CHICAGO – In just six years, death rates and heart failure in hospitalized heart attack patients have fallen sharply, most likely because of better treatment, the largest international study of its kind suggests.
The promising trend parallels the growing use of cholesterol-lowering drugs, powerful blood thinners, and angioplasty, the procedure that opens clogged arteries, the researchers said.
"These results are really dramatic, because, in fact, they're the first time anybody has demonstrated a reduction in the development of new heart failure," said lead author Dr. Keith Fox, a cardiology professor at the University of Edinburgh.
The six-year study involved nearly 45,000 patients in 14 countries who had major heart attacks or dangerous partial artery blockages. The percentage of patients who died in the hospital or who developed heart failure was nearly cut in half from 1999 to 2005.
And the heart attack patients treated most recently were far less likely to have another attack within six months of being hospitalized when compared to the patients treated six years earlier — a sign that the more aggressive efforts of doctors in the last few years are working.
There have been other signs that better treatment of heart patients has been saving lives, but not on a scale as large as this international study, the researchers said.
"It's much more dramatic than we expected, in the course of six years," Fox said.
The new study follows landmark research results in March that showed angioplasty is being overused on people who have chest pain but are not in immediate danger of a heart attack. But this popular procedure, which typically uses stents to keep an unclogged vessel open, is still a powerful tool for saving those who are having a heart attack or are at high risk of one.
Patients for the study enrolled between July 1999 through December 2005 and were followed for up to six months after hospitalization. Besides the United States, they were in hospitals in Argentina, Australia, Austria, Belgium, Brazil, Canada, France, Germany, Italy, New Zealand, Poland, Spain and the United Kingdom.
The research showed that in 2005, 4.6 percent of the heart attack patients died in the hospital, compared with 8.4 percent in 1999. Heart failure developed in 11 percent of heart attack patients in 2005, versus nearly 20 percent in 1999. And just 2 percent had subsequent heart attacks in 2005, compared to 4.8 percent previously.
Improved outcomes also were found in those with partial blockages, which include less severe heart attacks.
The researchers said these marked improvements are probably a "direct consequence" of new practices that followed updated guidelines from key organizations of heart doctors in the United States and Europe.
The study "is the first report of what's actually going on in the real world," said Dr. Joel Gore, a co-author and cardiologist at the University of Massachusetts Medical Center.
Recommendations in those guidelines include quick use of aspirin or more potent blood thinners; beta blockers to reduce the damaged heart's oxygen needs, statins to lower cholesterol; ACE inhibitors to relax blood vessels; and angioplasty to open blocked vessels soon after hospital arrival.
Use of each of these treatments climbed during the study and in some cases more than doubled. For example, 85 percent of heart patients studied got cholesterol drugs in 2005 versus just 37 percent in 1999; 78 percent got potent blood thinners including Plavix versus 30 percent in 1999; and 53 percent had quick angioplasty, compared to just 16 percent six years earlier.
The study appears in Wednesday's Journal of the American Medical Association. It was funded by a grant from Sanofi-Aventis, maker of several heart drugs including Plavix and ACE inhibitors. Fox and several other authors reported getting fees and grants from Sanofi and other drug makers.
Dr. Steven Nissen, former president of the American College of Cardiology and a Cleveland Clinic heart specialist, said the study doesn't prove the recommended treatments were saving lives but he suspects that's the case.
"I really am encouraged that those things that appear in our guidelines are being used by physicians around the world," Nissen said.
American Heart Association spokesman Dr. Sidney Smith said the results are "exactly what we would hope would happen from the major efforts in this area over the past decade.
"The tragedy is that too many patients delay before coming to the hospital," Smith said.
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On the Net:
American Heart Association: http://www.americanheart.org
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