The rates of heart failure and death are dropping, as more doctors and medical centers start implementing new heart disease treatment guidelines.
New guidelines call for more aggressive use of medications, such as oral anti-clotting drugs like aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and statins. Guidelines also recommend that when appropriate, angioplasty be performed quickly.
Numerous randomized clinical trials have been conducted, and more and more evidence is available to doctors regarding treatment of heart disease.
As a result of all these trials, many organizations, such as the American Heart Association, the American College of Cardiology and the European Society of Cardiology, have issued new treatment guidelines, according to Dr. Keith A. A. Fox, the British Heart Foundation professor of cardiology at the University of Edinburgh in Scotland.
Background
Every year, almost eight million Americans will have a heart attack and another five million will have heart failure, according to the American Heart Association. A heart attack occurs when blood flow to the heart is blocked, usually by a blood clot. Heart failure occurs when the heart becomes so damaged that it can no longer pump blood efficiently.
The Study
To assess the impact these new guidelines have had on patient care, Fox and his colleagues gathered data on almost 45,000 people treated at 113 hospitals in 14 different countries. The researchers assessed in-hospital and six months post-discharge outcomes.
Fox said that due to implementation of new guidelines, "survival was markedly improved, and, for the first time in any study, we have shown a marked reduction in the development of new heart failure."
Overall, he said, "deaths in heart attack declined from 8.4% to 4.6%, new heart failure from 19.5% to 11%, and new heart attacks from 4.8% to 29%."
Conclusions
"The changes must be due to improved treatment of patients after presentation to hospital," said Fox. The improvement is due to the combined effect of better use of anti-clotting and other heart attack drugs, and greater use of angioplasty."
Dr. Louis Teichholz, medical director of cardiac services and division director of cardiology at Hackensack University Medical Center, agrees that the use of medications and increased use of angioplasty are the biggest contributors to the decline in heart failure and deaths.
"One of the most important changes is the more aggressive use of medications," said Teichholz, who added that the use of angioplasty was also a big factor in the improved mortality and heart failure statistics. "When you take patients to the catheterization lab and open up the artery, it markedly improves mortality and saves heart muscle."
Teichholz pointed out that recent studies have questioned the use of angioplasty and stenting in chronic heart conditions, but in acute situations, such as a heart attack, he said, "Opening up the artery can be lifesaving."
Teichholz said that the six-month, follow-up statistics weren't as impressive. Most of the gains made in the acute care setting had leveled off, he noted.
"For most people," he said, "what's really important to know is the clock starts ticking as soon as you get chest pains. Don't wait hours before going to the hospital."
