Heart Attacks Deaths Halved in the Last Decade, Experts Say

Heart attacks deaths halved in the last decade, experts say

Heart attack is a life threatening condition requiring urgent medical attention The death rate from heart attacks in England has halved in the last decade, says an Oxford University study. The research, published in the British Medical Journal, looked at more than 800,000 men and women who suffered heart attacks between 2002 and 2010. They found that fewer heart attacks occurred in later years and, of those that did occur, fewer were fatal. Researchers say improvements in NHS care and better prevention measures have contributed to the decline. The Oxford researchers used national hospital and mortality data to analyse 840,175 men and women in England who had suffered a total of 861,134 heart attacks over eight years. Comparing 2002 with 2010, they found death rates falling by 50% in men (78.7 per 100,000 population to 39.2) and by 53% in women (37.3 per 100,000 to 17.7). A declining mortality rate was also seen in all age groups and for both sexes. Focus on youngest The research on bmj.com concluded that just over half of the decline in deaths can be attributed to a decline in the number of new heart attacks, and just under half to a decline in the death rate after a heart attack. But the greatest rates of decline occurred in men and women aged 65-74 and the lowest in those aged 30-54 and 85 and older. The study said that rising rates of obesity and diabetes could explain the lack of improvement in the occurrence of heart attacks among the youngest age group. The factors behind the decrease in heart attack death rate differed by age, sex and geographical area. The research authors said that further research is needed to gain a clearer understanding of the specific elements of prevention and treatment that have led to the fall in death rates. And Prof Peter Weissberg, medical director at the British Heart Foundation, said there was still more to do to cut unnecessary deaths. "This impressive fall in death rates is due partly to prevention of heart attacks by better management of risk factors such as smoking, high blood pressure and cholesterol and due partly to better treatment of heart attack patients when they reach hospital. "But far too many heart attack victims still die from a cardiac arrest before medical help arrives. Many of these deaths could be prevented by rapid cardiopulmonary resuscitation."

Heart medicine advances help patients enjoy active life By Philippa Roxby Health reporter, BBC News

A patient recovers after cardiac arrest in the first coronary care unit in 1966 Robert Walker-Smith was eight years old when his father died of a heart attack in 1971. He has never forgotten seeing his father collapse in the hallway at home. "I was ushered quickly away, then I saw an ambulance coming slowly along the road. I remember telling a friend, 'I think my Dad's just died'." In the 1960s, there was no treatment for a heart attack. If they survived, victims were confined to a hospital bed, given painkillers and told to take complete rest. If they died in their 50s or 60s, like Robert's father, it was considered a fact of life. Knowledge of how the heart functions and how best to treat heart disease has improved dramatically over the past 50 years, says a new book written by the British Heart Foundation. In 1961, there were 322,917 deaths from cardiovascular disease, accounting for nearly half of all deaths in the UK. Heart attacks and angina chest pain were common, but little understood. “Start Quote Fifty years ago too many people were condemned to a life of inactivity.” End Quote Prof Brian Pentecost Nearly 50 years later in 2009, UK deaths from CVD had fallen to 32%, a total of 180,626. Now the chances of having a heart attack are much less and surviving one is much more likely. There is no mystery as to why. Smoking levels in the 1960s were high and consumption of foods loaded with saturated fats were the norm. In half a century the average UK diet has improved and the number of smokers has declined sharply, although obesity rates continue to rise. But it is advances in treating heart damage that have really altered the landscape of heart medicine. Fifty years ago, heart attack victims would be lucky to be offered any treatment en route to hospital. Doctors could only cross their fingers that their patient would not go on to suffer a cardiac arrest.

