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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Wednesday, May 02, 2007

    Triumph of Cardiology: There's been an improvement worldwide in heart attack survival:

    Deaths due to heart attacks in hospitals have almost halved in the past six years, new research has shown.

    The introduction of new drugs and the improvement of other forms of treatment are responsible for the trend, experts said.

    In the largest-ever study of heart attack deaths in care, more than 44,372 patient records were studied from 113 hospitals in 14 countries.

    Researchers found that the greatest improvement in survival rates occurred in those patients who had severe heart attacks.

    In cases where patients' arteries were completely blocked, death rates fell from 8.4 per cent to 4.5 per cent between 1999 and 2006.

    Deaths among patients with milder forms of heart attack were reduced from 2.9 per cent to 2 per cent.

    In total, for every 1000 patients admitted to hospital, there were 39 fewer deaths from heart attacks.

    The study claims to be one of the longest running, most comprehensive looks at the outcomes of people entering the hospital with heart attacks. It has wonderful acronyms - GRACE (Global Registry of Acute Coronary Events) and CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines), and it showed that there were substantial increases in the number of aggressive interventions worldwide from 1999 to 2006.

    For example, the use of drugs to open the coronary arteries declined while the use of percutaneous interventions, such as angioplasty, increased. The use of drugs also increased. Beta-blockers, statins, angiotensin-converting enzyme inhibitors, thienopyridines, glycoprotein IIb/IIIa inhibitors, and low-molecular-weight heparin were all in more frequent use by the end of the study. The rates of heart failure and death declined impressively during hospitalization, but not so impressively six months later:

    Rates of congestive heart failure and pulmonary edema declined in both populations: STEMI [a heart attack with obvious EKG changes-ed.], –9 percentage points .... and NSTE ACS [a heart attack without EKG changes-ed], –6.9 percentage points.... In patients with STEMI, hospital deaths decreased by 18 percentage points.... and cardiogenic shock by –24 percentage points..... Risk-adjusted hospital deaths declined –0.7 percentage points.... in NSTE ACS patients. Six-month follow-up rates declined among STEMI patients: stroke by –0.8 percentage points .... and myocardial infarction by –2.8 percentage points....In NSTE ACS, 6-month death declined –1.6 percentage points..... and stroke by 0.7 percentage points .... [isn't it nice to see an abstract presented in absolute percentage changes rather than relative risks?-ed.]

    The treatments that made these changes possible are, of course, more expensive. Which will lead us to tomorrow's headline - "Use of Physician's Services under Medicare's Resource-Based Payments Have Increased Over the Past 10 Years." Wait for it.

    posted by Sydney on 5/02/2007 06:28:00 AM 0 comments


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