U.S. study offers grim outlook for cardiac patients

U.S. researchers have released some pretty grim statistics about the long-term chances of survival after being admitted to a hospital for either a heart attack or heart failure.

Within the first year of discharge from hospital, 70.3 per cent of heart-attack patients are readmitted to a medical centre and 25.9 per cent die.

The outlook is even worse for patients treated for heart failure, which is essentially a weak heart that has trouble pumping blood around the body. Within the first year, 70.3 per cent are readmitted to hospital and 41.8 end up dead.

"Our findings show that the risk is elevated for a long period of time after hospitalization," said the lead researcher Dr. Kumar Dharmarajan, a visiting scholar at Yale University in New Haven, Conn.

In recent years, he noted, big strides have been made in the treatment of heart disease. So patients now have a greater chance of surviving an initial heart attack or case of heart failure. But that doesn't mean they are in the clear.

"I think patients have a lot of misunderstandings," said Dharmarajan, who is also a fellow in cardiology at Columbia University Medical Center in New York. In the case of heart-attack patients, they may have undergone an angioplasty or bypass surgery as part of their treatment, "and they think they are fixed."

The study demonstrates a continuing vulnerability, however. Using U.S. Medicare data, the researchers looked at what happened to 878,000 patients who were hospitalized for heart failure and 350,000 admitted after a heart attack.

The findings, which were presented Thursday at a scientific meeting of the American Heart Association, showed that patients were at greatest risk immediately after discharge: In the month after a heart attack, the likelihood of death is 21 times higher and the risk of hospitalization is 12 times higher than among the general Medicare-age population (over the age of 65). And for heart failure, in that first month, the likelihood of death is 17 times higher and the likelihood of hospitalization is 16 times greater than the general Medicare-age population.

"Their risk declines with time, but it is still elevated for many months," he said. "I think it's important that patients know that because that knowledge may motivate them to be more vigilant in self-monitoring, looking for symptoms or signs of deterioration and maintaining close ties with their health-care team."

In some respects, the elevated chances of rehospitalization and death reflects the fact that many of these patients suffer from underlying health problems. But their chances of further problems could be made worse if they don't get proper medical attention. "If they just don't feel right for any reason, they should take it seriously and they should talk to their health-care team … even if it is for something that doesn't seem related to the initial reason that they are hospitalized."

He said patients should also consider advanced-care planning, such as a living will or health-care proxy. "It is important for them to look ahead so they can exert control on their health care rather than have other people make decisions for them."

So what lessons does this study have for Canadian patients?

Heather Sherrard, vice-president of clinical services for the University of Ottawa Heart Institute, noted that readmission rates are not usually collected for a full year after discharge from hospitals in Canada. She also pointed out that the study is based on just one segment of the population – people, aged 65 and older, whose health care is paid by the U.S. medicaid system. That means it would not include younger people who have had heart attacks.

Despite these differences, "we would have somewhat of the same patterns in terms of readmissions and deaths," said Sherrard.

"Just because you have been in the system and gotten out, don't presume you are safe," she said. "It is a chronic disease and if you don't take your medications and don't follow what you are told at hospital you will be back."