| News From The AHA Conference | Briefs from American Heart Association Nov. 18, 2002 By Lisa Ellis
InteliHealth News Service Lower Deaths Using Heart-Attack Guides CHICAGO — Death rates from heart attack are one-third lower at hospitals that comply with American Heart Association (AHA) guidelines for the best treatment than at hospitals that do not follow the guidelines, researchers reported at the AHA's annual Scientific Sessions. The study, which included data from 1,085 U.S. hospitals, shows that following best treatment practices does make a difference, says study author Eric D. Peterson, M.D., an associate professor of medicine at Duke University School of Medicine. Nearly 18 percent of heart-attack patients died at hospitals that had the lowest compliance with the AHA recommendations, which also are endorsed by the American College of Cardiology. At hospitals where most patients received state-of-the-art treatment, the death rates were about 12 percent. The guidelines include clot-busting drugs within 30 minutes of arrival for appropriate patients; angioplasty within 90 minutes; several drugs — aspirin, beta-blockers, heparin and glycoprotein IIb/IIIa — within 24 hours; prescription of certain drugs at discharge; and counseling on smoking cessation and increasing physical activity. Back to top Nursing-Home Patients Miss Best Treatment CHICAGO — Patients in nursing homes are less likely to get the best medicines to treat heart failure, according to a study of nearly 33,000 patients admitted to hospitals. Specifically, patients admitted from nursing homes — about 11 percent of the total — were less likely than other heart-failure patients to be prescribed a type of drug called an ACE inhibitor, said Edward P. Havranek, M.D., clinical coordinator of the Colorado Foundation for Medical Research in Denver. ACE inhibitors improve symptoms such as shortness of breath and help to prevent hospitalizations of patients with heart failure. "Nursing homes represent a significant reservoir of missed opportunity to provide high-quality care for heart failure," Dr. Havranek said. Back to top Surgery Backup And Death Rates CHICAGO — The lack of an on-site, heart-surgery backup team does not affect death rates for patients receiving emergency angioplasty after a heart attack, researchers report in a study involving more than 30,000 patients. The findings show that hospitals capable of performing angioplasty to reopen blood vessels and restore flow to the heart should perform these emergency procedures rather than lose time in transferring patients to a medical center with on-site heart surgery, said lead researcher Timothy A. Sanborn, M.D., chief of cardiology at Evanston Northwestern Healthcare in Evanston, Ill. He presented this research at the annual Scientific Sessions of the American Heart Association. Angioplasty is a procedure that uses a tiny balloon attached to a thin tube called a catheter. The catheter is threaded through an artery to the site of a blockage, and the balloon is inflated to crush the plaque that has narrowed the artery. Researchers examined data on emergency angioplasty at more than 700 hospitals, collected as part of the National Registry of Myocardial Infarction (heart attack). They found that death rates were 3.2 percent in hospitals that had a catheter lab but usually used it for diagnosis only, 4.4 percent at hospitals that performed angioplasty but had no heart surgery team, and 5.0 percent at hospitals that had both angioplasty and surgery available. The death rates were highest — 6.5 percent — among patients transferred to the surgery center for angioplasty. This is the largest study so far to find that doing angioplasty in a hospital without on-site heart surgery capability — in case something goes wrong — does not increase death rates. Back to top Patients Over 80 Do Worse After Angioplasty CHICAGO — Patients older than 80 are nearly five times as likely to die, have a stroke or need bypass surgery after angioplasty as are younger patients, even those with the same degree of illness, New York investigators found. Using a New York state database, the study compared results for 61 octogenarians with 1,103 younger patients, all of whom had angioplasty within 24 hours of a heart attack. The rate of adverse events — death, stroke or bypass surgery — was 12 percent for people over 80. Although older patients are also sicker, their death rates are higher even after allowing for these differences in illness, said lead author Robert Minutello, M.D., a cardiology fellow at New York Presbyterian Hospital— Weill Cornell Medical Center in New York City. The age-related trend also extended to people under 80; adverse event rates doubled for every 11 extra years of age, beginning at about age 50. The study’s findings show that doctors, in weighing the risks and benefits of a procedure, need to consider age itself as an additional problem that could increase the risk to a patient, Dr. Minutello said. Related Stories:
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