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Medications as simple as aspirin can treat heart disease and prevent heart attacks, and specialty groups have issued guidelines for their best use.

But many patients nationwide don't receive these potentially lifesaving therapies.

Now, in a region with some of the highest rates of heart disease and death in the nation, that's about to change for many patients.

Physicians at Kaleida Health, in collaboration with the area's major health insurance companies, announced Thursday they would institute a program to ensure that heart patients are treated according to "best practices" from admission through discharge and after they return home.

"There tends to be variation in care, especially as advances come that physicians have to keep up with. We need to organize and regionalize the care to keep up with those advances," said Dr. John Corbelli, a cardiologist with Buffalo Cardiology & Pulmonary.

An important Duke University study presented last year at an American Heart Association scientific conference underscores the importance of following agreed-upon recommendations.

It found that death rates for heart attack patients in hospitals ranged from 17.6 percent in those that lagged most in following guidelines for the use of ACE inhibitors, cholesterol-lowering drugs and other beneficial medications to 11.9 percent in those who led in following them.

Why is there such a gap?

One reason is the pace of change in medicine and the ability of physicians to stay abreast of every new medication, test and procedure. Another is that there isn't always agreement on best treatments for particular conditions.

Even when there is consensus, some doctors are reluctant to adhere to what critics derisively refer to as "cookbook medicine," while others are more aggressive in using guidelines. In addition, some patients comply with instructions when the right medications are prescribed but many don't.

"It's not just about what happens to patients in the hospital, but what happens to them after they leave," said Dr. Cynthia Ambres, chief medical officer at Kaleida Health.

One problem with using guidelines is that they tend to be voluminous. Doctors can't leaf through dozens of pages while taking care of patients, especially in emergencies.

Corbelli and his colleagues came up with the idea of boiling down a key set of guidelines and giving them to physicians in a simple form similar to the checklist a pilot might use before taking off in an airplane.

In this case, the medical form guides the physician to the most appropriate medications and treatment for patients with unstable angina and a common type of heart attack.

Unstable angina is the chest pain that signals someone is teetering on the edge of a heart attack.

Corbelli and others said that what separates the Kaleida Health strategy from others nationwide is a regional effort to apply the guidelines from throughout a patient's stay and after he or she goes home.

The Buffalo Niagara region's three major health insurance companies have agreed to cover recommended medications for heart conditions based on what's called for in the guidelines and to follow the patients as part of a study at intervals of three, six and 12 months after discharge from the hospital to make sure they are taking their recommended medications.

Dr. Lou Irmisch, medical director for medical management of Blue Cross and Blue Shield of Western New York, said a focus on what science says is best will help contain costs, as well as improve outcomes and leave patients more satisfied with their care.

The physicians said they will simultaneously conduct a study to learn if the strategy leads to fewer first and recurring heart attacks, and fewer heart-related deaths.

"We built a research component into the process so we can see if we are, in fact, making a true difference," said Dr. David Janicke, a physician with Millard Fillmore Hospitals Emergency Physicians' Service.

There's no question that improvement in preventive heart care is needed.

The Buffalo Niagara region experiences the worst death rates for heart disease in the state -- 351.7 cases per 100,000 population, compared with 258.2 in the United States and 305.2 statewide, according to 2000 data from the Research Center for Stroke and Heart Disease in Buffalo.

This region also has the highest amount of hospitalizations for heart disease. The rate in Niagara County -- 1,008.4 hospitalizations per 100,000 people -- is 60 percent higher than the average state rate and 254 percent higher than the rate in downstate's Rockland County.

"Our community has a problem with heart disease, and the status quo treatment approach isn't changing the situation," said Corbelli. "But if all physicians, hospitals and health plans used best practices, we could make a difference in patients' lives."

In addition to Kaleida Health's five hospitals, which include Buffalo General and Millard Fillmore, the strategy is being used at Lockport Memorial Hospital and Niagara Falls Memorial Medical Center. Corbelli said he also expects the Catholic Health System to adopt it.


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