Evidence-Based Heart Attack Care Reduces Deaths: Study
Clot-busting drugs, rapid angioplasty made a significant difference, researchers report
By Jenifer Goodwin
TUESDAY, April 26 (HealthDay News) -- The increased use of evidence-based treatments for heart attacks, such as clot-busting drugs and rapid angioplasty, has led to a decrease in deaths, a new study finds.
Researchers used data from a Swedish coronary care registry on more than 61,000 patients who had had a particular type of deadly heart attack known as STEMI between 1996 and 2007.
During those 12 years, the use of evidence-based treatments -- that is, treatments that were shown in large-scale, randomized medical studies to work -- became more widespread, according to the study.
That corresponded with a drop in deaths from that type of heart attack, the investigators found.
From 1996 to 2007, in-hospital deaths in Sweden fell from 12.5 percent to 7.2 percent. Deaths within a month of the heart attack fell from 15 percent to 8.6 percent, and deaths within a year of the heart attack dropped from 21 percent to 13.3 percent, according to the report.
The percentage of patients who had a second heart attack while in the hospital also fell from 4 percent at the start of the study period to 1 percent by the study's end.
Though this research was conducted in Sweden, experts said they'd expect to see a similar trend in the United States, where evidence-based treatments are also increasingly taking hold at the nation's hospitals.
"The combined use of simple therapies such as aspirin and cholesterol-lowering medications and balloon stents were associated with a significant reduction in mortality," said Dr. Debabrata Mukherjee, chief of cardiology at Texas Tech University Health Sciences Center. "We would expect to have similar findings in the United States."
Mukherjee wrote an editorial accompanying the study in the April 27 issue of the Journal of the American Medical Association.
Numerous therapies became more commonplace between 1996 and 2007, including several that quickly restore blood flow to the heart to prevent further damage, called reperfusion.
The most significant of those is primary percutaneous coronary intervention (PCI), also called balloon angioplasty, in which a catheter is threaded into the artery and a balloon at the end inflates inside the clogged artery. Usually, when the tube is removed, a stent, or wire mesh structure, is left behind to prevent the artery from narrowing again.
About 12 percent of patients underwent primary PCI at the start of the study period. By 2007, 61 percent did. (Primary means the PCI was done soon after the patient arrived at the hospital, usually within 90 minutes, Mukherjee explained.)
The percentage of people who received PCI or bypass surgery within 14 days rose from 10 percent to 84 percent.
In addition, the use of clot-busting, clot-preventing and cholesterol-lowering medications also surged during the study period, the study authors noted.
Use of glycoprotein Ilb/lIIa inhibitors (platelet inhibitors) rose from 0 percent to 55 percent; use of clopidogrel (blood thinner) rose from 0 percent to 82 percent; statin use rose from 23 percent to 83 percent; and use of ACE inhibitors or ARBs (angiotensin II receptor blockers, used to lower blood pressure) rose from 39 percent to 69 percent, according to the report by Dr. Tomas Jernberg, of the Karolinska Institute in Stockholm, and colleagues.
Still, there were differences between hospitals in whether or not patients received the recommended therapies. A similar problem exists in the United States, Mukherjee said.
"Evidence-based therapies take a while to get incorporated into daily clinical practice," Mukherjee explained. "It can take months or years. We see the same thing in the United States, with some hospitals that are very good and some that are not so good."
European evidence-based guidelines for STEMI care are similar to U.S. guidelines developed by the American College of Cardiology (ACC) and the American Heart Association (AHA), said Dr. Fred Kushner, an author of the ACC/AHA guidelines.
"They have shown very nicely that adherence to guideline-recommended therapy, which we work very hard at to try to promulgate in the United States, leads to improved outcomes," Kushner said.
Despite the gains, there is still room for improvement, Mukherjee added. Primary PCI at a catheterization lab is the most effective way to treat STEMI, he said. "Ideally, it should be 100 percent [that get the treatment]," he noted. "The more we do it, the more lives we save."
Patients also need to be aware that they should call 911 if they are experiencing the signs of a heart attack, which can include squeezing chest pain, shortness of breath and fatigue. Getting treatment quickly can mean the difference between life and death, Kushner said.
"One of the biggest challenges we face is patients may not recognize they are having a heart attack and may not call the appropriate emergency medical services team to get them to the appropriate hospital," Kushner pointed out. "Don't wait. Don't call your neighbor. Call the ambulance."
About 400,000 people in the United States have a STEMI heart attack annually, according to the American Heart Association.
The American Heart Association has more on heart attacks.SOURCES: Debabrata Mukherjee, M.D., chief, cardiology, Texas Tech University Health Sciences Center, El Paso, Texas; Fred Kushner, M.D., co-author, American College of Cardiology/American Heart Association STEMI guidelines; April 27, 2011, Journal of the American Medical Association Related Articles
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