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Report: Heart attack death rate in hospitals cut nearly in half

Research team credits new drugs, more angioplasty

LOS ANGELES -- Increased use of angioplasty and the introduction of new drugs over the past six years have nearly halved the number of hospitalized heart attack victims who die or suffer severe heart failure, an international team of researchers reported today.

The report showed "remarkable improvements" in the care of heart attack victims in all 14 countries studied, said Dr. Gregg C. Fonarow of the University of California, Los Angeles's Geffen School of Medicine. He was not involved in the study.

"It is not simple to manage these patients. Many therapies need to be applied very rapidly," he said. This study shows that individual drugs and treatments that have been validated in clinical trials can be combined in the real world to produce "very meaningful benefits."

Added Dr. Keith A.A. Fox of the University of Edinburgh , who led the study published in the Journal of the American Medical Association: "Our study supports the fact that hospitals are using new treatments effectively."

For every 1,000 patients admitted to hospitals, he said, there are 39 fewer deaths and 90 fewer patients with new heart failures compared with six years ago. In the United States, with as many as 5 million patients suffering the conditions each year, that would translate to nearly 200,000 fewer deaths if all hospitals were following the treatment guidelines.

"There have been a lot of lives saved, a lot of complications averted," said Dr. Joel M. Gore of the University of Massachusetts Medical School, another of the study's leaders.

In Massachusetts, deaths from heart attacks have been declining steadily since the mid-1990s.

The group could not attribute the improvements in outcomes to any one treatment or medication, concluding that it was the total of all combined that was responsible.

The improvements include a doubling in the use of balloon angioplasty to clear blocked arteries and the increased use of a variety of old and new drugs, including aspirin; cholesterol-lowering statins; anticlotting drugs called glycoprotein IIb/IIIa inhibitors; blood thinners such as clopidogrel and low-molecular-weight heparin; and blood pressure-reducing drugs such as angiotensin-converting enzyme, or ACE, inhibitors.

"The individual medications are all very good, but we were concerned that when it actually came to treating patients, the thought of using five or six right from the start would be intimidating," Gore said. "We're very encouraged to see that people are using all of the evidence-based medicine and showing excellent results."

There was also, he said, "a marked reduction in the use of ineffective medications," including clot-dissolving enzymes, calcium-channel blockers, and unfractionated heparin.

The study, called the Global Registry of Acute Coronary Events, or GRACE, enrolled 44,372 patients at 113 hospitals from 1999 to 2006. All the patients had either suffered a severe heart attack in which the coronary arteries were totally blocked or suffered from acute coronary syndrome, which includes other types of heart attacks and a kind of chest pain called unstable angina.

Death rates from severe heart attacks while in the hospital were reduced from 8.4 percent at the beginning of the study to 4.5 percent at the end, according to the report. The risk of progressing to heart failure declined from 20 percent to 11 percent.

The rate of progression to a critical form of heart failure called cardiogenic shock declined from 7.1 percent to 4.7 percent -- a crucial drop because 70 percent of such patients die.

Deaths in patients with milder heart attacks dropped from 2.9 to 2 percent.