Victims of Our Own Success

This week’s JAMA has confirmed the large drop in death by coronary heart disease in the setting of the acute heart attack. Trumpets have sounded, bands have blared, and patients have benefited. The study of over 44,000 patients proposed that the reasons for these improved outcomes were several:

• Improved adoption of coronary interventions (angioplasty and stenting) as the preferred method of treating an acute heart attack.
• The broad adoption of statin drugs to treat hyperlipidemia (high cholesterol).
• And the broader use of antiplatelet agents (like clopidogrel) in addition to aspirin (aspirin use stayed constant over the study period).

While there is no question that patients are doing better, nationally cardiologists are presently feeling about a 4-6% drop in coronary intervention rates. As such, interventional cardiologists are getting nervous. People are scrambling to explain the drop, since it affects every cardiology group across the country. Is it the statins? Is it the use of CT scans for earlier diagnosis?

Certainly the guidelines on the management of the acute heart attack have helped improve patient outcomes, but perhaps the reason the overall rate of coronary interventions have fallen and fewer patients are dying as a result of their heart attack is something much simpler.

-Wes