Why Is There a Reduction in Heart Attack Deaths in United States?

When heart attack victims are admitted into hospitals, the doctors therein might have different alternatives to treat their patients. For example, they could use angioplasty to clear out clogged arteries, perform heart bypass surgery, or prescribe medications to lower the cholesterol levels, reduce clotting and regulate heart beat. As such, the success rate of treating these patients could vary widely among various hospitals.

According to a study that was published on August 18, 2009 in the Journal of the American Medical Association, there has been a noticeable reduction in heart attack deaths over the period between 1995 and 2006 as a result of clearer United States guidelines on how to treat elderly heart attack patients.

The researchers from the Yale University School of Medicine in Connecticut found a reduction of 3 percent in the number of patients who died within a month of having a heart attack after the introduction of clearer standards on treatments by Medicare.

Medicare is a social insurance program administrated by the United States government to provide health insurance coverage to people who are of 65 years old and above or who meet other special criteria.

In 1990, the American College of Cardiology and the American Heart Association published joint guidelines on which care was suitable and when. 2 years later, Medicare followed the guidelines.

The researchers studied the records of 2.7 million patients discharged from 4,000 hospitals after having heart attack between 1995 and 2006, and found that among Medicare beneficiaries, there was 1 additional patient survive at 30 days for every 33 patients admitted in 2006 compared with 1995.

The 30-day mortality rate decreased from 18.9 percent in 1995 to 16.1 percent in 2006, and in-hospital mortality decreased from 14.6 percent to 10.1 percent,

Meanwhile, they also discovered that a lot less variation in death rates among the hospitals. Such finding might support the argument that healthcare reform efforts should include more standardized guidelines on patients’ care.

The cause of the reduction has yet to be determined with certainty. Nevertheless, the finding of this study might have already reflected one thing: individuals and organizations dedicated to improving health care during the period begin to see some positive and encouraging results.

Back in 1995, 24 percent or more of heart attack patients died within a month after being treated at 39 hospitals.

Study Seeking Way to Prevent Deadly Blood Clot in Stent Implanted Patients!

Every year, about 800,000 to 1 million American patients have one or more stents implanted inside their bodies to keep the artery open after it has been cleared out by angioplasty. While there is less than 1 percent has a clot form near the stent, there are still many complications, ranging from clots to strokes, heart attacks and even deaths.

In order to find out the best way to prevent potentially deadly blood clots from forming in heart patients who have artery-opening stents implanted, several competing drug and medical device makers are joining hands to start a new study, which also involves academic researchers and federal regulators, to find out how long patients should take blood-thinning medicine.

Since early this year, the trial has already been planned but the initial details were announced only on October 15, 2008 at a medical conference. The study will involve and be partly supported by the 4 United States competitors in the stent market plus 4 drug makers.

The multi-center study, which is expected to begin enrolling patients later 2008 or early 2009, will involve about 25,000 to 30,000 patients who have had one of the tiny, metal-mesh tubes implanted in a heart artery.

Most of these patients have today’s widely used drug-coated stents that will over time release a medication meant to prevent the artery from re-clogging. On the other hand, at least 5,000 of the participants will get older, bare-metal stents.

According to the investigators, patients in the study will get now-standard preventive treatment for a year after getting a stent implanted. Such treatment involves an anti-clotting drug and at least 81 mg of aspirin a day.

At the end of the one-year study, those who have no complications will be randomized, with half of them continuing on the dual blood-thinning therapy for an additional 18 months and the rest stopping it. Researchers will then determine which group had more heart attacks, strokes and deaths, as well as clots inside the stents.

How Is Obesity Paradox Related to People with Heart Disease?

As there are about 65 percent of Americans are either obese or overweight, the Centers for Disease Control (CDC) have in fact classified obesity as an epidemic in the United States. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and National Institutes of Health (NIH), obesity costs Americans more than $117 billion annually in health care.

If a person is obese, he or she will have a higher risk, ranges from 50 to 100 percent, of premature death than people of normal weight. Obesity is a risk factor for other diseases such as high blood pressure, heart disease and Type-2 diabetes.

However, recent studies have shown that obese people with chronic diseases have a better chance of survival than normal-weight individuals do. This finding is known as “obesity paradox”. Such an unexpected decrease in illness and death with increasing body weight or BMI is originally described in people with heart failure and in patients having angioplasty.

