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Heart Attack Rates Declining, But Hospitals Lag On Providing Best Care

State-of-the-art care for people with dangerous heart attacks really saves lives. The latest evidence out of Sweden — which arguably has the world's most complete data on cardiac care — makes that clear in this week's Journal of the American Medical Association.

That study documents a sharp drop in mortality from the most serious heart attacks over a 12-year period as Swedish doctors and hospitals adopted scientifically validated practices.

But getting the best heart attack care is still something of a crap shoot –- in the United States as well as in Sweden.

"We've gotten better, but we're not perfect," Texas cardiologist Debabrata Mukherjee told Shots. "I wouldn't say that every hospital is 100 percent. I think we mirror the Swedish data pretty well."

Mukherjee, chief of cardiology at Texas Tech University Medical Center in El Paso, has an editorial that accompanies the Swedish study.

The best practices employed by the Swedes include prompt restoration of blood flow to threatened heart tissue using artery-reaming angioplasty, clot-dissolving drugs or bypass surgery. They also used an array of medicines to prevent re-clotting, control blood pressure and lower cholesterol.

Here are the Swedish results, which span a period from 1996 and 2007:

  • Deaths during hospitalization after a heart attack went down from 13 percent to 7 percent.
  • Deaths in the 30 days following a heart attack decreased from 15 percent to 9 percent.
  • One-year mortality post-heart attack dropped from 21 percent to 13 percent.
  • These stats pertain to so-called STEMI heart attacks — the most dangerous kind. They occur when a coronary artery is completely blocked, starving the heart tissue "downstream" of oxygen. Unless blood flow is restored within about 90 minutes, the threatened heart tissue will die.

    About 29 percent of all heart attacks are STEMIs, Mukherjee says. These kinds of heart attacks have been declining in recent years, as have overall heart attack rates. That's due to better preventive care, such as control of blood pressure and cholesterol levels. But the death rate from STEMI heart attacks has not been going down.

    One reason for that: Many heart attack victims are not yet getting the best care with "evidence-based" medicine, the industry's favorite buzzword.

    "There's a lot of variability among hospitals," Mukherjee says. "And none of us is perfect. A lot of heart attack patients come in in the middle of the night, at 2 and 3 a.m., when we may not be at our best."

    To improve, he says everybody on the hospital team needs to monitor the treatment of every heart attack patient — and get feedback right away when things don't happen the way they should.

    And as the Swedish study shows, it takes a while for all doctors and hospitals to adopt the best evidence as habit. But it definitely pays off.

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