Heart patients in Latin America are twice as likely to die within 30 days of being hospitalized than heart patients in North America, according to a recent global study led by Duke Clinical Research Institute cardiology fellow Dr. Mauricio Cohen.
The study also found that Latin American patients are treated relatively conservatively, receiving fewer diagnostic angiograms, angioplasties and heart bypass surgeries than their North American counterparts. Cohen will present these findings Wednesday in Barcelona at the annual meeting of the European Society of Cardiology.
Cohen was quick to point out that the study did not find a direct link between the conservative treatment of heart patients in Latin America and the disparity in death rate between the two considered regions.
"A conservative approach in Latin America is to a large extent due to the fact that doctors there are trained not to perform certain procedures until there is proof that these procedures are needed," said Cohen, who was trained in Argentina. "In the United States, doctors are trained to perform lots of procedures and bill for them-they're trained to be aggressive and their patients expect this."
Cohen explained that the reason for the difference in death rates is multi-faceted. He speculated that the lower use of specialized drugs proven to help heart patients, such as beta blockers, heparin and lipid lowering agents, could be a reason for the discrepancy. Cohen also pointed out that there were many variables unmentioned in the study that could affect the death rates, including hospital technology, medical and paramedical training, number of beds per nurse and socioeconomic factors.
Dr. Stanley Rockson, chief of cardiovascular consultation at Stanford University, added that genetic predispositions as well as the relative lack of penetration of biomedical technology could also help explain these findings.
The study was performed from November 1995 to January 1997 during a clinical megatrial that tested the use of Integrilin, a platelet inhibitor drug. In addition to using the drug, the patients enrolled in the megatrial allowed the researchers to record information regarding their treatment.
The information gathered from these 585 patients in 72 different hospitals located in eight different Latin American countries was then compared to data from 4,358 patients in 307 U.S. hospitals.
In Latin America, 50 percent of heart patients had a diagnostic angiogram, 18 percent were given an angioplasty and almost 13 percent had a heart bypass surgery. These rates in North America, respectively, were 81, 35 and 21 percent.
Cohen points out that these findings should be considered with caution due to the fairly low number of Latin American patients enrolled. "Obviously, more research is needed in this area because this data is by no means conclusive," he said. "These findings should raise the issue and encourage further study."
Cohen emphasized the importance of this global study by saying that it comes from a reputable source and as such helps focus attention on medical practices in Latin America.
Rockson agreed that medical procedures in Latin America "do not hold a great level of cachet in the United States due to a patient population that is simply too far away."
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