3-Updated: Better Care is Less Expensive Care in Heart Artery Disease
The Promise of Optimal Medical Therapy (OMT)
The best care is the least expensive care because it reduces hospitalizations, emergency room visits, and progression to more expensive drugs. Optimal medical treatment (OMT) has been proven to be the best care for heart artery disease in many research studies. Heart artery disease is the highest risk chronic condition. The higher the risk, the more benefit there is in improving health and lowering cost, so that is where we begin our training in consistently producing OMT.
Heart disease is the leading cause of death in the United States. One in every four of us will die of that condition. Half of the deaths from heart artery disease are sudden and they occur without warning. One fourth of heart attack patients have no risk factor identified prior to the event. Male sex and age are major risk factors. Therefore, a sixty-one-year-old man has a cardiac risk estimate of 7.9% in the next ten years. Nearly 8% of those men will have a heart attack in the next decade. His age and sex alone make him high enough risk to recommend statin treatment and blood pressure control to 130 on the top number. Use the cardiac risk link just above to calculate your own likelihood of having a heart attack.
The person who has already had a heart attack is especially high risk for dying or having another heart attack. Surveys show that 13% of Medicare patients have already had a heart attack and another 12% have heart artery disease. Patients who receive usual care with heart disease—the care that most of us receive—are especially high risk when compared with those who benefit from best practice treatments or optimal medical therapy (OMT).
The most important medical study of heart artery disease patients in the last 50 years came from the Kaiser Permanente organization in Colorado. They compared 628 heart attack patients receiving usual care with 628 individuals assigned to a team of nurses and pharmacists who made certain they got every element of best practice treatment or OMT. The team worked diligently to assure that every OMT patient achieved their cholesterol, sugar, and blood pressure goals while stopping smoking and taking aspirin. They performed much better than usual care. Patients who received OMT within the first 3 months of having a heart attack or a stent had a 90% reduction in death from arterial causes. The all-cause death rate was twice that of death related to cardiovascular disease and it was reduced by half as well. That means OMT has benefits beyond heart artery disease.
The Kaiser Permanente team achieved an average LDL cholesterol of 78 and an average blood pressure was 126/72. Only 44% of Americans with hypertension have a blood pressure of 140/90 or less. 99% of patients were taking aspirin or another anticoagulant. 91% were on a statin. 93% of those with diabetes were on a medication like lisinopril or another ACE inhibitor (a generic medication ending in -pril.) You can see easily that OMT for heart attack victims includes aggressive targets for blood pressure, cholesterol, and sugar reduction along with stopping smoking and taking aspirin.
The results of OMT are very dramatic. If you have a heart attack, and you receive OMT you are ten times as likely to live to see your grandchild graduate or get married 5 years later. Patients who received OMT also cost $21,900 a year less than usual care patients because they did not go into the hospital as often with additional heart attacks, extra beats, and heart failure. Today we can do even better. Patients who have had a heart attack should achieve a blood pressure of 130/80 or less, a glucose of 100 or less (HbA1c of 7), and an LDL of 70 or less while stopping smoking and taking aspirin. The treatments used to achieve those goals are equally important and the next few training sessions will help you apply those treatments consistently.
The most recent stable heart artery disease guidelines make OMT first the standard of care. Patients only move on to stress tests, heart catheterizations, and stents if OMT does not provide adequate chest pain relief. The path to better health at lower cost in patients who have had a heart attack is very specific and the results are proven. That is what everyone should be doing until someone shows a way that produces better results. You can proceed with the training segments which are numbered from 3 to 43. When you go to the site scroll to the bottom and click on “see all.” Then scroll down again and the training segments begin at the bottom. Enroll as a free subscriber to receive regular updates.