Most heart patients do not receive appropriate treatment, and as a consequence death rates and medical costs rise, according to leading cardiovascular diseases experts.

The Chinese Society of Cardiology and the Sydney-based Jorge Institute recently joined forces in a study of clinical pathways for the management of Acute Coronary Syndrome (ACS).

A total of 18,000 patients and 70 hospitals will be involved in the study, which aims to reduce the fatality rate, rehospitalization rate and medical fees through researching and promoting the clinical pathways. This refers to the whole clinical procedure doctors must follow from diagnosis to treatment.

ACS is a set of signs, usually a combination of chest pain and other symptoms, interpreted as being the result of abruptly decreased blood flow to the heart resulting from coronary disease.

Coronary heart disease is the leading cause of death in China's major cities, and it is estimated that there are 500,000 new patients every year. By the year of 2020, cardiovascular diseases could account for 40 percent of all deaths in China, according to the estimate of the World Health Organization.

A phase one study completed last year observed 3,000 ACS patients in 51 hospitals and found that the clinical treatment for ACS in most Chinese hospitals did not follow treatment guidelines.

According to Gao Runlin, principal investigator of the study and chairman of the Chinese Society of Cardiology, high-risk ACS patients received inadequate intervention treatment, while the low-risk ACS patients received more treatment than necessary.

The patients' inability to pay, a doctor's poor knowledge of the guidelines and even the disregard of the guidelines based on their own experience are possible causes of such poor practice.

"Not observing the guideline results in a great loss of medical resources and low medical quality," says Gao.

According to the co-principal investigator of the study, the Jorge Institute's Anushka Patel, a similar research program conducted in a few hundred United States hospitals showed that after promoting guideline adherence, improvements were seen not only in getting patients to change their lifestyles but also in adopting appropriate treatments.

It also translated into more cost-effective care for patients, says Patel.

The fatality rate reduced from 5 percent to 4 percent, and the heart failure rate fell from 10.9 percent to 7.5 percent after one year of clinical pathway intervention.

While heart disease is one of the costliest diseases to treat, these studies may shed light on how to achieve an equitable and cost-efficient allocation of the scarce medical resources in China.

(Shanghai Daily October 31, 2007)