(Press-News.org) In an analysis of data from a coronary care registry in Sweden, between 1996-2007 there was an increase in the prevalence of use of evidence-based invasive procedures and pharmacological therapies for treatment of a certain type of heart attack, and a decrease in the rate of death at 30 days and one year after a heart attack for these patients, according to a study in the April 27 issue of JAMA.
Although recent population-based studies indicate a reduction in incidence, ST-elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack) is still a major health issue worldwide. Over the last 15 years a series of large-scale prospective randomized trials have documented the efficacy and safety of several new treatments available for patients with heart attack. "Over the years, several generations of international and national guidelines have been presented to support the implementation of these evidence-based treatments in clinical practice," the authors write. "However, only limited information is available on the speed of implementation of these new treatment strategies and its association with long-term survival in real-life health care."
Tomas Jernberg, M.D., Ph.D., of Karolinska University Hospital, Stockholm, Sweden, and colleagues conducted a study to examine the adoption of new treatments for STEMI and short- and long-term survival. The study included data from the Register of Information and Knowledge about Swedish Heart Intensive Care Admission, which records baseline characteristics, treatments, and outcome of patients with acute coronary syndrome admitted to almost all hospitals in Sweden. This study included 61,238 patients with a first-time diagnosis of STEMI between 1996 and 2007. The authors examined the proportions of patients treated with different medications and invasive procedures and the mortality rate over this time period.
The researchers found that of evidence-based in-hospital treatments known to influence outcomes, use of reperfusion treatment (i.e., thrombolysis or primary percutaneous coronary intervention [PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries]) showed an increase from 66 percent to 79 percent, primary PCI from 12 percent to 61 percent, any revascularization (i.e., PCI or bypass surgery) within 14 days from 10 percent to 84 percent and average use of glycoprotein Ilb/lIIa inhibitors from 0 percent to 55 percent. However, large variations existed between hospitals regarding speed of implementation of new treatments.
The estimated use of aspirin, clopidogrel, beta-blockers, statins, and ACE inhibitors or angiotensin receptor blockers (ARBs) all continuously increased over the study period, clopidogrel from 0 percent to 82 percent, statins from 23 percent to 83 percent, and ACE inhibitor or ARB from 39 percent to 69 percent. There was also variation between hospitals in the implementation of these medications.
The authors also found that over the 12 years, in-hospital complications continuously decreased. The estimated proportion of patients experiencing a new MI during hospitalization decreased from 4 percent at the start of the study period to 1 percent at the end.
Regarding mortality, from 1996 to 2007 the estimated in-hospital, 30-day and 1-year mortality decreased from 12.5 percent to 7.2 percent, from 15.0 percent to 8.6 percent, and from 21.0 percent to 13.3 percent, respectively. The 12-year survival analyses also showed that the decrease in mortality was sustained over time.
"The first finding of this study, in a nearly complete nationwide cohort of patients with STEMI, is that the adoption of evidence-based and guideline-recommended treatments was gradual. The initial large variation in treatments between hospitals gradually decreased with an increase in equality of care over time. The second finding is that this increase in adherence to treatment guidelines is associated with a gradual lowering of both short- and long-term mortality, which could not be explained by changes in baseline characteristics. From 1996 to 2007, the 30-day mortality has been more than halved with an absolute reduction of almost 8 percent. The improvements in survival tended to be greater in the latter part of this 12-year period," the authors write.
The researchers add that the improvement of survival outcome can be expressed as an average gain of at least 2.7 years of life in patients with STEMI in 2007 compared with 12 years earlier.
###
(JAMA. 2011;305[16]1677-1684. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Implementation of Evidence-Based Therapies for Myocardial Infarction and Survival
The results of this study have significant clinical implications for clinicians, hospitals, and patients, writes Debabrata Mukherjee, M.D., of the Texas Tech University Health Sciences Center, El Paso, Texas, in an accompanying editorial.
"They point to an opportunity to improve the quality of care provided to patients with STEMI by decreasing the lag time for adoption of life-saving therapies and improving adherence to evidence-based care across hospitals. The difficulty in disseminating and implementing new technology as reported in the current study is not unique to health care; the slow adoption of innovation has been documented in fields as different as agriculture, education, and communication. Successful training of clinicians in implementing new therapies requires a balance of both didactic training, defined as the methods used for information transfer such as written materials, lectures, and workshops, and competence training, defined as the process of acquiring skills necessary to administer a treatment skillfully and with fidelity. Quality improvement exercises that promote the use of systems that embed guideline knowledge into the care process are often more successful than simple dissemination of information."
(JAMA. 2011;305[16]1710-1711. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
To contact Tomas Jernberg, M.D., Ph.D., email tomas.jernberg@karolinska.se. To contact editorial author Debabrata Mukherjee, M.D., call Lisa Ruley at 915-783-5621 or email lisa.ruley@ttuhsc.edu.
For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org. END
Increase in evidence-based treatments followed by decreased risk of death in heart attack patients
2011-04-27
ELSE PRESS RELEASES FROM THIS DATE:
Activation of biomarker linked with improved survival among obese patients with colorectal cancer
2011-04-27
Among obese patients, activation of the protein biomarker CTNNB1 was associated with better colorectal cancer-specific survival and overall survival, whereas post-diagnosis physical activity was associated with better colorectal cancer-specific survival among patients negative for CTNNB1, according to a study in the April 27 issue of JAMA.
