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 had 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 burn of cardiovascular disease is estimated at $500 billion annually. This country can’t afford it much longer.
The good news is both heart attack and stroke are now largely preventable. The Centers for Disease Control’s Million Hearts Initiative aims to prevent 1 million heart attacks and strokes in just five years. This initiative can succeed if it receives more support an participation. If you are 50 years 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evolved, heart bypass was mostly replaced by balloon angioplasty, and less than a decade later, balloon angioplasty was superseded by stent placement.
This became the default practice of most cardiologists until 2007, when a landmark clinical trail called the COURAGE Trial was published in the New England Journal of Medicine. It was a game changer. The COURAGE Trial demonstrated in stable patients with advanced multi-vessel CAD who are not receiving optimal medical therapy, the addition of stent placement did not prevent heart attacks, cardiac deaths, or cardiac hospitalizations.
The number of stents deployed dropped steadily from 1,250,000 in 2007 to about 800,000 last year. The American Heart Association states that 85 percent of he 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 case for acute major heart attacks 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 one in five patients will die without reaching the hospital. For those who reached the hospital alive, aster 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-Pocket Cost Shifted to Patients. Another reason to prevent heart attacks 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 Ratings 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.
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 three questions to ask: 1.) Am I at high risk? 2.) It is 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.
Princeton Preventive Cardiology, 416 Bellevue Avenue, Suite 303, Trenton. 1445 Whitehorse-Mercerville Road, Suite 109, Hamilton. Two Capital Way, Suite 333, Pennington. www.princetonpreventivecardiology.com. 609-396-6363. See ad, page 23.