American College of Cardiology: Following Treatment Guidelines in Potential Heart Attacks

Speaker: Eric D. Peterson, MD, Associate Professor of Medicine, Division of Cardiology, Department of Medicine, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina.

Results from the database of a national quality improvement initiative showed that hospitals with the highest adherence to national guidelines for treating patients with acute coronary syndrome (ACS) had significantly better patient outcomes, with more lives saved, than did hospitals that were less adherent. These findings are important, because although many studies have proved the effectiveness of individual treatment modalities in improving outcomes for patients with ACS, few have correlated individual hospitals’ use of these different therapies with actual patient outcomes.

Data from the an initiative called Can Rapid Risk Stratification of unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) were assessed to determine how hospitals adhered to nine American College of Cardiology/American Heart Association class I care indicators of in-hospital and discharge care. The trial encompassed 64,775 patients at more than 400 hospitals in the U.S. Hospitals that were in the top 25 percentile of adherence were rated as “leading”; those in the bottom 25 percentile were rated as “lagging.” canadian pharmacy support net

In each of the nine performance measures, significant performance gaps existed between the two types of hospitals. For example, there was a narrow gap in the rate of initial aspirin use (96% for the leading hospitals versus 85% for the lagging hospitals) and a wide gap in the use of glycoprotein (GP) IIb/IIIa inhibitors (50% for the leading hospitals versus 17% for the lagging hospitals).

The leading hospitals tended to be larger, with an average of 388 beds; the lagging hospitals had 321 beds. The leading hospitals were more often academic institutions (34% versus 21%, respectively). Finally, the leading hospitals were more likely to have the capability of performing coronary artery bypass graft surgery (81%) and percutaneous coronary interventions (59%).

Fasudil in Patients with Stable Angina

Speaker: Ralph M. Vicari, MD, Director, Mina Century Research, Melbourne, Florida.

Fasudil, a novel investigational oral vasodilator manufactured by Berlex, acts by inhibiting rho-kinase. It appears to be of particular value in patients with stable angina. It offers potential relief by a unique method of action and does not interact with beta blockers or calcium antagonists.
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A phase 2 study was carried out to evaluate the effects of fasudil on total exercise duration and time to onset of myo-cardial ischemia in patients with stable angina. The patients were also taking antianginal therapy, either a beta blocker or a calcium antagonist and nitroglycerin as needed, as well as cardiovascular medications, including aspirin, statins, and ACE-inhibitors. Of 206 patients screened, 84 patients met the inclusion and exclusion criteria.

After a three-week washout period, fasudil or matching placebo was given three times daily for eight weeks. The active drug was force-titrated from 20 mg three times daily to 80 mg three times daily, at 290 mg every two weeks. The efficacy of the regimen was assessed by exercise testing in which symptoms of angina were decreased after eight weeks of therapy.

All groups were able to increase their duration of exercise over their baseline values, the fasudil group by 1.97 minutes and the placebo group by 1.43 minutes. At eight weeks, the fasudil patients experienced a significantly delayed time to myocardial ischemia (2.83 minutes), compared with those taking placebo.

No significant differences in the incidence of adverse drug events (ADEs) or in heart rate, systolic blood pressure, diastolic blood pressure, or the product of heart rate and systolic blood pressure were observed between these two groups.

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