In the May 2 issue of the Journal of the American Medical Association, researchers say that since 1999, doctors have significantly improved the way they treat patients with myocardial infarctions (heart attacks), and as a result, the outcome of patients with heart attacks has gotten significantly better. Myocardial infarctions occur when one of the coronary arteries -- the blood vessels that provide oxygen and nutrients to the heart muscle -- suddenly becomes blocked, usually by a blood clot. Sudden blockage of a coronary artery can cause part of the heart muscle to die. ( You can read an overview of coronary artery disease and heart attacks here.)
To assess how doctors are doing in treating myocardial infarctions, the researchers studied the GRACE registry, the world's largest database of heart attack patients. The GRACE registry contains information on over 44,000 patients treated for myocardial infarctions in 113 hospitals and 14 countries between 1999 and 2006. The researchers came to two conclusions.
First, doctors have significantly improved their management of patients with heart attacks over the past few years, and have done so by more closely following evidence-based guidelines. Specifically, more patients with acute heart attacks are receiving early angioplasty and stents to open the acutely blocked coronary artery as rapidly as possible. If a blocked artery can be opened within a few hours, permanent damage to the heart muscle can be greatly limited. In addition, doctors are significantly more likely today than they were a few years ago to prescribe drug therapy that has been shown to improve outcomes after heart attacks. Significantly more heart attack patients are receiving aspirin, beta blockers, statins, and ACE inhibitors than in the past.
Second, patients who have myocardial infarctions today are significantly less likely to die, to develop heart failure, or to have another heart attack, than patients in the past.
The researchers conclude that the doctors' more routine use of aggressive acute therapy (i.e., immediately opening the blocked artery), combined with their more routine use of proven drug therapy (to prevent heart failure and additional heart attacks) have led to these significantly improved outcomes.
DrRich comments:
It is indeed a good thing that the treatment of patients with heart attacks, on average, has improved significantly over the past few years. This indicates that more doctors than before are aware of the most recent guidelines for therapy. They know what they are supposed to do when a patient shows up in the emergency department with symptoms suggestive of myocardial infarction, and have established the systems necessary to do it. Even so, many patients still do not receive optimal therapy when they have heart attacks. Even today, only about half the patients with heart attacks have their blocked coronary arteries successfully reopened soon enough to prevent significant heart muscle damage, and only three quarters or so receive all the recommended drug therapy after a heart attack. There is still a lot of room for improvement.
It is important for any person who has known coronary artery disease, or whose risk factors place them at an elevated risk for coronary artery disease, to be aware of what's supposed to happen when you have a heart attack. Be aware of the symptoms, and get yourself to a hospital if you experience those symptoms. If you are diagnosed with an acute myocardial infarction, then by asking the right questions, patients (or their families) can often remind their doctors to take the measures that have been shown to improve outcomes. ( Read about how to survive a heart attack here.)
Sources:
Fox KAA, Steg PG, Eagle KA, et al. Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006. JAMA 2007; 297:1892-1900.
