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NEW YORK, Mar 16 (Reuters Health) - Over the last 20 years, the number of patients dying within the first month after a heart attack has declined by about one-third, researchers report. And they suggest this is due largely to a drug that has been around for 100 years--aspirin.
Between 1975 and 1995, the 30-day mortality from heart attack decreased from 27% to 17%. After adjusting for potential interactions between therapies, 71% of this decrease is explained by the increased use of medications and procedures that restore the flow of blood to the heart, according to a report in the February issue of The American Journal of Medicine.
Aspirin is by far and away the biggest reason people are less likely to die after a heart attack, according to Dr. Paul A. Heidenreich, from the Veterans Affairs Medical Center in Palo Alto, and Dr. Mark McClellan from Stanford University in California.
"The greatest effect of a given therapy was that of aspirin, which accounted for 34% of the decrease in 30-day mortality, followed by thrombolysis (17%)," the authors write. Thrombolysis is treatment with drugs that dissolve clots, which are a primary cause of heart attacks.
The use of artery-clearing angioplasty, and drugs such as beta-blockers and angiotensin-converting enzyme (ACE) inhibitors also helped reduce the mortality rate, the report indicates.
In a related editorial, Dr. Lee Goldman from the University of California, San Francisco, notes that the majority of the decrease in mortality resulted from the increased use of appropriate medication, not from more costly "hi-tech" procedures.
"Even as we live and practice medicine in an era of high technology, we must always remember that widespread application of relatively low technology, efficacious, and cost-effective therapies is often the way we help most of our patients and provide the greatest aggregate benefit for the broader population," Goldman emphasizes.
The study was based on heart attack data from the US Health Care Financing Administration and case fatality rates from the National Hospital Discharge Survey. The treatment effects were calculated from previously published analyses.
SOURCE: The American Journal of Medicine 2001;110:165-174, 221-223.
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