skincaremanual.org

Heart attack not a death sentence

November 06, 2017

Research published today in BioMed Central's open access journal Critical Care is the first to show that the allocation of resources to the treatment of heart attack patients is equally as justified as the treatment of other intensive care patient groups.

More than 600,000 people in Europe suffer cardiac arrest each year. Following successful CPR, patients are routinely admitted to intensive care units (ICUs). Although ICUs only care for a minority of patients, they consume a large proportion of hospital budgets. The lead author of the study, Juergen Graf from the Philipps-University Marburg, Germany, said, "economic constraints create pressure to ration ICU care. Restricting the demand for futile medical services by limiting access to the ICU, at least for those patients likely to die anyway, has been proposed as a way of lowering expenditures".

In order to investigate this, Graf and his colleagues conducted an assessment of health status of patients five years after discharge from the ICU of Medical Clinic I, University Hospital Aachen, and combined this with a fully costed economic evaluation. Of 354 patients admitted to the ICU with cardiac arrest, 204 died prior to discharge from the hospital. Of the 150 remaining, 40 died before year five, leaving 110 patients (31%) eligible for the survey. The total costs for the ICU treatment of all 354 patients amounted to more than 6.3million euros.

According to Graf, "This is approximately double the cost of an average ICU patient, but it does compare favorably to a variety of other routine interventions such as mechanical ventilation or kidney dialysis". Furthermore, patients who survived cardiac arrest do not necessarily have as bleak a prognosis as is often anticipated. As the authors explain, "The health-related quality of life five years after discharge was only slightly lower than healthy controls of the same age and gender of the patients".

Graf concludes, "Our study is the first to demonstrate that patients who survive cardiac arrest without severe neurological disabilities may expect fair long-term survival and a good quality of life for reasonable expenses to the health care system".

ccforum

The study is described in an article that appeared in advance online publication on June 20, 2008 in the American Journal of Physiology. The participants were six men and six women, ages 60 to 75, who were not obese but who had been living an inactive lifestyle. They were put on an eleven-month program of endurance exercise under the careful guidance of a trainer.

For the first three months, they were required to exercise to about 65 percent of their maximum capacity. After that, the program was stepped up so participants reached about 75 percent of maximum. Soto says the volunteers enjoyed the experience and told him they felt in the best shape they had been in years.

The researchers tested the volunteers' heart metabolism before and at the end of their exercise programs by using PET scanning techniques. "Here at the School of Medicine, we are uniquely able to look at the metabolism of the heart because we have the right combination of technology and expertise in cardiology, radiology and radiochemistry," Soto says. "We are one of the few places that can do this kind of study."

Next, the research team will investigate exercise training in individuals with heart failure. "In the past heart failure patients were told to limit their activity," Soto says. "Now more and more we're seeing there is potentially a benefit to getting them as active as possible. We want to know if heart failure patients will experience the same benefit in heart metabolism with exercise that we saw for older people."

medicine.wustl/