If they did, their chances of survival were very low. If they were lucky enough to be close to an operating theatre then a quick-thinking surgeon could open up their chest and massage the heart by hand to get it beating again. It was only in the mid-1960s that the revolutionary procedure of administering regular compressions to the chest by leaning on the breastbone, not reaching inside the chest, was used to generate a heartbeat. This simple procedure is now a basic part of first aid training. Defibrillators, a machine used to give the heart an electric shock, were in use in the 1960s, but they were extremely cumbersome. Professor Brian Pentecost, a junior doctor at this time who later became medical director of the BHF in the 1990s, recalls his hospital's defibrillator: "It was an enormous thing known as the Red Devil, about the size of a refrigerator. It had to be wheeled through the hospital, bells ringing." The first mobile defibrillators used by ambulance crews to treat people in their homes weighed over 11 stones and had to be powered by two car batteries. "By the seventies you could get a defibrillator the size of a small suitcase. We could fit them in all ambulances so it was as good as being in hospital," says Prof Pentecost. "They made a major contribution to saving lives." Once in hospital, heart patients were scattered inefficiently throughout the general wards.

Early defibrillators were cumbersome, noisy and not very mobile Professor Desmond Julian, medical director of the BHF from 1987 to 1993, who started working in cardiology in the 1950s, saw that something had to change. He set up the UK's first coronary care unit in Edinburgh in the 1960s in an effort to get heart patients admitted quickly, keep them monitored continuously and keep the right equipment and staff on standby. His example was soon followed throughout the world. Once experts agreed in the 1970s that blood clots in blood vessels were the cause of heart attacks - and not the other way round - medicine could begin to find the drugs to tackle the problem and develop techniques to improve blood flow to the heart. So much so that when Robert had a heart attack in 2005, aged 43, his blocked up arteries were gently opened using tightly folded balloons passed into the right location via a catheter, a procedure called an angioplasty. “Start Quote Like many people, I didn't know I'd had a heart attack.” End Quote Robert Walker-Smith Following the procedure, Robert was told to go home and stay active - not put his feet up. He now swims three times a week and does at least two to three hours of salsa dancing and walking. "I was lucky really. I only had minor damage to my heart. Like many people, I didn't know I'd had a heart attack. "I went to my GP feeling awful, like I had flu. Even walking up stairs was hard work. "He checked my pulse, gave me a blood test and an ECG then sent me home. Later I got a call telling me I had to go to hospital." Professor Pentecost says there has been a complete change of emphasis when dealing with patients like Robert.

An BHF ad campaign warning people how a heart attack might feel "Fifty years ago too many people were condemned to a life of inactivity. The treatment of angina has changed people's ability to enjoy life. "Before, people were in bed so long they ended up with deep vein thrombosis and then got clots on the lungs." Taking drugs to control heart disease is now a standard and effective approach. Over one and a half million people currently living in the UK have had a heart attack. Over two million people have angina or heart failure. The British Heart Foundation predicts that these numbers will increase as the population continues to age, making new approaches to treating heart damage very important. Robert takes daily doses of statins, beta blockers and aspirins for his heart and will do so for the rest of his life. These drugs give him, and countless thousands of others, a good quality of life - something his father was never lucky enough to enjoy. '50 Years at the Heart of Health, 1961-2011' is published by the British Heart Foundation. To support the Mending Broken Hearts Appeal or the British Heart Foundation, please visit www.bhf.org.uk

Working long hours 'raises heart attack risk' Putting in extra hours can take its toll Working more than 11 hours a day rather than the usual 9am to 5pm markedly increases heart disease risk, say UK experts. The magnitude of risk goes up by 67% for people who work long hours, they say in Annals of Internal Medicine. The University College London team base their findings on over 7,000 civil service employees whose health they have been tracking since 1985. They suggest GPs should now be asking their patients about working hours. Lead researcher Professor Mika Kivimäki said: "Considering that including a measurement of working hours in a GP interview is so simple and useful, our research presents a strong case that it should become standard practice. “Start Quote This study might make us think twice about the old adage 'hard work won't kill you'” End Quote Professor Stephen Holgate of the Medical Research Council "This new information should help improve decisions regarding medication for heart disease. "It could also be a wake-up call for people who overwork themselves, especially if they already have other risk factors."

