Heart Attacks, Survival Rates Increased

Non ST elevation myocardial infarction increased while mortality in hospitals decreased

(RxWiki News) The incidence of one type of heart attack has risen, but fewer patients died after hospitalization — and medical procedures right after admission may be the reason.

Guidelines for treating one type of heart attack, called non-ST-elevation myocardial infarction (NSTEMI), were put into place several years ago. They called for treatments like cardiac catheterization in the first hours the patient is in the hospital.

Researchers studied the trends in the numbers of people with NSTEMI and looked to see whether their outcomes improved during the last decade.

The research showed that a greater percentage of the people who had heart attacks had an NSTEMI, and a smaller percentage of them died after hospitalization.

"Learn the risks and symptoms of heart attacks."

The study was conducted by Gregg C. Fonarow, MD, from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues.

"Cardiologists have become better at taking care of heart attack patients, and are reacting faster to those at highest risk," said Jeffrey M. Schussler, MD, an interventional cardiologist at Baylor Heart and Vascular Hospital and Baylor University Medical Center at Dallas.

"In patients with heart attacks, looking for closed heart arteries and then opening them if they're closed helps patients do better. Along with aggressive medical therapy, angioplasty (stents) can make a dramatically positive impact in these higher risk patients," said Dr. Schussler, who was not involved in this study.

To study trends in rates of death in patients hospitalized with an NSTEMI, Dr. Fonarow and team examined data from the Nationwide Inpatient Sample databases collected between 2002 and 2011.

The data included information on more than 6.5 million people 40 and older who had been hospitalized after a heart attack. Of those people, almost 4 million had an NSTEMI.

Dr. Fonarow and team also collected information on how long patients spent in the hospital.

The researchers found that the percentage of heart attack patients who had an NSTEMI increased from 52.8 percent in 2002 to 68.6 percent in 2011.

The use of an invasive medical intervention like cardiac catheterization (inserting a thin tube into the heart) on the day of admission increased during the study period.

In 2002, 14.9 percent of the patients received an early invasive medical intervention on their first day of hospitalization. By 2011, this number had risen to 21.8 percent, the study authors noted.

The average length of time spent in the hospital decreased in all heart attack patients from 2002 to 2011. In 2002, heart attack patients stayed an average of 5.7 days. In 2011, the stay was 4.8 days.

Patients with an NSTEMI who had early invasive intervention on their first day of admission spent the shortest time in the hospital, the study authors reported. In 2002, these patients spent an average of 4.8 days in the hospital. In 2011, they spent an average of 4.1 days.

The rate of death while in the hospital decreased in all heart attack patients from 2002 to 2011. In patients with an NSTEMI in 2002, 5.5 percent died in the hospital, while 3.9 percent died in 2011.

“The substantial reductions in in-hospital mortality observed for NSTEMI patients nationwide over the last decade reflect greater adherence to evidence-based, guideline-directed therapies,” Dr. Fonarow said in a press release.

Patients who did not receive early invasive treatment also had a decreased in-hospital death rate — from 6.7 percent in 2002 to 5.4 percent in 2011.

A potential reason death rates decreased both with and without early invasive treatments, the authors wrote, was that heart attack treatments improved overall during the study period.

The authors cited several limitations of their study. They noted that they had to rely on codes in the databases they searched to identify heart attack patients and that this method may have missed some patients.

Also, increased use of more precise blood tests during the study period may have contributed to more precise heart attack diagnoses, increasing the number of NSTEMIs detected.

The research was published Aug. 1 in the Journal of the American Heart Association.

The authors did not disclose funding information. One co-author served as chair for the American Heart Association's Get with the Guidelines Steering Committee.

Review Date: 
August 7, 2014