Navigation Links
Many Heart Attack Patients Don't Get Best Emergency Treatment
Date:8/19/2007

ANN ARBOR, Mich., Aug. 3 /PRNewswire-USNewswire/ -- Far more of today's heart attack patients receive emergency angioplasty treatment or clot-busting drugs to re-open their clogged heart arteries than even a decade ago, a new study finds.

But 10 percent of patients who could benefit from this urgent treatment -- which is known to save lives and prevent lasting damage to the heart muscle -- don't get it at all, the study shows.

And the chance of missing out on lifesaving emergency treatment was highest among those patients whose heart attack symptoms don't include typical symptoms like chest pain, those who didn't reach the hospital until six or more hours after the start of their attack, women, people over age 75, and non-white people.

The study, published in the American Journal of Medicine by a team led by cardiologists from the University of Michigan Cardiovascular Center and the Yale University School of Medicine, is based on data from 238,291 patients who had had a type of heart attack for which this therapy is appropriate between 1994 and 2003.

It's the most current and comprehensive look at the use of emergency "reperfusion" -- a term that describes treatments that can break up blood clots and other blockages in the tiny blood vessels of the heart and restore blood flow to the heart muscle.

In the ten-year study period, the percentage of patients who could have received emergency reperfusion but didn't declined from more than 20 percent to 10 percent - a notable achievement that the authors attribute to the increasing evidence of the benefit of emergency angioplasty, and the rise in the availability of the treatment at American hospitals and concerted national efforts to improve care.

The database used for the study, called the National Registry of Myocardial Infarction, includes detailed information about each patient's condition that can be used to determine if they would meet the criteria to receive emergency angioplasty or treatment with fibrinolytic (clot-busting) medications.

But it's those details that reveal the troubling gap between the number of patients who could have received the treatments, and those who actually did.

"We may never be able to get to 100 percent, but 10 percent of eligible patients going untreated is still too many," says first author Brahmajee Nallamothu, M.D., MPH, assistant professor of cardiovascular medicine at the U-M Medical School. "We hope our study highlights the opportunities to improve care and particularly some of the "at-risk" subgroups still less likely to receive reperfusion therapy despite eligibility, so that we can focus our clinical efforts on them."

Adds senior author Harlan Krumholz, M.D., S.M., "This study has good and bad news. We have definitely made progress in treating appropriate patients, but our findings indicate that we need to improve further to be sure that no patient who could benefit from this treatment is missed." Krumholz is the Harold H. Hines, Jr. Professor of Medicine in the Section of Cardiovascular Medicine and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation.

The study was funded by the National Heart, Lung and Blood Institute of the National Institutes of Health. Genentech, Inc. provided the researchers access to the registry, which it sponsors.

To track the changes in acute (emergency) reperfusion therapy over time, the researchers divided the study data into three time periods: June 1994 through May 1997, June 1997 through May 2000, and June 2000 through May 2003.

The rise in emergency angioplasty was fastest from the first time period to the second; the rate of increase leveled off from the second time period to the third. Correspondingly, the number of patients receiving medication-based reperfusion dropped over the study period.

This is an appropriate shift, says Nallamothu: shifting patients from clot-busting medications to emergency angioplasty may save 12 to 20 lives for every 1,000 heart attack patients treated, if the angioplasty is performed in a timely manner.

The study involved patients who had a particular type of heart attack, called STEMI, for ST-elevated myocardial infarction. Emergency angioplasty is considered the best immediate treatment for STEMI. However, the study did not look specifically at the time that elapsed from the moment the STEMI patient arrived at the hospital to the time when the reperfusion treatment began. This is often called "door to balloon time" because of the use of tiny artery- opening balloons in the angioplasty procedure.

Hospitals around the nation, including U-M and Yale, are taking part in a national campaign to reduce this time interval for patients who receive emergency angioplasty, and studies have shown that patients who are treated within an hour or two of arrival at the hospital do better in the long term than those who wait longer for angioplasty.

But the fact that 10 percent of possible emergency angioplasty candidates still aren't even getting the procedure at all is a significant issue of its own, the authors say. Increasing its use in these patients could save up to an additional 30 lives for every 1,000 heart attack patients treated when performed in a timely manner.

In fact, the authors state that hospitals should be judged in part by their ability to deliver acute reperfusion to as many candidate patients as possible. "Our findings support the incorporation of a measure of reperfusion use into national quality improvement efforts," they write. An American College of Cardiology/American Heart Association task force has endorsed this same idea.

