February 16, 1999
Web posted at: 11:56 p.m. EST (0456 GMT)

In this story: Some proven therapies underused Aspirin slighted in many cases RELATED STORIES, SITES

NEW YORK (CNN) -- Herb Danska's heart attack came two years ago.

"Suddenly in the evening after dinner, I felt a kind of dull but nagging pain. Something told me I was in trouble," he said.

Herb went to a hospital in New York City, his home, and received the best treatment available.

"I had confidence that my doctor would know what should be done, and that I would get top-notch care. It was a quiet confidence," Danska said.

Danska was luckier than many. According to a study in this week's Journal of the American Medical Association, heart attack treatments can vary greatly depending on where in the United States the victim lives.

"For the most part, patients treated in the Northeast received appropriate treatment more frequently than patients in some of the other regions around the country," said Dr. David Vorchheimer, a cardiologist at New York City's Mount Sinai-NYU Medical Center.

Some of those treatments studied -- like aspirin, beta blockers, drugs that open blocked arteries or ACE inhibitors -- have been shown to improve the chances of survival after a heart attack.

The discrepancies between treatments used in different regions result in unnecessary deaths and illness because some important therapies are underused, the study from Dartmouth Medical School concludes.

"Therapies with proven benefit ... are underused despite strong evidence that their use will result in better patient outcomes," it says.

The report is based on a national sample of 186,800 Medicare beneficiaries who suffered heart attacks.

One variation they found was in the prescribing of aspirin during hospitalization to prevent blood clots. There were lower rates of that therapy in South-Central and Southeastern states than elsewhere.

Aspirin therapy after discharge was more often prescribed in the Northeast, North-Central and Mountain states than elsewhere.

Researchers used treatment guidelines published by the American College of Cardiology and the American Heart Association in their study. They suggested some doctors may not be aware of those guidelines, while some may disagree with them or think they interfere with professional freedom.

Doctors say a treatment that might help one person could be dangerous for another. But when it comes to simple treatments like aspirin, doctors say, there's no excuse not to have the treatment ready.

"Everybody knows that aspirin helps patients with heart attacks. But for the most part, only about 80 percent of the patients overall received aspirin," Vorchheimer said.

Among other conclusions in the Dartmouth study:

• Doctors prescribed beta-blocking agents on discharge more frequently in the Northeast and North-Central regions and least often in the South-Central and Southeast states. Overall, only about half of eligible patients were prescribed beta-blocking drugs when discharged.

• Physicians gave advice on quitting cigarette smoking more frequently in Alaska and in the Mountain states than in the South-Central and Southeastern parts of the country.

Medical Correspondent Dr. Steve Salvatore and Reuters contributed to this report.