Hard graft Over the course of the 11-year study, 192 of the participants suffered a heart attack. People who worked 11 hours or more a day were more than half as likely again to have a heart attack than those who worked shorter hours. And adding working hours to well-established heart risk factors, such as high blood pressure, made the researchers' predictions far more accurate. If GPs were to add this to their usual list of heart questions they might spot 6,000 more of the 125,000 people who suffer heart attacks in the UK each year, the researchers suggest. Studies are now needed to see if getting people to cut back on their working hours will improve their heart health, they add. Professor Stephen Holgate of the Medical Research Council, which part-funded the investigation, said: "This study might make us think twice about the old adage 'hard work won't kill you'. "Tackling lifestyles that are detrimental to health is a key area for the MRC, and this research reminds us that it's not just diet and exercise we need to think about." Professor Peter Weissberg of the British Heart Foundation said: "These most recent findings raise the possibility that long working hours may increase the risk of a heart attack. "But further studies are required to confirm this association and clarify how it might be used to change our current approach to assessing someone's risk of developing heart disease and what advice we give on working conditions." Experts suspect a number of underlying factors may be at play, such as undetected high blood pressure, stress, anxiety or depression, and being a driven, aggressive or irritable personality. Drug makes hearts repair themselves By James Gallagher Health reporter, BBC News

More people are surviving heart attacks, but that means more are living with heart failure A drug that makes hearts repair themselves has been used in research on mice. The damage caused by a heart attack had previously been considered permanent. But a study in the journal Nature showed the drug, thymosin beta 4, if used in advance of a heart attack, was able to "prime" the heart for repair. The British Heart Foundation described repair as the "holy grail of heart research", but said any treatment in humans was years away. Due to advances in health care the number of people dying from coronary heart disease is falling. But those living with heart failure are on the rise - more than 750,000 people have the condition in the UK alone. Wake up The researchers at University College London looked at a group of cells which are able to transform into different types of heart tissue in an embryo. UK Heart statistics Deaths from coronary heart disease  1961 - 165,216  2001 - 117,743  2009 - 80,223 Estimated people living with heart failure  1961 - 100,000  1971 - 300,000  2010 - 750,000 Source: British Heart Foundation In adults epicardium-derived progenitor cells line the heart, but have become dormant. Scientists used a chemical, thymosin beta 4, to "wake them up". Professor Paul Riley, from the University College London, said: "The adult epicardial cells which line the muscle of the heart can be activated, move inward and give rise to new heart muscle." "We saw an improvement in the ejection fraction, in the ability of the heart to pump out blood, of 25%." As well as pumping more blood, the scar tissue was reduced and the walls of the heart became thicker. Peter Weissberg, medical director of the British Heart Foundation, said he was "very excited" about the research but warned the scale of improvement seen in animals was rarely seen in humans.

Epicardium derived progenitor cells (in red) lining the heart However, he argued that even a small improvement would have a dramatic impact on people's quality of life. "A normal heart has lots of spare capacity. In patients with heart failure it is working flat out just to sit down [and] it's like running a marathon," he said. "You could turn a patient from somebody who's gasping while sitting in a chair to somebody who can sit comfortably in a chair." Advance therapy The mice needed to take the drug in advance of a heart attack in order for it to be effective. As the researchers put it, "the priming effect is key". If a similar drug could be found to be effective in humans, then the researchers believe it would need to be prescribed in a similar way to statins. Professor Riley said "I could envisage a patient known to be at risk of a heart attack - either because of family history or warning signs spotted by their GP - taking an oral tablet, which would prime their heart so that if they had a heart attack the damage could be repaired." He said this could be available in 10 years. The British Heart Foundation, which funded the study, said repairing a damaged heart was the "holy grail" of heart research. The results strengthened the evidence that drugs could be used to prevent the onset of heart failure, it said.