Sudden Death Risk Peaks in Month After Heart Attack

More research needed to spot those in greatest danger, experts say

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HealthDay Reporter

WEDNESDAY, June 22, 2005 (HealthDay News) -- Even patients with relatively strong hearts are at heightened risk for sudden death in the 30 days following a heart attack, a new study finds.

"It's been known that the time right after a heart attack is the high-risk period," said Dr. Scott D. Solomon, lead author of the report in the June 23 issue of the New England Journal of Medicine. "What we didn't expect was that patients with better cardiac function were equally at risk in this early period."

The study tracked the outcomes of more than 14,600 people in the United States and abroad in the months after they suffered heart attacks. Of those, 1,067 either died suddenly or were resuscitated after cardiac arrest over the next two years.

During the first month after the heart attack, 1.4 percent of the patients died suddenly or required resuscitation. The risk decreased steadily after that, dropping to just 0.14 percent per month after two years, the researchers report.

"These results present a challenge to the medical community, to figure out which patients are at higher risk and to develop new strategies, technologies and therapies to reduce that risk," said Solomon, director of noninvasive cardiology at Brigham and Women's Hospital in Boston. "As we discharge patients earlier and earlier after heart attack, we need to consider this risk."

Extending the time that patients are hospitalized after a heart attack is not the answer, Solomon said. "We don't recommend keeping people in the hospital longer," he added.

Current guidelines call for surgical implantation of a defibrillator, a device that delivers an electric shock to restart the heart when it stops beating, for heart attack survivors whose ability to pump blood is reduced significantly. However, the guidelines mandate that these devices not be implanted until at least 30 days after the heart attack.

An alternate strategy suggested in an accompanying editorial by Dr. Alfred E. Buxton, a professor of medicine at Brown Medical School, would be to provide people leaving the hospital with newer-model, external defibrillators.

Those devices need not be implanted surgically, Buxton explained. Some defibrillators are worn as vests, while others sit on the skin. Automatic external defibrillators are currently being tested in a large-scale trial sponsored by the National Heart, Lung, and Blood Institute, Buxton noted.

The Boston study is "a useful reality check on the risk of sudden death" among survivors of a heart attack, Buxton wrote. "The challenge going forward is to translate these observations into cost-effective preventive therapy," he said.

What might really help would be some sort of biological or medical marker that could identify those heart attack survivors at highest risk of sudden death, Solomon said. Unfortunately, no such marker emerged from the current study, he noted.

More information

Heart attack and its treatment are described by experts at the Texas Heart Institute.

SOURCES: Scott D. Solomon, M.D., director, noninvasive cardiology, Brigham and Women's Hospital, Boston; June 23, 2005, New England Journal of Medicine

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