Good News on Heart Attack and Chest Pain

Good News on Heart Attack and Chest Pain

CHICAGO, IL -- May 1, 2007



-- 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 a new international
study in the May 3 issue of the Journal of the American Medical
Association.



It's the first time that a study has shown a significant drop in the
rate of heart failure and death over such a short time in this
population.



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, 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.



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% in STEMI patients and around 20%
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, MD, 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% of STEMI patients and 83% 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% 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."



U-M heart specialists lead or co-lead several key efforts to increase
the use of evidence-based STEMI and ACS care in the state of Michigan.
Eagle, for instance, has co-led the Guidelines Applied in Practice -
Myocardial Infarction project sponsored by the American College of
Cardiology, which has improved heart attack care at dozens of Michigan
hospitals and provided a model for hospitals nationwide. He recently
received the Raymond Bahr award from the American Society for Chest
Pain Centers in recognition of his leadership role in such projects.



At the same time, U-M CVC director of interventional cardiology Mauro
Moscucci, MD, has co-led the Blue Cross Blue Shield of Michigan
Cardiovascular Consortium, which has focused on improving angioplasty
care and has saved both lives and dollars. U-M heart failure specialist
Todd Koelling, MD, is leading a Michigan-wide effort to improve heart
failure care. And U-M is heavily involved in the national D2B Alliance,
which seeks to accelerate the use of emergency angioplasty by helping
hospitals be ready to deliver the life-saving treatment as quickly as
possible after a patient arrives.



So, as hospitals work to improve their heart care even more, the new
study's authors hope that additional gains in patients' outcomes can be
made. They are continuing to collect data on hospitalized STEMI and ACS
patients in 30 countries around the world, and to contact patients at
home after their initial hospitalization to get follow-up information.
GRACE now includes 236 hospitals in North America, South America,
Europe, Asia, Australia and New Zealand.



Meanwhile, 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."



GRACE is supported by an educational grant from Sanofi Aventis, which plays no role in data collection, analysis or publication.