A study by researchers from St Luke's-Roosevelt Hospital in New York City found that overweight and obese adults with high blood pressure and coronary artery disease also had a lower risk of heart attack, stroke or death, compared with the normal-weight people. Nevertheless, the rationales behind such phenomenon are still unclear. Their findings were published in the American Journal of Medicine.

The effect of overweight and obesity on heart-related outcomes was investigated in 22,576 people who participated in a large study. These people had treated high blood pressure and coronary artery disease.

People who were overweight (BMI between 25 and 30), class I obesity (BMI between 30 and 35) and class II-III obesity (BMI 35 or greater) actually had lower risk of heart disease, stroke, or death than those who weighed normal (BMI between 20 and 25).

The researchers also noted that the so-called “obesity paradox” did occur in both men and women across all age groups, even though the blood pressure was better controlled in normal-weight patients.

While improved outcomes appear to be consistently linked to increased BMI, other health experts do caution that one should not conclude that weight reduction is detrimental in overweight populations.

Despite the “obesity paradox”, findings of numerous studies still clearly support the benefits of weight reduction in obese patients with heart disease.

Which is Superior, Angioplasty or Bypass?

I always hear people around me debating about the superiority of angioplasty and coronary artery bypass grafting. Some insisted angioplasty is good because it carries lesser risk than bypass, while others argued that bypass could prevent heart patients from getting a repeat procedure or surgery over a longer period.

Coronary Angioplasty (or angioplasty, in short) is a technique to treat coronary heart disease and angina. It involves opening narrowed or blocked blood vessels known as coronary arteries of the heart.

Angina is chest pain or discomfort that occurs when an area of the heart muscle does not get enough oxygen-rich blood. A person with angina may feel pressure or squeezing in the chest. The pain may also occur in the shoulders, arms, neck, jaw, or back.

While angioplasty is a procedure, coronary artery bypass grafting (in short, bypass) is a type of heart surgery. It is sometimes called CABG ("cabbage"). During the operation, the surgery reroutes, or "bypasses," blood around clogged arteries by using a segment of a healthy blood vessel from another part of the body to improve blood flow and oxygen to the heart.

In October 2007, a new study revealed that bypass is indeed better than angioplasty at relieving chest pain and preventing the need for a repeat procedure. On the other hand, both angioplasty and bypass could provide patients with heart disease who need a procedure or surgery to clear their clogged coronary arteries the similar 10-year survival rates.

1.2 percent of patients undergoing bypass and 0.6 percent of those being treated with angioplasty incurred strokes. Angina was relieved over a 5-year period in 84 percent of bypass patients comparing with 79 percent of the angioplasty group.

Meanwhile, the researchers also found that 43 percent of patients treated with angioplasty and less than 10 percent of patient undergone coronary bypass required repeat procedures after 5 years.

Nevertheless, as noted by the researchers, emergence of new and refined techniques has made such a comparison to “remain a moving target”. In fact, new studies have already begun to investigate how the availability of drug-coated stents used in angioplasty affects the comparative efficacy of these techniques.

Stent-Related Blood Clot May Lead To Repeat Stent Thrombosis!

Angioplasty procedure is commonly used to clear the blockages in the coronary arteries that supply blood to the heart. Thereafter, stents, which are wire mesh tubes, will be inserted into the coronary arteries to help keep the vessels from reclogging.

The Dutch Stent Thrombosis Study indicated that one in six patients who suffer a potentially deadly clot inside a coronary stent are at a higher risk of developing another clot, especially if they had a second stent implanted during emergency treatment for the first clot.

The study was conducted by Dutch researchers from St. Antonius Hospital in Nieuwegein, the Netherlands, and its findings were presented at a joint meeting of the American College of Cardiology and the Society for Cardiovascular Angiography and Interventions in Chicago.

Clots that form inside a stent, which is known as stent thrombosis, can block the blood flow to the heart and can therefore cause a heart attack or even death. According to the researchers, using an additional stent during emergency treatment of a stent-related blood clot is a strong predictor of repeat stent thrombosis.

The study examined 437 patients with various types of stents who had stent thrombosis between January 2004 and February 2007 and found that 16.9 percent of the patients had multiple episodes of stent thrombosis: 61 patients had 2 episodes, 12 had 3 episodes and one had 4 episodes.

Meanwhile, the study also discovered that:

• Patients who had a second stent implanted during emergency treatment for their first clot were 4.2 times more likely to have another episode of stent thrombosis comparing with other patients.

• Patients who previously had a heart attack and those who developed a clot long after stent implantation (known as late stent thrombosis) were 2.6 times and 2.1 times respectively more likely to suffer a repeat episode.