Increased use of angioplasty and the introduction of new drugs over the past six years have nearly halved the number of hospitalized heart attack victims who die or suffer severe heart failure, an international team of researchers reported today.
The report showed “remarkable improvements” in the care of heart attack victims in all 14 countries studied, said Dr. Gregg C. Fonarow of the University of California, Los Angeles’ Geffen School of Medicine, who was not involved in the study.
“It is not simple to manage these patients. Many therapies need to be applied very rapidly,” he said. This study shows that individual drugs and treatments that have been validated in clinical trials can be combined in the real world to produce “very meaningful benefits.”
Added Dr. Keith A.A. Fox of the University of Edinburgh in Scotland, who led the study published in the Journal of the American Medical Association: “Our study supports the fact that hospitals are using new treatments effectively.”
For every 1,000 patients admitted to hospitals, he said, there are 39 fewer deaths and 90 fewer patients with new heart failures compared with only six years ago. In the United States, with as many as 5 million patients suffering the conditions each year, that would translate to nearly 200,000 fewer deaths if all hospitals were following the treatment guidelines.
“There have been a lot of lives saved, a lot of complications averted,” said Dr. Joel M. Gore of the University of Massachusetts Medical School, another of the study’s leaders.
The group could not attribute the improvements in outcomes to any one treatment or medication, concluding that it was the total of all combined that was responsible.
The improvements include a doubling in the use of balloon angioplasty to clear blocked arteries and the increased use of a variety of old and new drugs, including aspirin; cholesterol-lowering statins; anti-clotting drugs called glycoprotein IIb/IIIa inhibitors; blood thinners such as clopidogrel and low-molecular-weight heparin; and blood pressure-reducing drugs such as ACE inhibitors.
“The individual medications are all very good, but we were concerned that when it actually came to treating patients, the thought of using five or six right from the start would be intimidating,” Gore said. “We’re very encouraged to see that people are using all of the evidence-based medicine and showing excellent results.”
There was also, he said, “a marked reduction in the use of ineffective medications,” including clot-dissolving enzymes, calcium-channel blockers and unfractionated heparin.