Reports From the Field: Lack of awareness impairs stroke treatment

Clot-busting underutilized

People at high risk for stroke need a more structured stroke education and prevention program, researchers at the Mayo Clinic have concluded.

Clot-busting for acute stroke victims may be underutilized because of poor recognition of stroke symptoms and inadequate knowledge of acute treatment options, the researchers say.

While the majority of respondents to a random survey recognized paralysis as a symptom of stroke, other symptoms, such as the inability to articulate thoughts into words, visual loss, and numbing and tingling were far less commonly recognized.

"We were surprised to find virtually no difference in knowledge of symptoms or treatment between those with stroke risk factors and those without," says study author Kelly Flemming, MD.

Thrombolytic therapy critical

Nearly two thirds of the respondents did not know about treatment options or the urgency of administering therapy, and less than half said they would call 911 if they thought they were having a stroke.

The researchers called on all health care providers to improve their stroke education programs, including stroke prevention, presenting symptoms, treatment options, and what to do if the symptoms occur.

"Thrombolytic therapy can be critical to the subsequent quality of life for stroke victims and, while stroke prevention education may be most helpful overall, education about the urgency of stroke treatment is perhaps the most important in the event of a stroke," Flemming says.

The researcher reported the results of their survey at the American Academy of Neurology’s 54th Annual Meeting. For more information, visit the American Academy of Neurology’s web site at www.aan.com.

Reports From the Field: Most effective asthma drug not most often prescribed

Insurance claims analyzed

The most effective and intensive medication treatment for asthma is not the drug most commonly prescribed for the condition, a new study has found.

Researchers at Ohio State University (OSU) analyzed 18 months of insurance claims for asthma medications and concluded that the most effective of the medications cost two to three times less than the more frequently prescribed medications.

Results of the study, sponsored by Glaxo-SmithKline as part of an internship project in pharmacoeconomics at OSU, was published in the April issue of Pharmacotherapy.1

Patients who take the asthma drug fluticasone propionate (sold under the brand name Flovent) had fewer hospitalizations, fewer trips to the emergency department, and needed less medication to help control the symptoms than patients taking two other drugs, the researchers concluded.

Fluticasone propionate, an inhaled cortiosteroid, was compared to montelukast (Singulair) and zafirlukast (Accolate). The other two drugs are leukotriene receptor blockers in tablet form that help decrease the inflammation.

"These findings confirm what clinical trials have already shown. While doctors have to decide what’s best for their patients, we’re not sure why, given its effectiveness, fluticasone propionate is not prescribed more often as the first step in treating mild asthma," says Dev Pathak, DBA, study co-author and professor of pharmacy at OSU.

The researchers collected claims data from 781 patients covered by four nationwide managed care plans. The average cost for patients using fluticasone propionate was $528 for nine months. For patients using montelukast, the cost was $967.

For zafirlukast it was $1,359. Costs include filling prescriptions, trips to physicians’ offices and emergency departments, hospitalizations, and prescriptions for additional medicine for asthma symptoms.

Reference

1. Pathak D; Davis A, Stanford R. Economic Impact of Asthma Therapy with Fluticasone Propionate, Montelukast or Zafirlukast in a Managed Care Population. Pharmacotherapy:2002; 22:166-174..

Reports From the Field: Experienced hospitals a better choice for seniors’ surgery

Death rates lower at high-volume hospitals

Older patients who face high-risk surgery, such as cardiovascular or cancer operations, are more likely to survive if they go to a hospital that is highly experienced with their particular procedure, according to a new study.

The research, sponsored by the Agency for Healthcare Research and Quality (AHRQ) compared elderly patients who had any of 14 high-risk operations in hospitals that performed a high volume of the procedure with those at a hospital where only a few of the procedures were informed.

Each year, more than 20,000 elderly patients die undergoing one of the high-risk operations studied. More than 1,000 of these death could be averted if the patients at the lowest volume hospitals had surgery at the higher volume hospitals, concluded John D. Birkmeyer, MD, associated professor of surgery at Dartmouth Medical School in Hanover, NH, and a general surgeon at Dartmouth-Hitchcock Medical Center, lead researcher for the study.

The differences were most dramatic for patients undergoing surgery for cancer of the pancreas. Only 4% of patient at the highest- volume hospitals died compared to 16% at the lowest volume hospitals. Death rates for patients having surgery for cancer of the esophagus were 8% at the highest volume hospitals compared to 20% at the lowest volume ones.

Death rates were between 2% and 5% lower at high-volume hospitals for patients undergoing heart valve replacement, abdominal aneurysm repair, and surgery for lung, stomach, or bladder cancer.

The researchers concluded that hospital volume was less important for patients undergoing coronary artery surgery, carotid endarterectomy, and surgery for colon or kidney cancer.

The study examined outcomes in 2.5 million Medicare patients who had surgery between 1994 and 1991 and focused on total hospital volume, not Medicare volume.

Related article:

• Birkmeyer J, Siewers A, Finlayson E, et al: Hospital Volume and Surgical Mortality in the United States. NEJM, 2002; 346:1,128-1,137.