The U.S. not only saw a significant decline in the overall rate of heart attack-related deaths in the past 20 years, but also a reduction in racial disparities for heart attack deaths, according to a study presented at the American College of Cardiology's Annual Scientific Session Together With the World Congress of Cardiology. The gap in the rate of heart attack deaths between White people and African American/Black people narrowed by nearly half over the 22-year period, researchers reported.
The findings, based on an analysis of data from the Centers for Disease Control and Prevention (CDC) from 1999-2020, indicate that age-adjusted rates of death attributed to acute myocardial infarction (the medical term for heart attack) fell by an average of over 4% per year across all racial groups over the two-decade period.
It's good news. Researchers often highlight the bad news, but people should know that even if we're not there yet, we're making progress in the right direction. I think the reasons are multifactorial, spanning all the way from health-promoting and prevention activities through treatment during and after a heart attack."
Muchi Ditah Chobufo, MD, cardiology fellow at West Virginia University and study's lead author
Researchers found the overall rate of death from heart attack, adjusted for age, fell from about 87 deaths per 100,000 people in 1999 to about 38 deaths per 100,000 people in 2020. Rates of heart attack-related death were highest among African American/Black people, with a rate of 104 deaths per 100,000 people in 1999 and 46 deaths per 100,000 people in 2020, and lowest among Asians and Pacific Islanders.
It is difficult to definitively determine whether the decline is the result of fewer heart attacks occurring or better rates of survival when they do occur because of new diagnostic strategies and treatment options, researchers said. For example, hospitals now frequently test for troponin in the blood when a heart attack is suspected, which can help clinicians diagnose a heart attack at an earlier stage than was possible with previous diagnostic strategies. This change has led to earlier and more sensitive heart attack detection but also makes it challenging to compare data on heart attacks over time.
On the prevention side, the public has become more aware of the need to reduce cardiovascular risk factors through steps such as quitting smoking and managing cholesterol. Clinicians also have a better understanding of the signs of a heart attack and improved tools to quickly diagnose and treat them when they occur. More hospitals are also equipped with mechanical support devices to assist with heart attack treatment and new medications such as potent antiplatelets have become available, which may have improved survival rates and reduced the likelihood of a second heart attack.
The study also found that racial disparities have narrowed considerably. For example, the difference in the rates of heart attack-related deaths between African American/Black and White individuals was about 17 deaths per 100,000 people in 1999 and eight deaths per 100,000 people in 2020. "That's a big closure of the gap," Chobufo said. "I didn't think the disparities were going to drop this far this fast."
One exception to the overall steady decline in heart attack-related deaths was a slight uptick in 2020. Researchers suggested this is likely related to the COVID-19 pandemic but said further study is needed to determine the causes for that change and the trajectory after that point.
"For everyone involved in providing the best care to these patients, they should know that they've been doing a great job," Chobufo said. "But that doesn't mean we can stop. Even one death is one too many, and even a disparity of one is a disparity of one too many. We can push even further and try to eliminate those gaps."
An estimated 80% of premature heart attacks and strokes could be prevented with heart-healthy lifestyle practices such as maintaining a healthy diet, exercising regularly and avoiding tobacco. In a separate study being presented at the meeting, only 1 in 10 Americans reported receiving recommendations from their doctor on how to maintain a heart-healthy lifestyle covering the four key areas of weight control, exercise, salt intake and fat or calorie intake. The study suggested clinicians could do more to ensure patients understand current recommendations for preventing heart disease, particularly earlier in life when forming heart-healthy habits brings especially large and long-lasting benefits. The trial, "Cardiovascular Risk Factor Burden and Control Among Young Adults Age 18 to 44 Years in the United States, 2009-2020," will be simultaneously published in the Journal of the American Medical Association.
According to the CDC, more than 800,000 people suffer a heart attack in the U.S. each year. Common signs of a heart attack include shortness of breath, pain or discomfort in the chest, jaw, neck, back, arm or shoulder; and feeling weak, lightheaded or faint. A heart attack is a medical emergency and anyone experiencing these symptoms should call 911 immediately and get to an emergency room.
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