Invasive Cardiac Therapies Linked To Better Survival Following Heart Attack Interview with:

Dr Marlous Hall PhD Senior Epidemiologist Leeds Institute of Cardiovascular and Metabolic Medicine

Dr. Marlous Hall

Dr Marlous Hall PhD
Senior Epidemiologist
Leeds Institute of Cardiovascular and Metabolic Medicine What is the background for this study? What are the main findings?

Response: It is well known that death rates following heart attacks have fallen considerably over recent decades. Many studies have looked at the effect of medications and invasive strategies, and their association with better clinical outcomes is clear.

However, a big question remains: why have heart attack deaths fallen? Is it due to increased use of medications and treatment, is the risk of patients simply lower over time due to things like earlier diagnosis or are patients generally healthier with fewer comorbidities such as diabetes? Answering this is not straightforward – as “gold standard” studies like clinical trials on historic data cannot be done.

An alternative approach is to look for patterns in data observed from routine care to look at all these factors together. This study used a large and rich dataset covering heart attack care in the UK (Myocardial Ischaemia National Audit Project (MINAP)). This dataset was linked to outcome data from the Office for National Statistics to allow us to look at all the different factors that could influence the change in mortality over time. What should readers take away from your report?

Response: Using data on approximately 400,000 patients with a specific type of heart attack, NSTEMI (non ST-elevation myocardial infarction), we confirmed that the population had become less ‘at risk’ of death over the ten year study period between 2003 and 2013. Over the same period, we also showed that patients had higher rates of co-morbidity, i.e. heart attack with other illness such as diabetes, renal failure and previous bypass. The medications people received (e.g. statin therapy) as well as interventions significantly increased over time.

However, of all factors the one that explained the reduction in mortality most was the greater use of ‘invasive’ therapies via operations (e.g. angiograms, stents, bypass grafts). While medications are shown to be beneficial they did not fully explain the lower mortality rates over time. What recommendations do you have for future research as a result of this study?

Response: Nowadays, people are generally living longer, therefore, we will end up with increasingly older clinical populations who are also more likely to experience more co-morbidities. Better diagnostic techniques will help these patients to obtain care earlier in the course of their disease to improve survival further. At the end of the study, in 2012-13, we showed that about 2 in 10 patients did not receive an invasive coronary strategy. Future work should be focused on ensuring all patients who are eligible receive invasive coronary strategies to further reduce premature deaths from heart attack. Thank you for your contribution to the community.


Marlous Hall, Tatendashe B. Dondo, Andrew T. Yan, Shaun G. Goodman, Héctor Bueno, Derek P. Chew, David Brieger, Adam Timmis, Phillip D. Batin, John E. Deanfield, Harry Hemingway, Keith A. A. Fox, Christopher P. Gale. Association of Clinical Factors and Therapeutic Strategies With Improvements in Survival Following Non–ST-Elevation Myocardial Infarction, 2003-2013. JAMA, 2016; DOI: 10.1001/jama.2016.10766

Marlous Hall <[email protected]

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on September 2, 2016 by Marie Benz MD FAAD