CHICAGO – In just six years, death rates and heart failure in hospitalized heart attack patients have fallen sharply, most likely because of better treatment, the largest international study of its kind suggests. The promising trend parallels the growing use of cholesterol-lowering drugs, powerful blood thinners, and angioplasty, the procedure that opens clogged arteries, the researchers said. “These results are really dramatic, because, in fact, they’re the first time anybody has demonstrated a reduction in the development of new heart failure,” said lead author Dr. Keith Fox, a cardiology professor at the University of Edinburgh. The six-year study involved nearly 45,000 patients in 14 countries who had major heart attacks or dangerous partial artery blockages. The percentage of patients who died in the hospital or who developed heart failure was nearly cut in half from 1999 to 2005. And the heart attack patients treated most recently were far less likely to have another attack within six months of being hospitalized when compared to the patients treated six years earlier – a sign that the more aggressive efforts of doctors in the last few years are working. There have been other signs that better treatment of heart patients has been saving lives, but not on a scale as large as this international study, the researchers said. “It’s much more dramatic than we expected, in the course of six years,” Fox said. The new study follows landmark research results in March that showed angioplasty is being overused on people who have chest pain but are not in immediate danger of a heart attack. But this popular procedure, which typically uses stents to keep an unclogged vessel open, is still a powerful tool for saving those who are having a heart attack or are at high risk of one. Patients for the study enrolled between July 1999 through December 2005 and were followed for up to six months after hospitalization. Besides the United States, they were in hospitals in Argentina, Australia, Austria, Belgium, Brazil, Canada, France, Germany, Italy, New Zealand, Poland, Spain and the United Kingdom. The research showed that in 2005, 4.6 percent of the heart attack patients died in the hospital, compared with 8.4 percent in 1999. Heart failure developed in 11 percent of heart attack patients in 2005, versus nearly 20 percent in 1999. And just 2 percent had subsequent heart attacks in 2005, compared to 4.8 percent previously. Improved outcomes also were found in those with partial blockages, which include less severe heart attacks. The researchers said these marked improvements are probably a “direct consequence” of new practices that followed updated guidelines from key organizations of heart doctors in the United States and Europe. The study “is the first report of what’s actually going on in the real world,” said Dr. Joel Gore, a co-author and cardiologist at the University of Massachusetts Medical Center. Recommendations in those guidelines include quick use of aspirin or more potent blood thinners; beta blockers to reduce the damaged heart’s oxygen needs, statins to lower cholesterol; ACE inhibitors to relax blood vessels; and angioplasty to open blocked vessels soon after hospital arrival. Use of each of these treatments climbed during the study and in some cases more than doubled. For example, 85 percent of heart patients studied got cholesterol drugs in 2005 versus just 37 percent in 1999; 78 percent got potent blood thinners including Plavix versus 30 percent in 1999; and 53 percent had quick angioplasty, compared to just 16 percent six years earlier. The study appears in today’s Journal of the American Medical Association. American Heart Association spokesman Dr. Sidney Smith said the results are “exactly what we would hope would happen from the major efforts in this area over the past decade. “The tragedy is that too many patients delay before coming to the hospital,” Smith said.160Want local news?Sign up for the Localist and stay informed Something went wrong. Please try again.subscribeCongratulations! You’re all set!
Thibaut Courtois is back in the Chelsea starting XI for Saturday’s Premier League visit of Bournemouth.The Belgian goalkeeper has been sidelined since the start of September with a knee injury picked up on international duty.But, having returned to training earlier this month, he has now been brought back into the team, with Asmir Begovic dropping to the bench.Diego Costa is on the bench for Chelsea for the second successive game.Costa was dropped for last weekend’s goalless draw with Tottenham and made his frustrations clear, throwing a bib at boss Jose Mourinho during the game.Mourinho denied any problems existed with the striker ahead of the clash with Bournemouth but has decided to leave him out again, with Eden Hazard operating as a striker.Bournemouth, meanwhile, have recalled Artur Boruc to their starting line-up.The goalkeeper comes in for Adam Federici, who suffered an injury during last weekend’s draw with Everton.Sylvain Distin misses out for the Cherries through illness, but Harry Arter is fit enough to start after overcoming a hamstring injury.Chelsea team:Courtois; Ivanovic (c), Zouma, Cahill, Baba; Fabregas, Matic; Willian, Oscar, Pedro; Hazard. Subs: Begovic, Azpilicueta, Mikel, Loftus-Cheek, Traore, Remy, Costa.Bournemouth team: Boruc, Daniels, Cook, Francis, Smith, Arter, Gosling, Surman, Ritchie, Stanislas, King. Subs: Allsop, Cargill, Butcher, O’Kane, Kermorgant, Murray, Rantie 1 Thibaut Courtois