Heart attack guidelines boost patient survival: study

CHICAGO (Reuters) - Better drugs and emergency hospital treatments have helped significantly more people survive heart attacks, with fewer complications, researchers said on Tuesday.

File photo shows the emergency entrance to Hollywood Memorial Regional Hospital in Hollywood, Florida on February 8, 2007. Better drugs and emergency hospital treatments have helped significantly more people survive heart attacks, with fewer complications, researchers said on Tuesday. REUTERS/Marc Serota

If hospitals follow proven guidelines for treating heart attacks or severe chest pain, more patients survive and have fewer serious complications down the road, the researchers report in the Journal of the American Medical Association.

Dr. Keith Fox, a professor of cardiology at the University of Edinburgh in Britain, and colleagues looked at how patients with heart attacks and unstable angina or chest pain fared when treated according to the latest guidelines.

“What’s exciting is it has had a dramatic impact at reducing deaths and the development of new heart failure,” Fox said in a telephone interview.

Fox said the study was the first large-scale demonstration that heart failure could be reduced by half in patients coming to the hospital with a heart attack or a threatened heart attack.

Heart failure, a condition in which the heart gets flabby and cannot efficiently pump blood, often occurs after an attack damages heart tissue.

Carefully controlled clinical trials have shown that the quicker a patient gets treatment, such as having a blocked artery opened up with angioplasty, the better the outcome.

The American College of Cardiology and many other groups recommend that heart attack patients get angioplasty within 90 minutes of entering the hospital.

Fox’s team found that when hospitals follow such guidelines, patients are more likely to survive the heart attack and have fewer cases of heart failure and stroke even by six months later.

Fox and colleagues analyzed data from 44,372 patients between July 1999 and December 2006 at 113 hospitals in 14 countries in Eastern and Western Europe, the United States and South America.


“The good news for patients around the world is that this data shows a significant drop in death in hospitals ... but also a significant drop in stroke and heart failure. And at six months, the trends continue,” said Dr. Kim Eagle, a University of Michigan cardiologist who worked on the study.

Deaths from ST-elevation heart attack, the most serious type, dropped to 4.6 percent in 2006 from 8.2 percent in 1999.

“That was a major drop,” Eagle said in a telephone interview.

They attributed the improvements to increased use of drugs such as beta-blockers, cholesterol-lowering statins, ACE inhibitors, anti-clotting drugs, blood thinners and glycoprotein IIb/IIIa inhibitors, which are drugs used to treat chest pain.

Angioplasty to clear arteries was performed in about a third of patients in 1999, and about two-thirds by 2006. Deaths of those heart attack patients in the hospital fell by 18 percentage points.

In patients with non-STEMI heart attacks, rates of angioplasty rose 18 percentage points. Rates of congestive heart failure and pulmonary edema -- the backup of fluid caused by a poorly functioning heart -- declined in both groups.

The benefits of better heart attack treatment lasted, the study found, with the rates of death and stroke falling six months after treatment.

“Our challenge is to translate this out to all hospitals in the respective countries,” Fox said.