After surviving a heart attack, the number of patients suffering a second attack within a year decreased between 2008 and 2017, although the rate of recurrent heart attacks, hospitalization for heart failure, and death remains high among heart attack survivors, according to a study by the American Heart Association.

Although the number of people dying from heart attacks has steadily decreased in recent decades, those who survive are at an increased risk of experiencing another heart attack or dying within a year after they leave the hospital. To examine this change in rates, researchers used data from Medicare and commercial health insurers on more than 770,000 women and 700,000 men who were hospitalized for a heart attack between 2008 and 2017.

They analyzed rates of recurrent heart attacks, procedures to open clogged heart arteries, and hospitalizations to treat heart failure during the first year after hospital discharge. According to the study results, recurrent heart attacks declined from 89.2 per 1000 person-years to 72.3 in women. Men saw less of a decline, from 94.2 per 1000 person-years to 81.3.

Notably, however, the rates did not decline among women 21 to 54 years of age or among men aged 55 to 79 years of age. Although the authors could not pinpoint a reason for the lack of decline in older men, they posited an idea for the lack of change in younger women.

“In women, it could be that younger women and their treating physicians may be more likely to miss signs of worsening heart disease,” said lead author Sanne AE Peters, PhD, in a press release.

Women also experienced a larger decline in recurrent heart disease event rates, going from 166.3 per 1000 person-years to 133.3 compared with 198.1 to 176.8 among men. Similarly, the rates of hospitalizations due to heart failure declined from 177.4 to 158.1 among women and from 162.9 to 156.1 among men.

The sex differences largely continued in the most recent year studied. In 2017, men had higher rates of heart attack and heart disease events as well as death, but women had higher rates of heart failure hospitalizations. These rates were adjusted for multiple variables including age, race, and various medical conditions and treatments.

“We expected to see a decline in the rate of events, however, we did not expect the rates to differ between the sexes,” Peters said. “It may be that the improvements in men were achieved before our study period, leaving less room for improvement in the most recent decade. It could also be that the attention paid to heart disease in women over recent years has resulted in the greater gains.”

The authors noted that the database used was large, multi-ethnic, and included a wide age range, although the findings might not be generalizable to the overall population. The data sources also did not include information on the severity of heart attack, so the reduction in repeat attacks over time may reflect a reduced severity of the initial attacks.

“Patients should speak with their doctors to ensure that they get the right treatment to prevent secondary events and must make sure that they adopt or maintain a healthy lifestyle,” Peters concluded.

REFERENCE
Recurrent heart attacks on the decline, yet risk remains high [news release]. American Heart Association; September 21, 2020. https://newsroom.heart.org/news/recurrent-heart-attacks-on-the-decline-yet-risk-remains-high?preview=1042. Accessed September 24, 2020.