26 january 2012

Heart attack deaths have halved

Health

Heart attack deaths have halved in the last decade

The death rate from heart attacks in England has halved in the last decade, according to Oxford University research.

The study published in the British Medical Journal found that there were fewer heart attacks in the last decade – and fewer of these were fatal – compared with earlier years.

‘These are big success stories for public health and for the NHS,’ says Kate Smolina, first author on the study.

The researchers led by Professor Michael Goldacre of the Department of Public Health at the University of Oxford used national hospital and mortality data for over 840,000 people in England who’d had heart attacks between 2002 and 2010.

In those 10 years, the death rates for heart attacks fell by 50% in men and 53% in women.

‘Over half of the decline in deaths from heart attacks can be attributed to a decline in the actual occurrence of the attacks, and just under half to improvements in survival after attacks,’ explains Dr Mike Rayner of Oxford University, one of the researchers involved in the study.

‘The decline in actual heart attacks (whether fatal or non-fatal) means that those of us (like me) who are concerned with the prevention of heart attacks seem to have been having an effect. That prevention works, in other words.’ 

‘The paper also shows that there have been significant improvements in survival after attacks in the last 10 years,’ says Dr Rayner. He adds: ‘The NHS – at least in this regard – has been performing well, and this calls into question whether it should needs to change radically in the way it does things.’

These are big success stories for public health and for the NHS.

Dr Kate Smolina

Dr Rayner says that the findings are good news, but that it is still possible to do better. ‘There is evidence from this paper and elsewhere that the decline in deaths is slowing – particularly in younger age groups.’

The greatest decline in heart attacks was seen among middle-aged men and women, while smaller declines were seen in younger and older age groups.

Rising rates of obesity and diabetes may help explain the lack of improvement in the occurrence of heart attacks in younger age groups, the researchers suggest.

Dr Rayner lists the factors that may have led to the decline in heart attack deaths: ‘I think it is less smoking, though the decline in smoking has been flattening recently. It is improvements in diets and nutrition, particularly in the type of fat we eat. We've been switching from saturated to unsaturated fat, there has been a slight increase in fruit consumption (but this has mainly been in the form of juice) and a slight recent decline in salt consumption.’

Some of these changes in lifestyle, and a substantial fall in the incidence of heart attack,  started before the period covered by the study, explains Professor Goldacre. As well as lifestyle factors, drugs for high cholesterol or raised blood pressure will also have had a beneficial effect, he suggests, but they came into use long after the decline in deaths started.

Better hospital care has had some effect on survival from an attack. A range of different improvements in care for people having or just having had an attack have probably contributed to increased survival rates, says Professor Goldacre. These include getting people to hospital faster, improvement in drugs for those suffering a heart attack and improvements in, and the increased use of surgical treatments.

Dr Rayner adds: ‘The improvements in survival after an attack are not just down to improvements in treatment, in my view, but also to a decline in the severity of the disease – again possibly due to lifestyle change.’