New Guidelines Greatly Improve Care of Heart Attack Patients

A study being conducted in 33 US hospitals shows that by incorporating a system of treatments, tests, counseling on lifestyle changes, and checklists, doctors can help heart attack patients live longer and healthier lives. The new concept is also being tried in Europe. The study results were presented at the annual meeting of the American College of Cardiology (ACC) in Chicago (IL, USA).

The results come from the latest phase of a study called AMI GAP (Acute Myocardial Infarction Guidelines Applied in Practice. The guidelines were developed by the ACC and the American Heart Association, based on the best available evidence on which drugs, tests, and lifestyle changes such as diet modification and smoking cessation work best for patients in preventing complications and recurrences. All hospitals in the study were offered a toolkit of reminders, checklists, stickers, standard orders, reference cards, and educational materials to make it easier for doctors, nurses, and patients to follow the guidelines.

The biggest gains were in diet and smoking-cessation counseling and in prescriptions for cholesterol-lowering drugs. Smaller but impressive gains were also seen in the early use of aspirin and beta blockers and prescriptions for ACE (angiotensin-converting enzyme) inhibitors. Based on the success of the guidelines, similar GAP programs have begun in other states. Hospitals in Italy have initiated a GAP project, and another effort is being planned in Spain.

"These are all proven therapies that, while not indicated for every single patient, have been shown to reduce the risk of death, additional heart attacks, and other complications in the vast majority of patients who receive them,” said study leader Kim A. Eagle, M.D., professor of internal medicine and chief of clinical cardiology at the University of Michigan Health System (Ann Arbor, USA). "Even though we know what works, it hasn't been easy to make sure that knowledge benefits every patient. This study aimed to close the gap between what experts recommend and what patients receive.”