Welcome to Touch Briefings

Gregory S Thomas, Joshua M Sugino and Samuel Wann
American Heart Hospital Journal Volume 8 No.1

The first publication of one of the authors (GST) was an article on heart disease prevention written as a medical student 30 years ago.¹ Upon finishing his cardiology fellowship in the mid-1980s, he was asked, "What will you do if this prevention stuff works?" He reassured himself, answering, "That would be a good thing; I'll deal with it when the time comes."

Well, the time has come. An 'outbreak of wellness' is affecting patients with and at risk for cardiovascular (CV) disease across the US. Life expectancy rose from an estimated 47.3 years in 1900 to 69.7 years in 1960 and to 77.7 years in 2006 (see Figure 1).² Investigators attributed, respectively, 65 and 70% of these increases to decreases in CV disease mortality.^3,4 Largely because the decrease in CV disease mortality was greater in men than in women, the gap in life expectancy between the two genders decreased from 7.6 to 5.1 years between 1970 and 2004 (see Figure 1).

Remarkably, the age-adjusted annual death rate for CV disease has decreased by a mean of 2–3% since 1960 (see Figure 2).2 Despite increasing rates of obesity and diabetes, these decreases accelerated in the most recent years for which data are available. Age-adjusted annual decreases in CV mortality between 2000 and 2005 were 3.8, 2.8, 3.3, 6.6, and 2.8%.

This is terrific news. As a population, and for each of us individually, we can expect to live substantially longer. In addition, the decreasing prevalence of disability generally results in these being quality years.⁵ Cardiologists have enjoyed heady times over this period, with increasing income and greater stature among specialties. New technology to diagnose and 'fix' patients has exploded. Testing and interventional volume increased in both the hospital and the office.

This outbreak of wellness, however, has now affected our volume of work. Remarkably, despite the increasing average age of Medicare patients, the frequency of admission of Medicare patients for acute myocardial infarction (AMI) decreased by an average of 5.5% annually between 2002 and 2007 (see Figure 3).⁶ Among those admitted, in-hospital mortality also decreased.⁷ Over the same time period, admissions for the diagnoses of unstable angina and coronary artery disease (CAD) decreased by an average of 19.9% annually (see Figure 4), while unstable angina decreased by 6.1% annually.⁵ Chronic heart failure (CHF) and dysrhythmia admissions were more stable, with mean annual decreases of 2.7 and 0.9%, respectively.⁵

View Article here