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Doctors performing heart surgery.
Reuters/Afolabi Sotunde
The heart attacks. Doctors fight back.
HEART HAPPY

Heart attacks used to be a major killer. Not anymore.

By Chase Purdy

In the US in the 1990s, having a heart attack was basically a death sentence for some 20% of the people who suffered one.

The country’s medical community has spent the last three decades or so working on this problem, and experts widely believe the efforts have paid off. Until now, however, researchers with Yale University say there hasn’t been clear evidence to show that the heart-attack death rate has actually fallen.

Eager to fix that, they set out to analyze data from more than 4.3 million Americans aged 65 or older who had suffered heart attacks. All of them were Medicare fee-for-service patients. The data spans from January 1995 to January 2015 and was pulled from 5,680 US hospitals. The results were published on March 15 in the Journal of the American Medical Association Open Network.

The numbers are pretty striking. Back in 1995, 20% of the patients whose cases were included in the study died from their heart attacks. By 2014, that number fell to just 12%. Over the same period, the rate of hospitalization for a first-time heart attack dropped by 38%—from 914 to 566 per 100,000 Medicare beneficiary-years. Because the number of people admitted to the hospital after a heart attack dropped, the healthcare costs attributed to heart attacks has decreased, even though hospital costs overall have increased (pdf) in the US over time.

So what led to these significant declines in costs and fatality rates for heart-attack patients? Much of it has to do with a concerted effort on the parts of three national organizations—the Centers for Medicare & Medicaid Services, the American College of Cardiology, and the American Heart Association—to spearhead changes in treatment.

In the 1990s, the health care community established that aspirin and a class of drugs called beta-blockers (used to reduce blood pressure) were some of the best ways to improve chances of survival after a heart attack. Also over the last 30 years, coronary angioplasty has become more widely available. Physicians use this non-surgical procedure to open arteries that are clogged with a buildup of plaque, thus helping blood flow from the heart. It’s a highly effective way to decrease the risk of mortality, far more so than any medication alone.

The researchers also credit lifestyle changes, such as more healthful dieting, for contributing to the decreases in heart-attack hospitalization and mortality rates.

Not everyone in the US has seen these benefits, however. After analyzing data from thousands of hospitals spread across the US, the researchers uncovered issues of disparity. In places where unemployment is high, the risk of death after suffering a heart attack is higher than in areas with a healthy employment rate. The study didn’t have a clear answer for why that’s the case.

“This is no time to be complacent,” one of the researchers, Harlan Krumholz, told Consumer Affairs. “We document extraordinary gains—but the effort is far from finished. The goal is to one day relegate heart attacks to the history of medicine.”