Prescription Delay Following Stent Implantation Is a Common and Deadly Problem

Following obtaining a stent, numerous patients delay or fail to fill their prescription for clopidogrel or an additional antiplatelet agent. Now, a study published in the Journal of the American Heart Association offers evidence that this issue is widespread and frequently leads to critical consequences.

Researchers analyzed information from all stent implantations performed in British Columbia from 2004 through 2006. In all, 15,629 stents had been implanted: 3,599 sufferers obtained at least one drug-eluting stent (DES), and 12,030 acquired bare metal stents (BMS) alone. Nearly a third of the sufferers in each stent group did not fill their prescription inside of three days soon after leaving the hospital.

A delay of 3 or more days in filling a 1st prescription for clopidogrel following hospital discharge was linked with considerable increases in the risk for death and readmission with MI at two years:

• DES group: 18% in the delay group versus 8% (hazard ratio, two., CI one.6 – two.six)


• BMS: 22% versus 8% (HR two., CI 1.8 – two.3)

The improved chance was most evident in the initial 30 days. Patients who by no means filled their prescription had the worst outcomes — DES individuals who by no means filled their prescription had a twelve-fold increase in the risk for death, whilst BMS patients had a 5-fold enhance.

The authors observe that medicine compliance is especially crucial following a stent implant: “The threat of coronary stent thrombosis appears highest in the early time period right after stent implantation and decreases in the subsequent weeks to months. This coincides with a period right away after hospital discharge when individuals often expertise problems with medicine compliance, the most typical concern being failure or a delay to fill a discharge prescription.”

“This research highlights the relevance of making sure patients have access to prescription drugs as quickly as they depart the hospital,” mentioned the lead author of the paper, Nicholas Cruden, in an AHA press release. “Even a delay of a day or two was linked with worse outcomes.”

Prescription Delay Following Stent Implantation Is a Common and Deadly Problem

Routine Shock Testing Not Necessary For the duration of ICD Implantation

When cardiologists implant defibrillators in sufferers at substantial risk of dying from a heart rhythm disorder they practically often execute a defibrillation check in which they induce a lethal arrhythmia, ventricular fibrillation, to make confident the gadget accurately detects the arrhythmia and terminates it with an acceptable shock. But program defibrillation testing has by no means been shown to be risk-free or required. In recent years some specialists have maintained that regimen defibrillation testing could not be required.

Now a new examine, presented yesterday at the Heart Rhythm Society meeting in San Francisco, offers proof that even though schedule testing is usually secure it could improve problems with out generating any improvement in outcomes.

In the Simple (Shockless Implant Evaluation) trial, sponsored by Boston Scientific and led by researchers at McMaster University in Hamilton, Ontario, two,500 patients in 18 countries undergoing ICD implantation have been randomized to routine defibrillation testing (DT) or no DT.

Soon after 3 years of followup there was no substantial difference in the major endpoint of the trial, which was the fee of death due to arrhythmia or the failure of a first shock to terminate a lethal arrhythmia (seven.2% in the no-DT arm versus 8.3%  in the DT arm, hazard ratio .86 CI .65-1.14,  non-inferiority p&lt0.001). There was no difference amongst the groups in complete mortality.

The authors concluded that defibrillation testing “does not enhance ICD shock efficacy or decrease mortality.” Despite the fact that regimen testing is “generally reduced risk,” problems may possibly sometimes get area. Since of these information, “the ‘no testing’ strategy to regimen ICD implantation should be preferred.”

“This is the very first time the connection between defibrillator testing and patient outcome has been studied independently in a randomized setting and with these results, we can confidently say that defibrillator testing, though protected, is not required at the time of ICD implantation,” explained the lead writer of the examine, Jeff Healey, in a press release. “These final results ought to alter physician practice and could aid reduce expenses without having compromising patient outcomes.”

Routine Shock Testing Not Necessary For the duration of ICD Implantation