Improved Medicines, Treatments : Hospital Time Shrinking for Heart Attack Victims

New medicines and technologies for emergency treatment of heart attacks could mean a hospital stay of only 72 hours for about one in four heart attack victims.

Gone are the days when people who suffered heart attacks were confined to cardiac care units and rarely even moved. Increasingly these days, patients get emergency treatment at local hospitals, a helicopter flight to a better-equipped regional medical center, and aggressive use of medicines and even surgery to restore blood flow to the heart muscle after an attack.

“This in itself is a revolution,” Dr. Bertram Pitt, director of the Division of Cardiology at the University of Michigan Medical Center, said at a recent American Heart Assn. symposium. “Ten years ago, we were afraid to move people . . . down the hall to get an X-ray. Today we’re moving them 100 miles.”

Savings in Mortality

Although the improved medicines and treatments are very costly, they could result in savings through shorter hospital stays for some patients, Pitt said.

“If this is justified, you have to have tremendous savings in mortality, which we do,” he said. “And maybe by being so aggressive, we actually save some money.

“We might be able to identify a low-risk subset (of patients) who could leave the hospital early--after 72 hours versus a usual hospital stay of seven to 10 days.”

In a pilot study, patients without evidence of heart failure, irregular heartbeats or recurrent angina were asked to undergo an exercise stress test 72 hours after their heart attack.

Those with good results on the stress test and no complications were determined to be members of this low-risk subset who did well after leaving the hospital, Pitt said. About one-quarter of patients in the pilot study fell into the early-release group.

Doctors thought patients would resist the idea of an early hospital release after a heart attack, Pitt said, and were surprised to find patients eager to return to home and work.

Psychological Improvement

“We saw no disadvantage in letting them go home early, no increased risk between day four and day 10 or in follow-up examinations,” he said.

Patients who left the hospital early also improved faster psychologically, Pitt said.

In addition, the early release showed a savings of about $5,000 per patient in hospital costs, Pitt said, a figure that could grow to $200 million a year if larger trials yield similar results.

Pitt cautioned that the pilot study was conducted with a small number of patients and that a larger trial involving at least 3,000 people should be done before early release is adopted.

He added that research across the country on different treatments and approaches could yield further advances treating heart attacks.

But Pitt predicted that “the real progress” will come when researchers can say heart attacks no longer are a major medical problem because physicians have learned to prevent them.

“Before the next 15 years, someone will be up here telling you that infarction is a thing of the past, (or) at least only a minor problem,” he said.