People having a heart attack for the first time are more likely to survive these days than they would have decades ago, researchers have confirmed.
But now doctors are trying to puzzle out why heart attacks have become more survivable - what doctors, hospitals and individuals are doing right, and how to keep that trend headed in the right direction.
"There are several possible reasons why heart attacks are not killing as many people," said Dr Merle Myerson, director of the cardiovascular disease prevention program at St Luke's-Roosevelt Hospital in New York City. "We need to look at those and determine how we should train the next generation of health-care providers to continue this progress."
Myerson co-authored a study, published in Circulation, that reviewed more than 10 000 first heart attacks in four widely separated areas of the United States. Her team found only a marginal decrease in the heart attack death rate, from 5.3% in 1987 down to 3.8% in 2002.
But when they looked at 20 indicators of severity, they found that heart attacks today are not as damaging and deadly as in years past.
Better medication available
Part of the reason for that, Myerson figures, lies in the quality of care people are receiving at the hospital. There are better medications available, including anti-platelet and anti-coagulant drugs to help clear blockages. There also are better medical procedures available, with more doctors becoming skilled at performing angioplasty and bypass surgeries, and implanting stents to open blocked arteries.
But Myerson thinks people also might be having less-severe heart attacks because of treatment they've been getting.
"People are getting better preventive care before they have a heart attack," she said. Doctors are doing a better job diagnosing and treating high blood pressure or high cholesterol, she said, and people are getting better at improving their diet, taking aspirin and exercising.
Time delay important
Yet despite the improvements, there are still ways to make heart attacks even less deadly. For example, Myerson's study found that people were taking as long as or longer to get to the hospital during a heart attack than they did 15 years ago, and the researchers ruled that out as something that might be contributing to the increased survivability.
Dr Alice Jacobs, director of interventional cardiology at Boston Medical Center, said it was "disappointing" that so many people having heart attack symptoms still take two hours or more to get to a hospital.
"This represents an opportunity to focus on strategies that will reduce pre-hospital delay for patients who experience signs and symptoms of a heart attack," Jacobs said.
Myerson and Jacobs agree that public education is the best way to reduce that delay. "When someone has chest pain or chest discomfort, they need to activate the emergency response system as quickly as possible," Myerson said. "We need to educate people on the impending signs of heart attack.
"It might not be the classic crushing chest pain," she continued. "Sometimes it's acute shortness of breath, it's a left arm or jaw pain. It could be a feeling of indigestion. It's always better to go have it checked out."
Jacobs said that primary care physicians could take a leading role in this. "Patients, particularly those at high risk for an event, and their physicians should discuss the warning signs of a heart attack and a plan for how, when and where to seek medical attention," she said.
Another way to improve heart attack survivability would be to place even more of an emphasis on prevention. Myerson said that could be accomplished by having health insurers step up to cover the cost of preventive measures such as nutritional counseling and gym memberships.
"I think the key to better reimbursement for these is to put them on a par with getting a prescription for medication," she said. "We should be able to write a prescription for nutritional counseling and it would be treated the same as any other prescription." - (Dennis Thompson/HealthDay News, June 2009)