How heart attacks became less deadly

Decades ago, a heart attack was often deadly, killing up to half of its victims within a few days. With only a vague understanding of the physiological processes underlying heart attacks, doctors couldn't do much but let nature take its course. Doctors were taught that what they should do for people having heart attacks was to keep them calm and quiet, ease their chest pain, do whatever was possible to prevent heart rhythm problems, and hope that another heart attack wasn't on its way.

Today, more than 90% of people survive myocardial infarction. That's the technical term for heart attack; it means an area of damaged and dying heart muscle caused by an interruption in the blood supply. Some of the decline in deaths is due to doctors' ability to diagnose and treat smaller, less deadly heart attacks. Some is due to the institution of specialized coronary care units in the early 1960s.

What changed?

Much of the improvement in heart-attack survival can be chalked up to the gradual understanding in the 1970s and 1980s that the main culprit behind heart attacks is the sudden formation of artery-blocking blood clots, and the new treatments that emerged from this knowledge. Growing use of aspirin, clot-busting drugs, and artery-opening angioplasty in the early stages of a heart attack account for more than half of the reduction in heart attack deaths since 1985, according to an analysis by Stanford researchers.

The improvement in survival hasn't come without a cost. More people surviving heart attacks means more people living with scarred and damaged hearts. This has contributed to the steady increase in heart failure, which now accounts for more than one million hospitalizations a year in the U.S. and costs nearly $40 billion annually.

Although we have come a long way, there is still much to be done:

• Get more heart attack victims to the hospital — and to treatment — within an hour of the start of symptoms.
• Develop faster and more accurate techniques for determining who is having a heart attack.
• Find ways to protect and support the heart during a heart attack.
• Devise treatments to rebuild and regenerate heart muscle after a heart attack.

More important, of course, is finding ways to prevent heart attacks and strokes from happening in the first place.