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Senior Citizen Health & Medicine
Emergency Angioplasty Saving Many but Too Many
Missing Life-Saving Treatment
Missing out are those with atypical symptoms, late
arrivals, females, non-whites, over 75
Aug. 3, 2007 Compared with their counterparts a
decade ago, todays heart attack patients are receiving emergency
angioplasty or clot-busting drugs to re-open clogged arteries at a far
greater rate, but 10 percent of patients who could benefit from this
life-saving treatment still do not receive it, according to a study
published in The American Journal of Medicine by Yale and University of
Michigan researchers.
The results also showed that the chance of missing
out on lifesaving emergency treatment was highest among patients without
typical symptoms like chest pain, patients who did not arrive at the
hospital until six or more hours after the heart attack began, female
patients, those over age 75 and non-whites.
In the ten-year study period, the percentage of
patients who could have received emergency reperfusion but didnt
declined from more than 20 percent to 10 percent a notable achievement
that the authors attribute to the increasing evidence of the benefit of
emergency angioplasty, and the rise in the availability of the treatment
at American hospitals and concerted national efforts to improve care.
The study was based on data from 238,291 heart
attack patients between 1994 and 2003 who were listed in the National
Registry of Myocardial Infarction.
The patients had a particular kind of heart attack
called ST-elevated myocardial infarction (STEMI). It is the most current
and comprehensive look at the use of emergency reperfusion, a treatment
that can restore blood flow to the heart muscle. To track the changes in
emergency reperfusion therapy over time, the researchers divided the
study data into three time periods: June 1994 through May 1997, June
1997 through May 2000, and June 2000 through May 2003.
This study has good and bad news, said senior
author Harlan M. Krumholz, M.D., the Harold H. Hines, Jr. Professor of
Medicine at Yale School of Medicine.
We have definitely made progress in treating
appropriate patients, but our findings indicate that we need to improve
further to be sure that no patient who could benefit from treatment is
missed.
We may never be able to get to 100 percent, but 10
percent of eligible patients going untreated is still too many, said
first author Brahmajee Nallamothu, M.D., assistant professor of
cardiovascular medicine at the University of Michigan Medical School.
We hope our study highlights the opportunities to
improve care and particularly some of the at risk subgroups still less
likely to receive reperfusion therapy despite eligibility, so that we
can focus our clinical efforts on them.
Hospitals around the nation, including U-M and
Yale, are taking part in a national campaign to reduce this time
interval for patients who receive emergency angioplasty, and studies
have shown that patients who are treated within an hour or two of
arrival at the hospital do better in the long term than those who wait
longer for angioplasty.
But the fact that 10 percent of possible emergency
angioplasty candidates still arent even getting the procedure at all is
a significant issue of its own, the authors say. Increasing its use in
these patients could save up to an additional 30 lives for every 1,000
heart attack patients treated when performed in a timely manner.
In fact, the authors state that hospitals should be
judged in part by their ability to deliver acute reperfusion to as many
candidate patients as possible. Our findings support the incorporation
of a measure of reperfusion use into national quality improvement
efforts, they write. An American College of Cardiology/American Heart
Association task force has endorsed this same idea.
Editor's Notes:
The National Heart, Lung and Blood Institute of the
National Institutes of Health funded the study. Genentech, Inc. provided
researchers with access to the registry.
Other authors on the study included Martha E.
Blaney, Susan M. Morris, Lori Parsons, Dave P. Miller, John G. Canto,
M.D., and Hal V. Barron, M.D.,
Citation: The American Journal of Medicine, Vol.
120, No. 8, (August 2007)
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