Scholarship & Creativity

Updated 12:30 PM May 16, 2007

Scholarship & Creativity

Modern treatments lower risk of death, stroke, heart failure

People who suffer a heart attack or severe chest pain today are much less likely to die or experience long-lasting effects than their counterparts even a few years ago, according to a new international study reported in the Journal of the American Medical Association.

It's the first time a study has shown a significant drop in the rate of heart failure and death over such a short time in this population.

The change occurred at the same time hospitals increased use of certain drugs, tests and procedures that have proven to help reduce the immediate and long-term impact of acute heart problems, suggesting that concerted efforts to standardize heart care are working.

But, authors say many patients who could benefit from treatments aren't getting them. Previous data have shown that the United States lags behind some countries in several aspects of acute coronary care.

The study is from the Global Registry of Acute Coronary Events, which has collected data from 44,372 patients treated at 113 hospitals in 14 countries.

The new paper is by cardiologists from the University of Edinburgh in Scotland, Hospital Bichat in France and the U-M Cardiovascular Center.

All patients studied had suffered either a severe heart attack, called ST-elevated myocardial infarction (STEMI), or had acute coronary syndrome (ACS), which includes a kind of chest pain called unstable angina.

Between 1999 and 2006, the use of heart-protecting drugs increased markedly, including aspirin, cholesterol-lowering statins, clot-reducing drugs, blood thinners and blood pressure reducing drugs.

At the same time, the use of angiography to see blocked arteries in the heart and as an emergency or secondary treatment to reopen blockages increased by more than 30 percent in STEMI patients and about 20 percent in ACS patients.

"These data are extremely encouraging, and suggest that we're definitely improving heart care and patients' outcomes through the uniform use of evidence-based, proven treatments and the development of guidelines to help providers understand the evidence behind them," says Dr. Kim Eagle, co-author, who is the Albion Walter Hewlett Professor of Cardiovascular Medicine at the Medical School and director of the Cardiovascular Center.
—Kara Gavin, UMHS

Aspirin therapy may be less effective for women

A new study shows that aspirin therapy for coronary artery disease is four times more likely to be ineffective in women compared to men with the same medical history.

Studies historically have shown that aspirin therapy is less effective in women than in men, but it has remained unclear how much less and whether this affects patient outcomes.

Michael Dorsch, clinical pharmacist and adjunct clinical instructor at the School of Pharmacy, and his team originally set out to determine if patients with a history of heart attack were more apt to be aspirin resistant than those with coronary artery disease but no history of heart attack. They found that gender and not medical history was a predictor for aspirin resistance.

"I was surprised by how big of a difference it was for females," says Dorsch. "This is another piece of information that affirms we need more studies in women."

Aspirin therapy is a cornerstone in managing heart disease because it inhibits blood clotting and can reduce the risk of a nonfatal heart attack or stroke by about 23 percent. An estimated 20 million men and women take a low dose of aspirin (81-325 mg daily) to control heart disease. Despite its effectiveness, there is evidence that aspirin is less effective in some patients, and researchers don't know why. Most doctors do not check for aspirin resistance before prescribing the therapy and therefore presume it's working in the patient when it may not, he says.

There isn't enough evidence to show if people who are aspirin resistant can take larger doses, but Dorsch warns that people taking aspirin on the advice of a doctor shouldn't stop therapy.

Not only did the study quantify how much more effective aspirin therapy is for men than for women, it also is the first study that Dorsch knows of to measure aspirin resistance in men and women with stable coronary artery disease. Previous studies have looked at the impact of aspirin therapy on people who have had a heart attack.

The study was funded by the National Institutes of Health.
—Laura Bailey, News Service

Oakland County well equipped to weather the economic storm

Oakland County's economy has been so strong for so long that even a lousy year like 2006 cannot drop it from the ranks of the nation's most prosperous counties, say U-M economists.

After losing more than 18,000 jobs last year, Oakland County still rates in the top three among comparably sized U.S. counties for conditions that nurture economic prosperity—greater educational attainment, a younger population, fewer children in poverty, higher earnings and income, and fewer households where monthly housing costs are excessive.

"Oakland's affluent, well-educated community has much more promising prospects for long-term economic success than localities less endowed in these resources," says George Fulton of the Institute of Labor and Industrial Relations. "Much of the recent travail in the Oakland County economy stems from the shrinkage of the industrial economy, particularly the segment that pertains to the domestic automotive industry.

"The adverse impact on auto-related activity has been dramatic. Coupled with a slumping residential construction market and general economic weakness dampening much of the service-providing sector, the Oakland economy turned sharply downward in 2006."

In their annual forecast of the Oakland County economy, Fulton and colleague Don Grimes predict another 4,400 job losses this year. In 2008, they expect a net gain of only 200 jobs, before the recovery picks up a bit and adds 2,500 jobs in 2009.

Though Oakland is forecast to lose another 8,400 manufacturing jobs and another 2,900 construction jobs through 2009, private service-providing industries are projected to create 9,600 jobs during that time.

Health services will account for half of the net job gains. Other service industries expected to see employment growth over the next three years include: administrative support, mostly in temporary help services and professional employer organizations; leisure and hospitality, primarily restaurants, golf courses and country clubs; professional and technical services; and information services.

Industries that serve a growing population of aging adults are expected to add 7,300 jobs over the period, and employment in nonautomotive technology and research is forecast to continue substantial growth.
—Bernie DeGroat, News Service

More children expected to seek care at retail clinics

Many department stores and pharmacies have everything a consumer could ever need—food, clothing, home goods—even a walk-in health care clinic.

Results from the C.S. Mott Children's Hospital National Poll on Children's Health reveal a growing trend for adults and children to use retail clinics for routine health care needs, including screening tests and vaccinations.

The poll found that 10 percent of children and 11 percent of adults have used retail clinics, and 15 percent of children and 19 percent of adults plan to use them in the future. For the majority of the children, health care insurance covered the visit.

"This trend, and the fact that parents are so satisfied with the care they have received, suggests that the demand for retail clinic care for children will rise steadily," says Dr. Matthew Davis, director of the National Poll, part of the U-M Department of Pediatrics and Communicable Diseases and the Child Health Evaluation and Research Unit in the Division of General Pediatrics.

More than 20 companies today operate approximately 300 retail clinics in the United States, with an estimated 2,000 or more clinics expected to open by the end of 2008.

The National Poll, in collaboration with Knowledge Networks, Inc., conducted a random sample survey in March of 2,076 adults ages 18 and older.

They found that among parents who had taken their children to a retail clinic for care, more than 70 percent planned to return. The research also revealed that most of the children who use retail clinics have an established physician and health care provider. For those with regular physicians, Davis says, the use of retail clinics could present challenges in coordination of care. For now, he says, parents will be responsible for sharing information with primary physicians.

"Parents view retail clinics as a fresh and convenient alternative to taking their child to a doctor's office for minor health concerns—it saves them time, and most often is covered by their insurance. But there are pros and cons to seeking medical care for your child at these clinics, and we need to make sure that parents have the information they need to make educated consumer decisions," says Davis, associate professor of general internal medicine and pediatrics at the Medical School, and of public policy at the Gerald R. Ford School of Public Policy.
—Krista Hopson, UMHS

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