unsafe heart medications
In a national study of diabetic patients hospitalized with heart failure, researchers from Yale and Denver Health Medical Center found that more than a quarter are treated with diabetes medications not considered safe by the U.S. Food and Drug Administration (FDA).
Published in the July 2 issue of the Journal of the American Medical Association, the study showed that two popular types of diabetes medications -- metformin and thiazolidinediones -- are frequently used in patients with both diabetes and heart failure despite warnings against their use in this context.
Metformin (Glucophage) is not recommended in patients requiring treatment for heart failure because such patients may be particularly susceptible to a serious condition called lactic acidosis.
Thiazolidinediones (Avandia or Actos) are not recommended for patients with significant heart failure symptoms because they may cause fluid retention and worsen symptoms. These warnings, approved by the FDA, are included in the package inserts for these medications.
Using data from the National Heart Care/National Heart Failure Project, a Centers for Medicare & Medicaid Services initiative to improve the care of Medicare patients hospitalized for heart failure between 1998 and 2001, the investigators studied the treatment of diabetes in more than 25,000 patients with heart failure. The researchers found that metformin or thiazolidinediones were prescribed to 13.5% of the patients in 1998-1999. This practice nearly doubled -- to 24.4% of patients -- by 2000-2001.
"The reasons for current patterns of treatment demonstrated in this study are unclear," says senior author Harlan Krumholz, professor of medicine and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation. "While it is possible that this practice reflects inadequate knowledge of the potential side effects of these drugs, it is also possible that some physicians believe that the potential benefits outweigh the potential risks, despite the FDA warnings -- and these physicians could be right."
Frederick Masoudi, assistant professor of medicine at Denver Health Medical Center and the University of Colorado Health Sciences Center, and lead author on the study, says, "This study identifies a striking discordance between recommendations from the FDA and current practice patterns for the treatment of diabetes in patients with heart failure nationwide. Furthermore, the use of these drugs has increased dramatically over a relatively short period of time."
Masoudi adds: "Additional research is urgently needed to determine whether this practice is safe. Until such data are available, physicians must either act contrary to the FDA recommendations or have fewer options for the effective treatment of diabetes in patients with heart failure."
Although the care of patients with heart failure has been examined extensively, this study is one of the first to assess the approach to the care of conditions that commonly occur along with heart failure, such as diabetes.
"Our findings have important implications for future research efforts," says Krumholz. "A national surveillance system based upon large databases such as that used for this study could be helpful in assessing other patterns of care relevant to patient safety."
In addition to Krumholz and Masoudi, the study authors included JoAnne Foody, Silvio Inzucchi, John Setaro and Yongfei Wang of Yale; and Edward Havranek of the Denver Health Medical Center and the University of Colorado Health Sciences Center.
-- By Karen Peart
T H I S
W E E K ' SS T O R I E S
The answer is: 'Jeopardy!'
Yale students get lesson in organic farming
Gift to help create police station/community center
Study: Environment plays role in some reading disabilities
Works from Yale collection on view at the Met
Compounds being developed to treat infectious disease
IN FOCUS: Community Rowing Program
MEDICAL SCHOOL NEWSDiscovery reveals new way to monitor body temperature
Researcher develops test to determine if womb . . .
Study: Diabetics often prescribed unsafe heart medications
Diuretics may boost treatment success in cocaine addicts
Beinecke Library to celebrate women in the arts
Pilot Pen tournament features tennis and much more
Meg Bellinger joins Yale staff as associate librarian
Dr. Robert Donaldson, former medical deputy dean, dies
Recent graduates win honors in international design competition
Mystery, humor, tragedy -- Yale Rep's new season has them all
Three journalists will enhance their legal reporting as Knight Fellows
Globalization's impact on health, gender explored
Welcome to the future
Search Committee Named for Beinecke Library Director
YUWO scholarships to help 11 Yale affiliates further their education
Campus Notes
Bulletin Home|Visiting on Campus|Calendar of Events|In the News
Bulletin Board|Classified Ads|Search Archives|Deadlines
Bulletin Staff|Public Affairs|News Releases|
E-Mail Us|Yale Home