Public Release: 

Tip sheet Annals of Internal Medicine, Aug. 16, 2005

American College of Physicians

1. Study: Vulnerable Older Patients Who Receive Quality Care Live Longer

A study of 372 vulnerable older patients living in the community (not in nursing homes or hospitals) and cared for in two managed care organizations found that those who received care that met standards for a variety of conditions had better survival rates than those whose care did not meet these standards (Improving Patient Care, p. 274).

Researchers created a quality-of-care score based on 236 process-of-care quality measures, such as annual influenza vaccination, annual evaluation of urinary incontinence, weight measurement at every visit, and, for those with diabetes, blood pressure check at each visit, glycated hemoglobin levels measured at least every 12 months, etc. Survival improved steadily as the quality score improved.

Although the link between standard process of care and patient outcomes is logical, the authors say that "the relationship between performance on process of care quality indicators and better health outcomes remains a largely untested assumption" for older patients receiving care in community or ambulatory settings.

An editorial writer says the study's findings are "valid because the alternative hypothesis doesn't stand up to scrutiny. They are important because they provide evidence that quality improvement efforts that focus on the process of care improve patient outcomes, and they remind us that if vulnerable patients want the best we have to offer, we should do everything we can for them, not just what seems practical," (Editorial, p. 305).

2. Warfarin Plus Aspirin Benefits Some Heart Patients

A new study of published research finds that treatment with a blood thinner plus aspirin was beneficial for people after a heart event, such as heart attack or unstable angina, who had a low risk for bleeding (Article, p. 241).

Researchers analyzed data from 10 randomized trials involving 5,938 patients who had had a coronary event and who had not received a stent.

It is known that people who survive coronary events are at high risk for blood clots in the heart's arteries and for repeated heart attacks, and that both warfarin and aspirin can be used as blood thinners to prevent stroke and blood clots.

In this study, patients with low to average risk for bleeding who took warfarin plus aspirin had fewer subsequent heart events than major bleeding episodes.

Researchers cite other data showing that only half of eligible patients receive warfarin therapy, and therapy with another drug, clopidogrel, is popular even though it has been shown to be less effective than warfarin in reducing heart attack and is not cost effective. Researchers urge primary care physicians to prescribe warfarin plus aspirin to eligible patients.


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