Activation of the WNT signaling pathway (a network of proteins known for their roles in cancer) and cadherin-associated protein beta-1 (CTNNB1; [beta-catenin]) plays a critical role in colorectal carcinogenesis. Accumulating evidence ...
Studies of mutated protein in Lou Gehrig’s disease reveal new paths for drug discovery
2011-04-27
PHILADELPHIA -- Several genes have been linked to ALS, with one of the most recent called FUS. Two new studies in PLoS Biology, one from the University of Pennsylvania School of Medicine, and the other from colleagues at Brandeis University, both examined FUS biology in yeast and found that defects in RNA biology may be central to how FUS contributes to ALS, or Lou Gehrig's disease. These findings point to new targets for developing drugs.
Proteins aggregate to form insoluble clumps in the brain and spinal cord of ALS patients. In some instances of ALS, the clumping ...
Teen sleep study adds to evidence of a 'neural fingerprint'
2011-04-27
PROVIDENCE, R.I. [Brown University] — Teens are rarely described as stable, so when something about their rapidly changing brains remains placidly unaltered, neuroscientists take notice. Such is the case in a new study of electroencephalography (EEG) readings gathered from dozens of teens while they slept. Despite the major neural overhaul underway during adolescence, most individuals maintained a unique and consistent pattern of underlying brain oscillations. The work lends a new level of support to the idea, already observed in adults, that people produce a kind of brainwave ...
Will minorities be left out of health care law provision?
2011-04-27
Hospitals and physician practices that form care-coordinating networks called "Accountable Care Organizations (ACOs)," under provisions of the new health-care law could reap cost-savings and other benefits. However, experts at Johns Hopkins and the University of Pennsylvania warn that such networks could potentially be designed to exclude minorities and widen disparities in health care.
In a commentary appearing in the April 27 issue of the Journal of the American Medical Association, a Johns Hopkins physician says that as a result of new provisions in the Patient Protection ...
Dr Isabel Driggers, of Coastal Kids Dental & Braces, Was Selected as the South Carolina Delegate for the American Academy of Pediatric Dentist (AAPD) 2011 Congressional Lobby Day
2011-04-27
Coastal Kids Dental & Braces is proud to announce that Dr. Isabel Driggers, Owner and Founder of Coastal Kids Dental & Braces, was selected as the South Carolina representative by the AAPD to attend the 2011 Congressional Lobby Day. This is the 2nd year that Dr. Isabel has attending the AAPD Lobby Day as the SC representative.
As part of the AAPD Congressional Lobby Day, Dr. Isabel visited Washington, DC and met with the offices of Senators Lindsey Graham and Jim DeMint and Congressmen Tim Scott and Jim Clyburn to discuss current issues in Pediatric Dentistry ...
Chandra finds new evidence on origin of supernovas
2011-04-27
Astronomers may now know the cause of an historic supernova explosion that is an important type of object for investigating dark energy in the universe. The discovery, made using NASA's Chandra X-ray Observatory, also provides strong evidence that a star can survive the explosive impact generated when a companion star goes supernova.
The new study examined the remnant of a supernova observed by the Danish astronomer Tycho Brahe in 1572. The object, dubbed Tycho for short, was formed by a Type Ia supernova, a category of stellar explosion useful in measuring astronomical ...
Canadians should demand commitments for pharmacare program, says CMAJ
2011-04-27
OTTAWA, ONTARIO, CANADA — Canada needs a national pharmacare program and federal leaders must commit adequate funding, states an editorial in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/cgi/doi/10.1503/cmaj.110643.
Unlike many countries in Europe and Australia and New Zealand, Canada lacks a national pharmacare program that provides consistent coverage across all regions of the country. Currently, drugs that are covered in some provinces may not be in others.
"The inevitable consequence is that some people are prevented from getting the drugs they ...
Men's and women's immune systems respond differently to PTSD
2011-04-27
Men and women had starkly different immune system responses to chronic post-traumatic stress disorder, with men showing no response and women showing a strong response, in two studies by researchers at the San Francisco VA Medical Center and the University of California, San Francisco.
While a robust immune response protects the body from foreign invaders, such as bacteria and viruses, an over-activated response causes inflammation, which can lead to such conditions as cardiovascular disease and arthritis.
In a study published in the March, 2011 issue of Brain, Behavior, ...
CU-Boulder leading study of wind turbine wakes
2011-04-27
While wind turbines primarily are a source of renewable energy, they also produce wakes of invisible ripples that can affect the atmosphere and influence wind turbines downstream -- an issue being researched in a newly launched study led by the University of Colorado Boulder's Julie Lundquist, assistant professor in the atmospheric and oceanic sciences department.
The study, called the Turbine Wake and Inflow Characterization Study, or TWICS, also includes researchers from the National Oceanic and Atmospheric Administration, the U.S. Department of Energy's National Renewable ...
Researchers at Brandeis University make strides in understanding amyotrophic lateral sclerosis
2011-04-27
Brandeis researchers have made a significant advance in the effort to understand amyotrophic lateral sclerosis (ALS) by successfully reversing the toxicity of the mutated protein in the familial type of the disease.
Currently there is no cure or prevention for the disease, which affects nerve cells in the brain and the spinal cord. Most frequently referred to as Lou Gehrig's disease, after its most famous victim, ALS typically causes death due to respiratory paralysis within three to five years of onset. The only approved drug, Riluzole, can extend the lifespan of some ...