In the meantime, the study results again point to the importance of rapid response to heart-attack symptoms by individuals and their loved ones -- and the need to recognize that chest pain may not occur in everyone who has a heart attack.

In the study, patients who came to the hospital with no chest pain but with other symptoms of heart attack were less than one-third as likely as those with chest pain to get emergency reperfusion treatment. Patients who waited six or more hours before they reached the hospital were 40 percent less likely to get emergency reperfusion.

Reference: American Journal of Medicine, Vol. 120, No.8, August, 2007, online at http://amjmed.com

This news release was issued on behalf of Newswise(TM). For more information, visit http://www.newswise.com.


'/>"/>
SOURCE University of Michigan Health System

Copyright©2007 PR Newswire.

Related medicine technology :

1. Pixantrone Combination Therapy for First-line Treatment of Aggressive Non-Hodgkins Lymphoma Results in Reduction in Severe Toxicities Including Heart Damage When Compared to Doxorubicin-based Therapy
2. Lexicon Develops Antibodies That Lower Triglycerides and Cholesterol as Potential New Therapy for Heart Disease
3. Research Documents Scalable Production, Survival Following Engraftment and Positive Impact on Cardiac Function in Infarcted Rats for Gerons Human Embryonic Stem Cell-Based Therapeutic for Heart Failure
4. Treating Heart Disease Risk Factors May Slow Alzheimers Disease Progression
5. Pilot Phase 3 Results of NovaCardias KW-3902 for Acute Congestive Heart Failure Presented at Late-Breaking Session of Heart Failure Congress 2007
6. Drug for Treatment of Heart Failure Does Not Improve Survival, Compared to More Widely-used Medication
7. deCODE Announces Positive Topline Results for Phase I Study of DG051 for the Prevention of Heart Attack
8. Diovan Achieved 40% Reduction in Stroke and Cardiovascular Events in Landmark Jikei Heart Study
9. Diovan Achieved 40% Reduction in Stroke and Cardiovascular Events in Landmark Jikei Heart Study
10. First Controlled Large-Scale Intervention Angiotensin Receptor Blocker (ARB) Trial in a Japanese Population, JIKEI HEART Study Demonstrates Significant Reduction in Blood Pressure and Protection of Organs with Valsartan
11. New Anti-Rejection Medication 6-Month Results for Heart Transplant Recipients to Be Released at International Heart and Lung Transplant Meeting
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/24/2016)... , June 24, 2016 Dehaier Medical ... the "Company"), which develops, markets and sells medical devices ... , signed a strategic cooperation agreement with Hongyuan ... "Hongyuan Supply Chain") on June 20, 2016, to develop ... the strategic cooperation agreement, Dehaier will leverage Hongyuan Supply ...
(Date:6/24/2016)... Mass. , June 24, 2016   Pulmatrix, ... pharmaceutical company developing innovative inhaled drugs, announced today that ... Russell Investments reconstituted its comprehensive set of ... "This is an important milestone for Pulmatrix," ... will increase shareholder awareness of our progress in developing ...
(Date:6/23/2016)... 2016 Research and Markets has announced ... Forecast to 2022" report to their offering. ... the patients with kidney failure, it replaces the function of ... patient,s blood and thus the treatment helps to keep the ... balance. Increasing number of ESRD patients & ...
Breaking Medicine Technology:
(Date:6/26/2016)... ... June 26, 2016 , ... Pixel Film Studios Released ProSlice Levels, a ... can give their videos a whole new perspective by using the title layers ... Film Studios. , ProSlice Levels contains over 30 Different presets to choose from. ...
(Date:6/26/2016)... ... June 26, 2016 , ... ... they have been diagnosed with endometriosis. These women need a treatment plan to ... a comprehensive approach that can help for preservation of fertility and ultimately achieving ...
(Date:6/25/2016)... ... ... temporary closing of Bruton Memorial Library on June 21 due to a possible lice infestation, ... aspect of head lice: the parasite’s ability to live away from a human host, and ... necessary one in the event that lice have simply gotten out of control. , As ...
(Date:6/25/2016)... ... June 25, 2016 , ... As a lifelong Southern Californian, ... and his M.D from the David Geffen School of Medicine at UCLA. He trained ... Angeles to complete his fellowship in hematology/oncology at the UCLA-Olive View-Cedars Sinai program where ...
(Date:6/25/2016)... ... June 25, 2016 , ... Conventional wisdom preaches the ... In terms of the latter, setting the bar too high can result in disappointment, ... just slow progress toward their goal. , Research from PsychTests.com reveals ...
Breaking Medicine News(10 mins):