Summary of Cardiovascular Health Conference

The current chaotic healthcare environment blocks improvements in the care of people with cardiovascular disease, said Robert Brook, MD, ScD, professor of medicine at the University of California at Los Angeles and director of the Health Sciences Program for the RAND Corporation.“We are clinically practicing in a chaotic environment where some are getting treatment they don’t need and others aren’t getting the treatment they do need,” said Brook during the first session of Cardiovascular Health: Coming Together for the 21st Century: A National Conference. To buttress his argument, he pointed to the following findings:• A national study showed that only 35% of smokers were advised by their physicians to quit smoking, and a second stated that only 65% of adults had had their blood cholesterol measured in the past 5 years.• Only 41% of fee-for-service patients and 54% of HMO patients had their hypertension controlled in a study of 4 group practices in Massachusetts.• In a study of Medicare patients, 17% of coronary angiographies were deemed inappropriate, as were 14% of coronary artery bypass surgeries.• A study of 5 California hospitals showed that 25% of those who needed a cardiac revascularization procedure were not offered one, but at the same time, hospitals were performing such procedures on people who did not need them.• Similarly, another study of California hospitals found unnecessary coronary angiographies and other surgeries were being performed. In that study, Brook said, 50% of those individuals who met the necessary criteria for a coronary angiography did not receive one because there was no effective system to see that they received one, he said. Forty percent of high-risk candidates for heart attack did not receive aspirin during their first 2 days in the hospital, 30% did not receive thrombolytics, 30% did not receive …