November 6, 1998

Studies show need for improvements in cardiovascular treatment

MGH researchers have recently published two studies pointing out limitations in physician treatment of cardiovascular disease. In the Oct. 26 issue of Archives of Internal Medicine, Randall Stafford, MD, PhD, of the MGH General Medicine Division and the MGH-Partners Institute for Health Policy, and his colleagues report that American physicians treating patients with atrial fibrillation are slow to incorporate newer medications into their practice. Atrial fibrillation is a type of arrhythmia or irregular heartbeat that can lead to stroke.

The researchers looked at physicians' rates of prescribing two types of antiarrhythmic medications – rate control medications and sinus rhythm medications – and found that older medications continue to be used in most patients, even though newer options may be more effective and have fewer side effects. They also found that overall usage of these medications may be too low.

In the Nov. 1 issue of the Journal of the American College of Cardiology, Stafford and David Blumenthal, MD, director of the Institute of Health Policy, reported that many physicians could do more to prevent cardiovascular disease in their patients. In their analysis of services provided in more than 30,000 office visits to physicians across the country, the researchers found that cardiologists were most likely to provide such preventive services as checking blood pressure and cholesterol levels, counseling patients about smoking, exercise and a healthy diet, and prescribing medications to control cholesterol and blood pressure. General internists were the next most likely to provide such services; OB/GYN physicians, family practitioners and general practitioners were significantly less likely to address cardiovascular risk factors in their office visits.

"Both of these studies suggest the need for improved physician education and treatment guidelines," Stafford says. His colleagues on the Archives study were Daniel Singer, MD, Deborah Robson and Bismruta Misra, MPH, of the General Medicine Division; and Jeremy Ruskin, MD, of the Cardiology Division.