Stop A Heart Attack Before It Happens
The American Heart Association estimates that nearly 1,000,000 Americans
will be hospitalized for a coronary event this year, a vast majority - about
635,000 do not have any past history of heart disease. Of these, 525,000 will be
confirmed to have their first heart attack. The hospital charges for a major heart
attack can easily exceed $100,000 and we all pay for it. The total economic
burden of cardiovascular disease is estimated at $500 billion annually. This
country can’t afford it for much longer. The good news is both heart attack and
stroke is now largely preventable. The Center for Disease Control’s Million
Hearts Initiative aims to prevent one million heart attacks and strokes in just
five years. This Initiative can succeed if it receives more support and
participation. If you are 50 year old and older, you should know that you and
your physician can stop a heart attack before it happens to you.
Before the Era of Prevention
When I started my cardiology practice in 1980, many patients with newly
diagnosed heart disease underwent coronary bypass surgery which was the
treatment of choice at that time for many cases. As the treatment of coronary
artery disease (CAD) evolved, heart bypass was mostly replaced by balloon
angioplasty, and in less than decade later, balloon angioplasty was superseded
by stent placement. This became the default practice of most cardiologists until
2007, when a landmark clinic trial called COURAGE Trial was published in
the New England Journal of Medicine. It was a game changer. COURAGE
Trial demonstrated in stable patients with advanced multi-vessel CAD who are
already receiving optimal medical therapy, the addition of stent placement did
not prevent heart attacks, cardiac deaths or cardiac hospitalizations. The
number of stent deployed dropped steadily from 1,250,000 in 2007 to about
800,000 last year. The American Heart Association states that 85% of the
reduction in CAD mortality is due to medical therapy, not heart bypass and
stents.
Faster Heart Attack Care (Shorter Door-to-Balloon Time) Did Not Reduce
Mortality
One of the few remaining indications for balloon angioplasty and stent
placement is in the setting of a major heart attack. This is the current standard
of care for acute major heart attack called STEMI (ST Elevation Myocardial
Infarction) because it seemed intuitive for us cardiologists that when a plaque
ruptures and a clot forms within the artery and stops the flow of blood, then
opening up the blocked artery with a balloon or stent as quickly as possible will
improve the patient’s survival. A study of nearly 100,000 cases published in the
New England Journal of Medicine showed that there was no mortality benefit
of shorter door-to-balloon time.
About 1 in 5 patients will die without reaching the hospital. Those who reached
the hospital alive, faster heart attack care did not reduce mortality rate. More
than ever, it is even more important to prevent a heart attack before it happens.
More Out-Of-Packet Cost Shifted To Patients
Another reason to prevent heart attack is the financial burden to yourself and
your family. In addition to the loss of income from temporary or sometimes
permanent disability, your co-pay for hospitalizations will increase as it already
has in the last 10 years. Medicare patients are not immune to this. And it will
get more costly.
Medicare Star Rating of Hospitals
To help patients choose the best hospital in their region, Medicare started star
rating hospitals and has made it available to the public
at www.HospitalCompare.hhs.gov. More and more patients are willing to skip
the closest hospital and travel farther to a higher rated hospital.
Here are the rating (1 to 5 stars) of the local hospitals based on the survey of
patients' experiences: Doylestown Hospital - 4 stars, University Medical Center
of Princeton at Plainsboro - 3 stars, Capital Health Medical Center at Hopewell
- 3 stars, Robert Wood Johnson University Hospital at Hamilton - 3 stars, St.
Mary Medical Center - 3 stars, Capital Health System at Fuld Campus - 2 stars,
St. Francis Medical Center - 2 stars and Lourdes Hospital at Burlington County
- 1 star.
How to Prevent A Heart Attack Before It Happens
Talk to our physicians about your risk for heart attack and stroke in the next 10
years. Here are the three questions to ask: (1) Am I are high risk? (2) Is it
beneficial for me to have a coronary artery calcium scan to determine if I have
plaques in my coronary arteries and how much? (3) If I am at high risk and
have plaques, is the medical therapy I am receiving sufficient to stop plaque
progression and prevent plaque rupture?
To learn more, visit us
at www.PrincetonPreventiveCardiology.com and www.CholesterolClinic.com.
Featured in US1 Wellness Issue June 2015