Drugs for elderly are not always used wisely

Preventive Drug Underused In Elderly Heart Attack Patients
After a heart attack, people should be put on a beta-blocker drug, which goes under many brand names including Inderal, Lopressor, or Tenormin. This will not only reduce their rate of cardiovascular death and a second heart attack but it will also increase their odds of overall survival by 20-40%. Doctors should know this because many randomized clinical trials have clearly proven these benefits years ago. Yet these drugs are vastly under-prescribed for the elderly, according to a new study of over 5,000 people (JAMA, 8 January 1997).

Stephen B. Sourmerai, ScD., and colleagues at the Harvard Medical School, looked at all New Jersey Medicare patients who survived a heart attack between 1987 and 1992. Their drag claims for the 30 days post-heart attack were also assessed. Only 21% of the eligible people recieved a prescription for beta-blocker drug therapy. What were they getting instead? Calcium channel blocker drugs, which are heavily promoted to doctors by the drug companies. (This drug class has a long history of misuse and potentially fatal side effects. See HealthFacts, August 1996, September 1995, April 1993, December 1992.)

The elderly people were three times more likely to have been given a prescription for calcium channel blockers, which have many brand names, including Cardizem, Procardia, and Adalat. The use of this drug class was associated with a doubled risk of death, according to the researchers, not because they have a demonstrable adverse effect, but because they were used as substitutes for beta-blockers.

When the researchers looked at the people treated appropriately with beta-blocker drugs, they found a 43 % lower death rate, compared to those who had been given calcium channel blockers.

In an editorial that accompanied this study, Drs. William Campbell Felch and Donald M. Scanlon noted that this new study is notthe first to identify the underuse of beta-blockers. They cited a review from the National Registry of Myocardial Infarction from 1990 to 1993, which reported that only 36-42% of over 240,000 patients received the appropriate drug. The prescribing practices of specialists aren't much better. They cited an earlier study showing that even cardiologists prescribed beta-blockers in only half the circumstances for which they were warranted. Drs. Felch and Scanlon speculated about why the prescribing practices of so many physicians do not reflect the evidence from carefully designed clinical trials. They didn't come up with any good answers.

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