Related Resources • Surviving a heart attack: the 1st 24 hours • Survivng a heart attack: After the first day

By DrRich

In  a recent issue of the Archives of Internal Medicine, research conducted under the Medicare Health Care Quality Improvement Program showed that the quality of care for American patients hospitalized with acute myocardial infarction (heart attack) has improved over the past several years, but has not yet reached acceptable levels.  Up to 25% of patients are discharged from the hospital without receiving at least one of the treatments shown to reduce death and disability after heart attacks.

The study looked specifically at the use of three drugs that should be given to almost all patients after heart attack - aspirin, a beta blocker, and and Ace inhibitor - and at whether efforts were taken to counsel patients on lifestyle changes that are known to improve outcome (counseling on smoking cessation, in particular, was measured.)  While the use of the three drugs improved during the years 1998-99 (as compared with the years 1994-95,) the proportion of patients receiving lifestyle counseling actually dropped.  And overall, a quarter of patients judged to be ideally suited to receive the medications did not receive at least one of the three.  This is a serious oversight since all three of these medications have been shown to significantly reduce mortality in the months to years after heart attack.

Finally, the investigators noted that, while the usage of these treatments has continued to improve, the rate of improvement is dropping.  Reading between the lines, it appears as if most of American physicians who are educable have already been educated.  Those remaining, one fears, are relatively refractory to even the most intense efforts at professional enlightenment.

What this means to patients who have had heart attacks

If you rely on your doctors to do everything that ought to be done to protect your life and health after a heart attack, you have about a 75% chance of being right.  You can increase your odds substantially by knowing yourself what should be done after a heart attack, and pressing your doctor as necessary (or getting another doctor if yours is not following the program.)

Here is an article about the care you should receive after a heart attack: Surviving a heart attack - After the first day.