After heart attack, first 30 days riskiest

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The risk of sudden death or cardiac arrest after surviving a Heart attack is highest during the first 30 days and declines thereafter, according to a new report.

Dr. Scott D. Solomon, from Brigham and Women’s Hospital in Boston, and his colleagues documented the outcomes of 14,609 patients who had experienced a Heart attack. All were being treated with standard drug therapy and aspirin as well.

During an average follow-up of 2 years, there were 903 sudden deaths and 164 resuscitations after cardiac arrest, the multinational team reports in this week’s New England Journal of Medicine.

Overall, the risk of one of these events was 1.4 percent per month during the first 30 days, declining to 0.14 percent per month after 2 years.

Even among patients with the best heart function, “the rate of sudden death or cardiac arrest with resuscitation was more than six times as high in the first month as after one year,” the investigators report.

“Our data,” Solomon’s group concludes, “suggest the need to consider implementing strategies to prevent sudden death in selected patients before the time recommended by current guidelines.”

They note that under current Medicare regulations, an implantable cardioverter-defibrillator (ICD) - which can automatically administer a shock to re-start the heart if it stops - is only covered if it’s inserted 40 days or more after a Heart attack.

In a related editorial, Dr. Alfred E. Buxton, from Brown Medical School in Providence, Rhode Island, calls the current study “a useful reality check on the problem of sudden death” among survivors of a heart attack.

He suggests than an alternative to an ICD might be to provide vest defibrillators or automatic external defibrillators, which don’t have to be surgically inserted, for limited periods after a Heart attack.

SOURCE: New England Journal of Medicine, June 23, 2005.

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