STUDY CONFIRMS THAT GUIDELINES FOR TREATMENT AND CARE OF HEART ATTACK PATIENTS ARE SAVING LIVES

STUDY CONFIRMS THAT GUIDELINES FOR TREATMENT AND CARE OF HEART ATTACK PATIENTS ARE SAVING LIVES

Evidence-based guidelines for the treatment of heart attacks are saving significant numbers of lives.

That’s the gratifying conclusion of an international study, which sought to ascertain whether the creation and promulgation of guidelines was actually resulting in improved outcomes for patients.

The study was conducted from 1999 to 2006. Called the Global Registry of Acute Coronary Events, it examined 44,372 heart attack patients in 113 hospitals in the United States of America, Canada and 12 other countries in Europe and South America.

Deaths, cardiogenic shock and congestive heart failure or pulmonary oedema all declined.

Myocardial infarctions more than 24 hours after hospitalization also declined, as did those within six months of discharge.

In patients with ST-segment elevation myocardial infarction, hospital deaths declined by 18%, congestive heart failure and pulmonary oedema by 9% and cardiogenic shock by 24%.

Angioplasties increased by 37%. Treatment with beta blockers increased by 11%, with statins by 48% and with ACE inhibitors by 22%.

“This is good news for patients and for the use of evidence-based guidelines for hospital care,” said World Heart Federation Scientific Advisory Board Chairman Sidney Smith. “It confirms that we now have treatment strategies that contribute to reducing the burden of cardiovascular disease worldwide.”

Until the study, it was largely unknown whether the promulgation of guidelines was having a significant impact on patient care.

“That’s why the study is so tremendously important,” Dr Smith said. “Not only does it validate the guidelines but it shows clear cut reductions in cardiovascular events at the international level.”

Guidelines for the treatment of heart attacks were developed in the early 1990s by the American Heart Association and the American College of Cardiology, Dr Smith said. In 2001, the American Heart Association began a major effort to encourage their use. Other societies, notably the European Society of Cardiology, have been active in the same area.

In 2004, the World Heart Federation identified 10 principles that countries should follow for the formulation of national and regional guidelines. The principles include that governments and national heart societies and foundations should collaborate to develop population-appropriate guidelines targeting risk factors and emphasizing prevention.

Since 2005, the World Heart Federation has been participating in a study in China to determine whether there are gaps between the country’s guidelines and actual clinical treatment of patients with acute coronary syndromes. If such gaps are confirmed to exist, the next step will be to develop interventions for closing them.

China is the world’s most populous country. The study is being carried out at 63 hospitals with at least two from each province and autonomous region. Collaborators include the Beijing Institute of Heart, Lung and Blood Vessel Diseases, the Chinese Society of Cardiology and the China National Healthy Heart Programme.