Patients with acute coronary events whose care is based on current guidelines have better outcomes in terms of survival and development of heart failure than similar patients treated as recently as a few years ago, according to an article in the May 3 issue of the Journal of the American Medical Association.

The current analysis is the first to detect a significant decrease in the rate of heart failure and death over such a short time in this population.

The study finds that the change occurred at the same time that hospitals increased their use of certain drugs, tests and procedures that have been proven to help reduce the immediate and long-term impact of acute cardiac events. The results suggest that concerted efforts to standardize heart care are working.

The study is from the Global Registry of Acute Coronary Events (GRACE), which has collected data from 44,372 patients treated at 113 hospitals in 14 countries. The new analysis was led by cardiologists from the University of Edinburgh in Scotland, Hospital Bichat in France and the University of Michigan Cardiovascular Center.

All patients had either an ST-elevated myocardial infarction (STEMI) or acute coronary syndrome (ACS).

Between 1999 and 2006, the use of cardioprotective drugs in these patients increased markedly, including use of aspirin, statins, glycoprotein IIb/IIIa inhibitors, anticoagulants such as clopidogrel and heparin, and antihypertensive medications.
At the same time, the use of angiography and angioplasty as emergency or secondary treatment increased by more than 30 percent in patients with ST-elevation infarctions and around 20 percent in patients with acute coronary syndrome.

As use of these treatments increased, the death rate for patients both in hospital and in their first six months after discharge decreased significantly, as did risk for developing heart failure, pulmonary edema, or experiencing a stroke in the first six months after hospitalization.

“These findings are exciting because they provide good evidence that improved use of guideline-based treatments has resulted in fewer deaths and fewer patients with heart failure in those that present to hospital with heart attack or threatened heart attack," said Keith A. A. Fox, MB. ChB., FRCP, lead author of the paper, co-chair of GRACE and a professor of cardiology at Edinburgh.

“These data are extremely encouraging, and suggest that we’re definitely improving heart care and patients’ outcomes through the uniform use of evidence-based, proven treatments and the development of guidelines to help providers understand the evidence behind them,” said Kim Eagle, M.D., FACC, a co-author on the paper and co-chair of the publication committee for GRACE. He is the Albion Walter Hewlett Professor of Cardiovascular Medicine at the U-M Medical School and a director of the U-M Cardiovascular Center.

“Yet, these data and other studies show that we still have a ways to go before every heart attack and acute coronary syndrome patient receives the full range of tests and treatments that we know can benefit them,” Eagle continued. Only 85 percent of patients with ST-elevation infarction and 83 percent of patients with acute coronary syndrome in the study received a statin in 2006, when virtually all such patients should have received the medication.

The study did not include data on patients’ diet, exercise and tobacco habits, lifestyle components that are crucial to preventing further problems. Eagle concluded, “We all have a role to play in making sure that the news in heart attack care continues to be good.”