Fewer Heart Patients Dying After Hospitalization

Improvements in care are cutting heart failure, mortality rates, study finds

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HealthDay Reporter

TUESDAY, May 1, 2007 (HealthDay News) -- As more medical centers have begun adopting new heart disease treatment guidelines, the rates of heart failure and death have been dropping, new research suggests.

More recent guidelines have emphasized the need for more aggressive use of proven medications, such as aspirin and beta blockers, as well as the expedient use of angioplasty to open up blocked arteries. The good news is a study in the May 2 issue of the Journal of the American Medical Association that found that as hospitals start implementing these guidelines, the rates of new heart failure and mortality rates go down.

"By applying the benefits of existing clinical trials -- as synthesized in national and international guidelines -- huge benefits for patients can be gained, and it is possible to prevent deaths and heart failure," said study author Dr. Keith A. A. Fox, the British Heart Foundation professor of cardiology at the University of Edinburgh in Scotland.

Each year, almost 8 million Americans will have a heart attack and another 5 million will have heart failure, according to the American Heart Association. A heart attack occurs when blood flow to the heart is blocked, usually by a blood clot. Heart failure occurs when the heart becomes so damaged that it can no longer pump blood efficiently.

Numerous randomized clinical trials have been conducted, and more and more evidence is available to doctors regarding treatment of heart disease. As a result of all these trials, many organizations, such as the American Heart Association, the American College of Cardiology and the European Society of Cardiology, have issued new treatment guidelines, according to Fox.

New guidelines call for more aggressive use of medications, such as oral anti-clotting drugs like aspirin, beta blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and statins. Guidelines also recommend that when appropriate, angioplasty be performed quickly.

To assess the impact that implementation of these new guidelines has had on patient care, Fox and his colleagues gathered data on almost 45,000 people treated at 113 hospitals in 14 different countries. The researchers assessed in-hospital and six months post-discharge outcomes.

Fox said that due to implementation of new guidelines, "survival was markedly improved, and, for the first time in any study, we have shown a marked reduction in the development of new heart failure."

Overall, he said, "deaths in heart attack declined from 8.4 percent to 4.6 percent, new heart failure from 19.5 percent to 11 percent, and new heart attacks from 4.8 percent to 2 percent."

"The changes must be due to improved treatment of patients after presentation to hospital," said Fox. "The improvement is due to the combined effect of better use of anti-clotting and other heart attack drugs, and greater use of angioplasty."

Dr. Louis Teichholz, medical director of cardiac services and division director of cardiology at Hackensack University Medical Center, agreed that the use of medications and increased use of angioplasty were the biggest contributors to the decline in heart failure and deaths.

"One of the most important changes is the more aggressive use of medications," said Teichholz, who added that the use of angioplasty was also a big factor in the improved mortality and heart failure statistics. "When you take patients to the catheterization lab and open up the artery, it markedly improves mortality and saves [heart muscle]," he said.

Teichholz pointed out that recent studies have questioned the use of angioplasty and stenting in chronic heart conditions, but in acute situations, such as a heart attack, he said, "Opening up the artery can be lifesaving."

Teichholz said that the six-month follow-up statistics weren't as impressive. Most of the gains made in the acute care setting had leveled off, he noted.

For most people, he said, what's really important to know is the "the clock starts ticking as soon as you get chest pains. Don't wait hours before going to the hospital."

More information

To learn more about acute coronary syndrome, visit the American Heart Association.

SOURCES: Keith A. A. Fox, M.B., Ch.B., British Heart Foundation professor of cardiology, the University of Edinburgh, Scotland; Louis Teichholz, M.D., medical director, cardiac services, and division director, cardiology, Hackensack University Medical Center, N.J.; May 2, 2007, Journal of the American Medical Association

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