Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Earlier intervention for common form of heart attack linked to improved survival

05.08.2014

Changes in the treatment of the most common form of heart attack over the past decade have been associated with higher survival rates for men and women regardless of age, race and ethnicity, according to a UCLA-led analysis.

But the study also suggests that there is room for improvement in how current treatment guidelines are applied among specific patient groups.

The researchers reviewed records for 6.5 million people who were treated for heart attacks between 2002 and 2011. The analysis was among the first and largest national studies to assess the impact of the trend toward more aggressive care for patients who experience the type of heart attack known as non-ST elevation myocardial infarction, or NSTEMI.

Their findings are reported in the current online edition of the peer-reviewed Journal of the American Heart Association.

"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," said Dr. Gregg C. Fonarow, the study's senior author and UCLA's Eliot Corday Professor of Cardiovascular Medicine and Science.

"Nevertheless, there may be further opportunities to improve care and outcomes for patients with NSTEMI, who represent the greater proportion of patients presenting with myocardial infarction," said Fonarow, who also is director of the Ahmanson–UCLA Cardiomyopathy Center at the David Geffen School of Medicine at UCLA.

Heart attacks are broadly classified into two types. The more severe form, ST-elevation myocardial infarction (STEMI), involves complete blockage of an artery supplying blood to the heart muscle. The less severe type, NSTEMI, involves partial or temporary blockage of the artery. Studies in the U.S. and Europe have found that although the incidence of STEMI heart attacks is declining, the number of NSTEMI heart attacks increased in the past decade.

Guidelines issued in 2012 by the American College of Cardiology and American Heart Association recommended initiating cardiac catheterization in high-risk NSTEMI patients within 12 to 24 hours after the patient arrives at the hospital. This strategy had been evolving since 2009 following publication of the Timing of Intervention in Acute Coronary Syndromes trial. Previously, the recommendation was to begin catheterization in high-risk NSTEMI patients within 48 hours.

Fonarow and his colleagues examined trends in the use of cardiac catheterization for people who had been hospitalized after suffering an NSTEMI, within 24 hours and within 48 hours of presentation, seeking to determine whether changes in their care may have resulted in better outcomes.

The researchers analyzed publicly available records from the Nationwide Inpatient Sample, the largest U.S. database of hospitalized individuals. Of the 6.5 million patients whose records they examined, 3.98 million were admitted to hospitals with NSTEMI diagnoses.

The study tracked the proportion of those patients who underwent cardiac catheterization each year, and their outcomes — how many died in the hospital, the average length of their hospital stays, and the cost of hospitalization. They found that as the trend toward earlier intervention in NSTEMI patients took hold — with doctors beginning treatment within 24 hours after patients arrived at the hospital, rather than within 48 hours — the rate of in-hospital death declined from 5.5 percent in 2002 to 3.9 percent in 2011. Improvements were found for men and women, older and younger patients, and across all races and ethnic groups.

In addition, the average length of patients' hospital stays decreased during the decade-long study, from 5.7 days to 4.8 days. NSTEMI patients who underwent cardiac catheterization within the first 24 hours had the shortest average stays.

Although more NSTEMI patients in all demographic groups received early cardiac catheterization as the study progressed, there were still significant differences across age, gender, and racial and ethnic groups in how frequently early intervention was used. Men, for example, were more likely to receive earlier catheterization than women.

"Despite the improvement, there are significant differences in the age-, gender-, and ethnicity-specific trends in the use of invasive management of NSTEMI, and these findings may help guide further improvements in care and outcomes for male and female patients of all ages, races and ethnicities," said New York Medical College's Dr. Sahil Khera, the study's first author. "Further efforts are needed to enhance the quality of care for patients with NSTEMI and to develop strategies to ensure more equitable care for patients with this type of heart attack."

###

No outside funding was used in the study.

