Good News On Heart Attack And Chest Pain: Deaths Declining

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Heart Attack Deaths

Good news on heart attack and chest pain: International study shows patients who get modern treatments have lower risks of death, stroke & heart failure.

People who suffer a heart attack or severe chest pain today are much less likely to die, or to experience long-lasting effects, than their counterparts even a few years ago, according to a new international study in the May 3 issue of the Journal of the American Medical Association.

Dr. Kim EagleIt's the first time that a study has shown a significant drop in the rate of heart failure and death over such a short time in this population.

The study finds that the change occurred at the same time that hospitals increased their use of certain drugs, tests and procedures that have been proven to help reduce the immediate and long-term impact of acute heart problems. The results suggest that concerted efforts to standardize heart care are working.

But, the authors caution, there are clouds in this sunny sky. Many patients who could benefit from all of the proven treatments aren't getting them. Previous data have shown that the U.S. actually lags behind some other countries in several aspects of acute coronary care.

The study is from the Global Registry of Acute Coronary Events (GRACE), which has collected data from 44,372 patients treated at 113 hospitals in 14 countries. The new paper is led by cardiologists from the University of Edinburgh in Scotland, Hospital Bichat in France and the University of Michigan Cardiovascular Center.

All the patients had suffered either a kind of severe heart attack called ST-elevated myocardial infarction (STEMI), or had acute coronary syndrome (ACS), which includes non-STEMI heart attack and a kind of chest pain called unstable angina.

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Between 1999 and 2006, the use of heart-protecting drugs in these patients increased markedly, including use of aspirin, cholesterol-lowering statins, clot-reducing drugs called glycoprotein IIb/IIIa inhibitors, blood thinners such as clopidogrel and heparin, and blood pressure-reducing drugs including ACE inhibitors.

At the same time, the use of angiography to see blocked arteries in the heart and angioplasty as an emergency or secondary treatment to reopen blockages increased by more than 30 percent in STEMI patients and around 20 percent in ACS patients.

As the use of all these treatments increased, the death rate for patients both in the hospital and in their first six months after going home decreased significantly. So did the risk that patients would develop heart failure, have pulmonary edema, or suffer a stroke in their first six months after hospitalization.

"These findings are exciting because they provide good evidence that improved use of guideline- based treatments has resulted in fewer deaths and fewer patients with heart failure in those that present to hospital with heart attack or threatened heart attack," says Keith A. A. Fox, MB. ChB., FRCP, lead author of the paper, co-chair of GRACE and a professor of cardiology at Edinburgh.

"These data are extremely encouraging, and suggest that we're definitely improving heart care and patients' outcomes through the uniform use of evidence-based, proven treatments and the development of guidelines to help providers understand the evidence behind them," says Kim Eagle, M.D., FACC, a co-author on the paper and co-chair of the publication committee for GRACE. He is the Albion Walter Hewlett Professor of Cardiovascular Medicine at the U-M Medical School and a director of the U-M Cardiovascular Center.

"Yet, these data and other studies show that we still have a ways to go before every heart attack and ACS patient receives the full range of tests and treatments that we know can benefit them," Eagle continues. He notes, for example, that only 85 percent of STEMI patients and 83 percent of ACS patients in the study received a statin in 2006, when virtually all such patients should receive the cholesterol-lowering drug. And only 53 percent of STEMI patients received emergency angioplasty, when it has repeatedly been shown to be life-saving in such patients.

"The U.S. especially has a lot of ground to gain, compared with European and Canadian hospitals, in reducing the time lag between hospital presentation and acute coronary artery angioplasty," Eagle adds. "That's why efforts to improve hospitals' systems for providing this kind of care are so important."

U-M heart specialists lead or co-lead several key efforts to increase the use of evidence-based STEMI and ACS care in the state of Michigan. Eagle, for instance, has co-led the Guidelines Applied in Practice

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