Medical Innovation Largely Responsible for Huge Decline in Heart Attack Hospitalizations

 While media, politicians, and critics continue their crusade to limit physician-industry relationships, recent evidence suggests that the work between physicians and industry is helping patients. Specifically, the Wall Street Journal reported that “the heart-attack rate among elderly Americans appears to be falling sharply” as a result of using new medicines and treatments for prevention.

In fact, a recently published analysis of Medicare data found that “the rate of hospital admissions for heart attack was 23% lower in 2007 than in 2002, with 228,170 fee-for-service Medicare patients admitted in 2007 compared with 297,653 in 2002. That suggests there were nearly 87,000 fewer heart-attack admissions in 2007 than would have been expected had the rate remained constant.” It was also estimated that a reduction of 97,000 heart-attack admissions would be seen based on 38 million Medicare participants, including those enrolled in so-called Medicare Advantage managed-care plans.

The study, carried out by principal investigator Harlan Krumholz, a cardiologist at Yale University School of Medicine, noted the “cumulative impact of a variety of prevention initiatives that public-health groups, professional organizations and payers of health care have mounted over the past two decades to change health habits and improve treatment of heart patients.” These efforts included:

–    Quit-smoking campaigns;

–    Growing awareness of the importance of exercise and healthy diets;

–    Escalating adoption of 90 minute artery openings using angioplasty and stents;

–    Increasing use of medicines to control blood pressure and cholesterol; and

–    Efforts to encourage doctors and hospitals to follow evidence-based guidelines when treating heart patients are among the potential contributing factors.

Over the six-year period covered in the study, there were in all more than 300,000 fewer heart attack admissions than if the rate had remained steady at the 2002 level. In addition to this data, a 2007 study involving researchers at the data firm Thomson Reuters and published in the Journal of American Cardiology found a steady decline in heart-attack admissions between 2002 and 2005.

Janet Young, senior scientist at Thomson Reuters and a co-author of that study, noted that the data used was current through the third quarter of 2009, though not peer reviewed, and showed heart-attack admissions continuing to decline. Consequently, these findings showed after adjusting for factors such as age and gender, the annual decline in heart attack admissions between 2002 and 2007 averaged 5.8% per year.

Researchers such as Sidney Smith, a cardiologist at University of North Carolina, Chapel Hill, and past president of the American Heart Association, attribute these kinds of declines to the development of cholesterol-lowering drugs called statins. This so called “statin era” was ushered in after the success of the 4S trial from 1994—a “landmark study of 4,444 patients sponsored by Merck & Co. that was the first to show statins not only lowered cholesterol but also prevented heart attack and saved lives. As a result, “many doctors credit the drugs with preventing heart attacks among their patients.”

In addition to the development of statins—a collaboration of industry and physicians—declining heart attack admissions have also resulted from improved care of patients suffering a first attack. For example, the American Heart Association and the American College of Cardiology have established programs to improve in-hospital care for heart-attack patients.

Programs that “make sure patients are discharged on daily aspirin, blood pressure drugs called beta blockers and statins, for instance, has been linked to preventing second heart attacks and lowering death rates within 30 days of admission for a heart attack.” As a result, these efforts “helped reduce 30-day death rates for heart attack patients by 3 percentage points—from 18.8% to 15.8%, representing a relative risk reduction of 16%—between 1995 and 2006, according to a study published by Dr. Krumholz and his colleagues last August in the Journal of the American Medical Association.”

Another benefit that came from industry-physician collaboration is the ability for doctors “to open a blocked artery to under 90 minutes in patients suffering a major heart attack, which also improved survival and helped contain damage that leads to future complications.” These kinds of advances with industry and physicians have led those such as Barry Straube, chief medical officer of the Centers for Medicare and Medicaid Services, to become “optimistic” about the future of heart disease.  

Conclusion

Although heart disease still remains the nations leading killer, this recent analysis shows that efforts from physicians and industry to develop and use new medicine and treatments is paying off. While most progress or struggle against major diseases is typically measured by one or two percentage points a year, the progress in heart disease is incredible, and must continue considering the national obesity epidemic, with accompanying increases in diabetes may reverse this progress.

Without pharmaceutical and device innovation, investment and most importantly collaboration with the medical/scientific community this outcome probably would not have come into fruition.   At least for now though, the public can realize that the work of physicians and industry to create new medicine such as statins, along with other programs, is reducing heart attacks and making people healthier each year .