An increasing number of heart attack victims survive longer when doctors follow guidelines for treating patients after cardiac arrest, according to a new study from Sweden published in the Journal of the American Medical Association (JAMA), reports Reuters Health.
“Things that we test in clinical trials do work in real life (and) make huge impacts on mortality,” said Dr. Debabrata Mukherjee, a cardiologist at the Texas Tech University Health Sciences Center in El Paso who wrote a commentary published with the study in JAMA.
Improvements can still be increased, despite better adherence to guidelines, in Sweden and abroad, the researchers said.
In the current study, Dr. Tomas Jernberg of the Karolinska Institutet in Stockholm and his colleagues consulted a database of over 61,000 patients treated in Sweden between 1996 and 2007 for a certain kind of heart attack that damages a much of the heart muscle.
Sweden introduced new guidelines during that period, outlining the best way to treat patients who had just had a heart attack. Over those 12 years, treatments that have been proven to help heart attack patients, including prescribing drugs to break up blood clots and procedures to open arteries, became commonplace.
Statins for example, were prescribed to 23 percent of heart attack patients in 1996 and 1997, compared to 83 percent in 2006 and 2007. Only 12 percent of patients underwent an angioplasty after a heart attack at the beginning of the study, compared to 61 percent by the end.
In the study’s later years, fewer patients died after having a heart attack and the chance of dying in the year following a heart attack dropped from 21 percent to 13 percent.
Standardizing treatments in all hospitals has been slow to take hold however, Jernberg explains. “There are variations (in) how quickly they adopt new treatments. These variations are not as large as in previous years, but there is still room for improvement.”
Mukherjee tells Reuters Health that the story is similar in the United States, with hospitals understanding the positive results of standardizing treatments, but not everyone is fully on board to implementing those changes. “We’ve certainly gotten better, (but) we’re not at 100 percent. And even now, hospitals differ.”
Patients can help ensure they get the best treatment after a heart attack by educating themselves on different procedures and medications, and by understanding that treatment continues even after they leave the hospital.
“We see a lot of problems with patients who stop taking their medication when they start feeling better but those medications need to be taken long-term to prevent future heart problems.”
Researchers also proposed quicker feedback for doctors and “decision support” – which requires doctors to answer questions about the treatment they are giving a patient as they give it – to improve adherence to guidelines.
Improvements in treatment need to happen faster, said Dr. Eric Peterson, a cardiologist at the Duke University Medical Center in Durham, North Carolina, who is also an editor at JAMA. “The bad news is that was a 12-year period of time to do something that we needed to do,” Peterson told Reuters Health of the new Swedish findings.
“That’s way too long. Think about how many patients along the way … didn’t get treated before we got to those high rates of adherence.”
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