I’ve spent a lot of time addressing the accuracy of the initial medication list in the context of what patients (or their family or friends) remember. I certainly cannot argue about the importance of ensuring that medication orders, written anew for each setting of the hospital, are scrupulously checked to verify that a medication has not been lost to follow-up. But I want to make one final point regarding reconciliation of the patient’s discharge list of medications with the in-hospital list.

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Few would dispute the fact that many patients do not fill their prescriptions and many do not take medications as prescribed. Indeed, I have always suspected that most patients, when asked about their current medications, remember the drugs they actually take, or at least what problem those drugs are intended to treat, but generally do not remember the drugs that they don’t take.

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I hate to be a spoiler, especially amidst all the deafening applause, but I must ask: Just how reasonable is it to expect that most, or even many, patients (or their friends and family) will produce an updated and accurate medication form (much less schlep it around with them)?

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One didn’t have to watch this year’s presidential address to know that this motherhood-and-apple-pie line probably drew enthusiastic applause from both sides of the aisle. Who doesn’t want to reduce costs and medical errors? Who doesn’t want better information technology? Who wouldn’t ardently support a nonbinding resolution to improve the quality of health care, casting political caution to the wind?

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Presenter: William E. Boden, MD, Professor of Medicine and Public Health, University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York

A trial called Clinical Outcomes utilizing Revascularization and Aggressive DrufEvaluation (COURAGE) attempted to determine whether adding PCI to optimal medical therapy would reduce death, MI, or hospitalizations among patients with acute coronary syndrome (ACS). Dr. Bowden, the lead investigator, said that even though PCI had proved effective in lowering the frequency of angina and in improving exercise performance in the short term, there was no evidence that it could reduce death, MI, or hospitalization. By far, he said, most of the one million PCIs performed each year in the U.S. are of a non-emergency nature in patients with stable CAD.

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As the lead investigator of the Thrombin iteceptor Antagonist in Percutaneous Coronary intervention (TRA-PCI) trial, Dr. Moliterno also took up the recurring theme that for patients undergoing PCI, new agents intended to further reduce clinical events without adding a tendency to cause bleeding have been elusive so far.

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Presenter: John R. Crouse III, MD, Wake Forest University School of Medicine, Winston-Salem, North Carolina

In ASTEROID (AStudy To Evaluate the effect of Rosuvastatin On intravascular ultrasound-Derived coronary atheroma burden), measuring carotid artery intima media thickness (CIMT) with intravascular ultrasound (IVUS) was a reliable means of assessing atherosclerosis, itself a predictor of the risk for cardiovascular events. High-risk patients with CAD, as documented by angiography, received rosuvastatin 40 mg (Generic Crestor, AstraZeneca). As assessed by IVUS, aggressive statin therapy helped to promote regression of atherosclerosis.

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