Heart attack deaths down sharply
Increased use of angioplasty and the introduction of new drugs over the last seven years have nearly halved the number of hospitalized heart attack victims who die or suffer severe heart failure, an international team of researchers reports today.
The study found “remarkable improvements” in the care of heart attack victims in all 14 countries studied, said Dr. Gregg C. Fonarow of UCLA’s David Geffen School of Medicine, who was not involved in the research.
“It is not simple to manage these patients. Many therapies need to be applied very rapidly,” he said. This study shows that individual drugs and treatments that have been validated in clinical trials can be combined in the real world to produce “very meaningful benefits.”
Added Dr. Keith A.A. Fox of the University of Edinburgh in Scotland, who led the study, published in the Journal of the American Medical Assn.: “Our study supports the fact that hospitals are using new treatments effectively.”
For every 1,000 patients hospitalized with heart conditions, he said, there were 39 fewer deaths and 90 fewer patients with new heart failures compared with seven years ago. In the United States, with as many as 5 million such patients each year, that would translate to nearly 200,000 fewer deaths if all hospitals were following the treatment guidelines.
“There have been a lot of lives saved, a lot of complications averted,” said Dr. Joel M. Gore of the University of Massachusetts Medical School, another of the study’s leaders.
The researchers could not attribute the improvements to any one treatment or medication, concluding that it was the combination that was responsible.
The improvements included a doubling in the use of balloon angioplasty to clear blocked arteries and increased use of old and new drugs, such as aspirin, cholesterol-lowering statins, anti-clotting drugs called glycoprotein IIb/IIIa inhibitors, blood thinners such as clopidogrel and low-molecular-weight heparin, and blood-pressure-reducing drugs such as ACE inhibitors.
There was also “a marked reduction in the use of ineffective medications,” Gore said, including clot-dissolving enzymes, calcium channel blockers and unfractionated heparin.
The study, known as the Global Registry of Acute Coronary Events, or GRACE, included 44,372 patients at 113 hospitals from 1999 to 2006. All patients had either suffered a severe heart attack or suffered from acute coronary syndrome, which includes other types of heart attacks and a kind of chest pain called unstable angina.
Death rates from severe heart attacks while in the hospital fell from 8.4% at the beginning of the study to 4.5% at the end, according to the report. The risk of progressing to heart failure declined from 20% to 11%.
The rate of progression to a critical form of heart failure called cardiogenic shock declined from 7.1% to 4.7% -- a crucial drop because 70% of such patients die. Deaths in patients with milder heart attacks fell from 2.9% to 2%.
Among patients who suffered a severe heart attack, the risk of a subsequent stroke fell from 1.3% to 0.5%, while the risk of a second heart attack went from 4.8% to 2%. Similar declines were observed for patients who had suffered milder heart attacks.
Despite these gains, there is still room for improvement, said Dr. Kim Eagle of the University of Michigan Medical School, another coauthor. He pointed out that only about 85% of patients received statins, for example, although all should. He also noted that only 53% of severe heart attack patients received emergency angioplasty, even though it has been shown to save lives.
The study was funded by the pharmaceutical company Sanofi-Aventis through an unrestricted educational grant to the University of Massachusetts to maintain the GRACE registry. Most of the authors have received funds from pharmaceutical companies.
In another study published online this week in the American Heart Journal, Fonarow and colleagues observed similar improvements in the treatment of heart failure. They studied 159,168 patients at U.S. hospitals.
From 2002 to 2004, they found a 29% reduction in deaths while patients were in the hospital and a 36% reduction in the need for mechanical ventilation. Reductions were also seen in the length of stay in the intensive care unit and in the hospital overall.
The researchers attributed the improvements to a substantial rise in the use of oral beta-blocker drugs.
Fonarow’s study was funded by the biopharmaceutical company Scios, which supports the registry from which the data was drawn. Fonarow is a consultant to the company.
