Wednesday, January 12, 2005

Improving Outcomes for Heart Attack Patients
By Julie McKeel

Heart attack patients who also have heart failure are 6 times more likely to die in the hospital than other heart attack patients, according to a DCRI study published in the November 2004 European Heart Journal. These patients also have more complications and longer hospitalizations. However, these patients are less likely to receive the medical or procedural treatments that could improve their chances for survival.

Eric Velazquez, MD

The overall in-hospital death rate was 6.9%. However, the patients who developed heart failure and/or LVSD had a 13% death rate compared with 2.3% for the other patients. Even after adjusting for age, sex, weight, blood pressure, and prior heart failure, the death rate for this population was 4 times greater. Also, the heart attack patients with heart failure and/or LVSD averaged 12 days in the hospital compared with 7.6 days for the other group.

These findings are important because they clearly identify those heart attack patients who are at highest risk for death. Early identification of at-risk patients is critical to early and effective treatment. This study, combined with previous ones, shows that when a clinician finds evidence of either HF or LVSD in a heart attack patient, observation and treatment should become more aggressive, particularly regarding the proven beneficial treatments for these patients.

"This sizeable minority of heart attack patients appears to be at the highest risk for dying of their heart attack while in the hospital," Velazquez told the Duke Medical Center News Office. "The message for cardiologists is to identify these patients and aggressively treat them with therapies that have proven to be effective.

"We need to do a better job identifying and treating these patients" Velazquez said. "They are the sickest heart attack patients and they have the most to gain from aggressive treatment."

Heart failure is a condition marked by abnormal heart function that leads to symptoms of lung congestion and an inability to meet the metabolic demands of the body. Patients whose left ventricle pumps at less than 40% of its strength have left ventricular systolic dysfunction. LVSD can be a cause of heart failure.

According to the published study, 80% of the heart attack patients who die and 59% of patients with other major complications have HF and/or LVSD either at admission or during hospitalization, thus more aggressive and appropriate treatment of HF and/or LVSD may lead to higher survival rates for the general heart attack population

In addition to following how these patients fared during their hospitalization, Velazquez also gathered data on different treatments used on these patients.

"Only 34.2% of these patients received angiotensin-converting enzyme (ACE) inhibitors and 58% received beta-blockers within the first 24 hours," Velazquez continued. "These medicines have been proven in clinical trials to improve mortality rates. In addition, 31.4 % received angioplasty and 11% underwent coronary artery bypass surgery.

"This registry reinforces the critical need to identify the best strategies to treat this high risk group of MI [myocardial infarction] patients," Velazquez said. "We know that ACE inhibitors improve mortality for heart attack patients, and we are still determining the role of ARBs."

The VALIANT registry was supported by Novartis Pharmaceuticals, East Hanover, N.J. Faculty authors for this study included Drs. Chris O’Connor and Rob Califf. Lois Rittenhouse and Rakhi Kilaru also contributed to this study.