 Medicare recipients, suggest that the vast majority of heart attack victims should be taking beta blockers, which reduce the risk of death by as much as 40% in the first two years of use.
The findings "should change the prescribing practices of physicians," said Dr. Valentin Fuster, president of the American Heart Assn. and a cardiologist at Mt. Sinai Medical Center in New York City.
About 950,000 Americans survive heart attacks each year and as many as 11 million Americans have a history of heart attacks or angina pectoris.
The beta blockers are a prime example of a medical technology that both saves lives and reduces health care costs, but pharmaceutical companies do not promote them heavily perhaps because they are so cheap--about $5 per month, experts say. Many physicians are thus not aware of their true value.
"Now, our job is to get everybody who can benefit onto the treatment," said Dr. Rodman Starke, vice president for science and medicine of the American Heart Assn.
Beta blockers work by interfering with the activity of naturally produced hormones such as adrenaline and epinephrine. Those hormones create the "flight or fight" response to stressful or dangerous events. Among other things, the hormones make the heart beat faster and increase blood pressure.
Those are good responses if you are confronted with, say, a bear, Starke said, "but not so good if you have had a heart attack." By preventing the adrenaline response, beta blockers keep blood pressure and heart rates lower, decreasing the physical exertions that might trigger a second heart attack.
