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Eternal Vigilance Needed for Heart Attack Survivors

Researcher says the lesson is often ignored

MONDAY, Nov. 25, 2002 (HealthDayNews) -- Looking back at the medical records of people who had heart attacks before current advanced treatments were developed, British physicians find a lesson for today's patients and the doctors who treat them: Never relax your vigilance, because the increased risk of death persists for many years.

It's a lesson that often can be ignored because of lack of awareness of the persisting risk, says Dr. Malcolm R. Law, a professor of epidemiology and preventive medicine at the University of London, and the leader of the group reporting the study results in today's issue of the Archives of Internal Medicine.

"People sometimes forget that they had a heart attack," Law says. "They might imagine that they are OK after a few years, but it goes on indefinitely."

The magnitude of the risk, and the length of its persistence, came as a surprise, Law says. He and his colleagues analyzed 23 published studies in which 14,211 patients who had heart attacks in the decades before the 1980s. On average, 23 percent of them died before reaching the hospital, and another 13 percent died in the hospital.

One of every 10 survivors died in the first year after they left the hospital. In the years that followed, the annual death rate was 5 percent -- indefinitely. After 15 years, the overall death rate was 70 percent.

The record was worse for people who had a second heart attack. A third died before reaching the hospital, 20 percent died in the hospital, and the annual death rate after release was 10 percent -- again, indefinitely. "The risk never went away," Law says.

"The high mortality rate emphasizes the need to ensure that everyone who has had a myocardial infarction [heart attack], even years previously, receives effective preventive treatment," the researchers write.

It doesn't always happen, Law says. "If two men go into the hospital, one who had a heart attack years ago and the other with high blood pressure, doctors might pay more attention to the one with high blood pressure," he says. "But the first guy is the one at higher risk."

As for everyday care, data from hospital records and private medical practices indicate that many heart attack survivors are not getting the care they need, the researchers say. Two-thirds of them are not prescribed cholesterol-lowering statin drugs, half are not prescribed beta-blockers and other basic heart medications and up to half are not taking aspirin to prevent blood clots.

A large number of people need special care, the report says. In Western countries such as the United States and England, 6 percent of people ages 55 to 64 and 9 percent of those ages 65 to 74 have had heart attacks. Yet "it is unusual for physicians to seek out patients who have had myocardial infarctions years before to advise them of their ongoing high risk and to commence or reinstate preventive treatment," they write.

"It is difficult to identify any other group in the population at such high risk of death that can so readily be prevented by medical means," they say.

The long-term death rate for heart attack survivors has not changed all that much over the decades, says Robert J. Goldberg, director of the Worcester Heart Attack Study, which has followed more than 10,000 patients in that Massachusetts community for two decades.

"The mortality rate is about 8 to 15 percent in the first years, then 3 to 5 percent in the years that follow," Goldberg says.

It does not diminish with time for a variety of reasons, such as patients not complying with doctor's instructions and the presence of other illnesses, Goldberg adds.

What To Do

To learn more care after a heart attack, consult the American Heart Association or the Heart Information Network.

SOURCES: Malcolm R. Law, M.B.B.S., professor of epidemiology and preventive medicine, University of London, England; Robert J. Goldberg, Ph.D., professor of medicine, University of Massachusetts School of Medicine, Worcester; Nov. 25, 2002, Annals of Internal Medicine
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