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Senior Citizen Health & Medicine
Large Studies Show New Treatments Slowing Heart
Failure Deaths
Changes occur as hospitals increase use of certain
drugs, tests, procedures
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Fewer Heart Disease Patients Are
Dying, Thanks To Better Care During and After Hospitalization –
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May 2, 2007 – After people become senior citizens
the greatest threat to their life switches from cancer to heart attack.
Two new studies indicate significant progress in the fight against heart
failure.
The study in the Journal of the American Medical
Association released today says this is the first study to show a
significant drop in the rate of heart failure and death over such a
short time in this population.
People who suffer a heart attack or severe chest
pain today are much less likely to die, or to experience long-lasting
effects, than their counterparts even a few years ago, according to the
international study in the May 2 issue.
Good News on Heart Attack and Chest Pain
The study finds that the change occurred at the
same time that hospitals increased their use of certain drugs, tests and
procedures that have been proven to help reduce the immediate and
long-term impact of acute heart problems. The results suggest that
concerted efforts to standardize heart care are working.
But, the authors caution, there are clouds in this
sunny sky. Many patients who could benefit from all of the proven
treatments aren’t getting them. Previous data have shown that the U.S.
actually lags behind some other countries in several aspects of acute
coronary care.
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Health & Medicine |
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The study is from the Global Registry of Acute
Coronary Events (GRACE), which has collected data from 44,372 patients
treated at 113 hospitals in 14 countries. The new paper is led by
cardiologists from the University of Edinburgh in Scotland, Hospital
Bichat in France and the University of Michigan Cardiovascular Center.
All the patients had suffered either a kind of
severe heart attack called ST-elevated myocardial infarction (STEMI), or
had acute coronary syndrome (ACS), which includes non-STEMI heart attack
and a kind of chest pain called unstable angina.
Between 1999 and 2006, the use of heart-protecting
drugs in these patients increased markedly, including use of aspirin,
cholesterol-lowering statins, clot-reducing drugs called glycoprotein
IIb/IIIa inhibitors, blood thinners such as clopidogrel and heparin, and
blood pressure-reducing drugs including ACE inhibitors.
At the same time, the use of angiography to see
blocked arteries in the heart and angioplasty as an emergency or
secondary treatment to reopen blockages increased by more than 30
percent in STEMI patients and around 20 percent in ACS patients.
As the use of all these treatments increased, the
death rate for patients both in the hospital and in their first six
months after going home decreased significantly. So did the risk that
patients would develop heart failure, have pulmonary edema, or suffer a
stroke in their first six months after hospitalization.
“These findings are exciting because they provide
good evidence that improved use of guideline- based treatments has
resulted in fewer deaths and fewer patients with heart failure in those
that present to hospital with heart attack or threatened heart attack,"
says Keith A. A. Fox, MB. ChB., FRCP, lead author of the paper, co-chair
of GRACE and a professor of cardiology at Edinburgh.
“These data are extremely encouraging, and suggest
that we’re definitely improving heart care and patients’ outcomes
through the uniform use of evidence-based, proven treatments and the
development of guidelines to help providers understand the evidence
behind them,” says Kim Eagle, M.D., FACC, a co-author on the paper and
co-chair of the publication committee for GRACE. He is the Albion Walter
Hewlett Professor of Cardiovascular Medicine at the U-M Medical School
and a director of the U-M Cardiovascular Center.
“Yet, these data and other studies show that we
still have a ways to go before every heart attack and ACS patient
receives the full range of tests and treatments that we know can benefit
them,” Eagle continues.
He notes, for example, that only 85 percent of STEMI patients and 83 percent of ACS patients in the study received a
statin in 2006, when virtually all such patients should receive the
cholesterol-lowering drug. And only 53 percent of STEMI patients
received emergency angioplasty, when it has repeatedly been shown to be
life-saving in such patients.
“The U.S. especially has a lot of ground to gain,
compared with European and Canadian hospitals, in reducing the time lag
between hospital presentation and acute coronary artery angioplasty,”
Eagle adds. “That’s why efforts to improve hospitals’ systems for
providing this kind of care are so important.”
Eagle says, patients should ask their doctors and
nurses questions about what drugs they should be receiving both in the
hospital and after they go home. Aspirin, statins, beta blockers and ACE
inhibitors should be on the medicine cabinet shelves of nearly every
patient who has ever been hospitalized for chest pain or a heart attack
– and patients need to make sure to keep taking those drugs long after
they leave the hospital, perhaps for life.
At the same time, while the study did not include
data on patients’ diet, exercise and tobacco habits, those lifestyle
components are crucial to preventing further problems. Says Eagle, “We
all have a role to play in making sure that the news in heart attack
care continues to be good.”
Editor’s Note: GRACE is supported by an
educational grant from Sanofi Aventis, which plays no role in data
collection, analysis or publication. For more information on GRACE,
click here.
UCLA study also finds new treatment helps
In tghe second study, reported in the American
Heart Journal, UCLA researchers found that improved treatment of heart
failure patients resulted in a highly significant 29 percent reduction
of in-hospital mortality and 36 percent reduction in the need for
mechanical ventilation. Reductions in hospital and intensive care unit
length of stay were also found.
The researchers tracked heart failure in-hospital
patient trends from 2002 to 2004 for 285 hospitals nationwide including
data from more than 150,000 acute heart failure patient episodes, taken
from the Acute Decompensated Heart Failure National Registry (ADHERE).
If similar improvements had occurred at hospitals nationwide, this would
translate to 14,300 less in-hospital deaths and 880,000 costly hospital
days eliminated per year.
Treatment changes included
● decreased use of intravenous inotropic agents (drugs that make the
heart work harder),
● increased use of intravenous vasodilators (drugs that reduce the
work the heart needs to do to help blood flow),
● substantial rise in the use of oral beta-blocker medication during
hospitalization and
● hospital compliance with key quality-of-care measures including
patient receipt of discharge instructions, smoking counseling and left
ventricle function measurement increased.
The study highlights the need for further efforts
to accelerate improvements in care for heart failure patients, according
to author Dr. Gregg C. Fonarow, Eliot Corday Chair in Cardiovascular
Medicine, and professor of cardiology, David Geffen School of Medicine
at UCLA
Editor’s Note: The study was funded by
biopharmaceutical company Scios, Inc., which sponsors the ADHERE
registry. The authors have received research grants and served as
consultants for Scios.
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