Long-term survival after a heart attack has improved significantly overall among Medicare beneficiaries, although poorer people and Black Americans have been left behind, a new study claims.
"Our results demonstrate some accomplishments and some work ahead; we are making progress on improving long-term outcomes overall, but we are failing to reduce the inequalities in long-term health outcomes that may cause death or another heart attack," said senior study author Dr. Harlan Krumholz. He is director of the Center for Outcomes Research and Evaluation at Yale School of Medicine, in New Haven, Conn.
For the study, Krumholz and his team analyzed the medical records of 3.9 million Medicare beneficiaries, average age 78, who survived for at least 30 days after a heart attack between 1995 and 2019. Nearly half of the patients were women.
During the study period, the death rate was nearly 73% and the rate of hospitalization for another heart attack was 27% in the 10 years after a heart attack. But 10-year death rates fell 1.5% a year and 10-year hospitalizations for another heart attack fell almost 3% a year during the study period.
Compared to patients hospitalized from 1995 to 1997, those hospitalized in 2007 to 2009 (the last three years for which full 10-year follow-up data were available) had a nearly 14% lower 10-year death risk and a 22.5% lower risk of another heart attack.
The 10-year death risk was higher (about 81%) for patients who had another heart attack than for those who did not (72%), the investigators found.
The study also found that hazard ratios for death and heart attack recurrence were: 1.13 and 1.07, respectively, for men versus women; 1.05 and 1.08, respectively, for Black patients versus white patients; 0.96 and 1.00, respectively, for other races (including American Indian and Alaska Native, Asian, Hispanic, other race or ethnicity) versus white Americans.
The findings show that measures to prevent a second heart attack could have important long-term consequences, according to the report published online May 4 in JAMA Cardiology.
"Another notable finding is that about a quarter of the patients had another heart attack over the next decade, perhaps indicating that we need to be bolder in efforts to prevent repeat events and ensure that patients have access to the information and medications that can reduce their risk," Krumholz said in a Yale news release.
For more on heart attack recovery, go to the American Heart Association.
SOURCE: Yale University, news release, May 4, 2022