Additional study authors were Dr. Dhaval Kolte, Dr. Wilbert Aronow, Dr. Chandrasekar Palaniswamy, Dr. Kathir Selvan Subramanian, Dr. Marjan Mujib, Dr. Diwakar Jain, Dr. Rajiv Paudel, Dr. William Frishman and Dr. Julio Panza from the New York Medical College; Dr. Taimoor Hashim and Dr. Ali Ahmed from the University of Alabama at Birmingham; and Dr. Deepak Bhatt from Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School.

Rachel Champeau | Eurek Alert!
Further information:
http://www.uclahealth.org/

More articles from Health and Medicine:

nachricht Mobile phone test can reveal vision problems in time
11.02.2016 | University of Gothenburg

nachricht Proteomics and precision medicine
08.02.2016 | University of Iowa Health Care

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Production of an AIDS vaccine in algae

Today, plants and microorganisms are heavily used for the production of medicinal products. The production of biopharmaceuticals in plants, also referred to as “Molecular Pharming”, represents a continuously growing field of plant biotechnology. Preferred host organisms include yeast and crop plants, such as maize and potato – plants with high demands. With the help of a special algal strain, the research team of Prof. Ralph Bock at the Max Planck Institute of Molecular Plant Physiology in Potsdam strives to develop a more efficient and resource-saving system for the production of medicines and vaccines. They tested its practicality by synthesizing a component of a potential AIDS vaccine.

The use of plants and microorganisms to produce pharmaceuticals is nothing new. In 1982, bacteria were genetically modified to produce human insulin, a drug...

Im Focus: The most accurate optical single-ion clock worldwide

Atomic clock experts from the Physikalisch-Technische Bundesanstalt (PTB) are the first research group in the world to have built an optical single-ion clock which attains an accuracy which had only been predicted theoretically so far. Their optical ytterbium clock achieved a relative systematic measurement uncertainty of 3 E-18. The results have been published in the current issue of the scientific journal "Physical Review Letters".

Atomic clock experts from the Physikalisch-Technische Bundesanstalt (PTB) are the first research group in the world to have built an optical single-ion clock...

Im Focus: Goodbye ground control: autonomous nanosatellites

The University of Würzburg has two new space projects in the pipeline which are concerned with the observation of planets and autonomous fault correction aboard satellites. The German Federal Ministry of Economic Affairs and Energy funds the projects with around 1.6 million euros.

Detecting tornadoes that sweep across Mars. Discovering meteors that fall to Earth. Investigating strange lightning that flashes from Earth's atmosphere into...

Im Focus: Flow phenomena on solid surfaces: Physicists highlight key role played by boundary layer velocity

Physicists from Saarland University and the ESPCI in Paris have shown how liquids on solid surfaces can be made to slide over the surface a bit like a bobsleigh on ice. The key is to apply a coating at the boundary between the liquid and the surface that induces the liquid to slip. This results in an increase in the average flow velocity of the liquid and its throughput. This was demonstrated by studying the behaviour of droplets on surfaces with different coatings as they evolved into the equilibrium state. The results could prove useful in optimizing industrial processes, such as the extrusion of plastics.

The study has been published in the respected academic journal PNAS (Proceedings of the National Academy of Sciences of the United States of America).

Im Focus: New study: How stable is the West Antarctic Ice Sheet?

Exceeding critical temperature limits in the Southern Ocean may cause the collapse of ice sheets and a sharp rise in sea levels

A future warming of the Southern Ocean caused by rising greenhouse gas concentrations in the atmosphere may severely disrupt the stability of the West...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Symposium on Climate Change Adaptation in Africa 2016

12.02.2016 | Event News

Travel grants available: Meet the world’s most proficient mathematicians and computer scientists

09.02.2016 | Event News

AKL’16: Experience Laser Technology Live in Europe´s Largest Laser Application Center!

02.02.2016 | Event News

 
Latest News

LIGO confirms RIT's breakthrough prediction of gravitational waves

12.02.2016 | Physics and Astronomy

Gene switch may repair DNA and prevent cancer

12.02.2016 | Life Sciences

Using 'Pacemakers' in spinal cord injuries

12.02.2016 | Medical Engineering

VideoLinks
B2B-VideoLinks
More VideoLinks >>>