I was born in 1971. For some, that was not that long ago. For others (I’m looking at all you UVM students I bike past on the way to work!), it was ages ago.
However, during this blink in history, the field of cardiology and the treatment of heart attack have changed in stunningly incredible ways. The pace of this change was very attractive to me, and is one of the reasons I chose to become a cardiologist. I’d like to share with you some of these changes, with my own experience as mile markers along the journey.
Just a few short years before my birth, the rate of death from coronary artery disease in the United States hit its peak. This was not to last, as hospitals began to treat patients with heart attack in their newly-built cardiac care units instead of putting them in the room the farthest distance away from the observation of the nursing station for their 1-2 week admission, so that the patient “could get some rest.” Cardiologists also had just started to treat patients for their high blood pressure, high cholesterol, and tried to get them to quit smoking. All of these had been recently identified as “risk factors” for heart disease.
When I was in kindergarten, the chances of dying from your heart attack was 15 percent, but cardiologists began to attack that rate with new clot-busting drugs that could be given in the emergency room.
During my school-age years, cardiac surgeons were beginning to routinely improve circulation to blocked coronary arteries with coronary artery bypass graft surgery.
When I entered first grade, a cardiologist in Switzerland performed the first angioplasty on a partially blocked coronary artery. A cardiologist here at Mary Fletcher performed the first angioplasty in Vermont while I was in Mrs. Sizemore’s sixth grade math class. During that case, the surgeons had the operating room ready to go as back up for disaster. At the time, emergency heart surgery was required relatively frequently (about 1 in 30 cases) as a consequence of complications from angioplasty.
As I was putting on my parachute pants and a red leather Michael Jackson Thriller jacket getting dressed for middle school, the risk of dying from any given heart attack was inching below 10 percent, and all deaths from coronary artery disease in the United States was starting to fall, precipitously!
When I wore my maroon cap and gown as I graduated from Woodrow Wilson High School, cardiologists were implanting the first modern stents in coronary arteries, and as a result, the emergency surgery rate after these procedures dropped to below 1 in 500!
During my 100th hour of my critical care work week while I was in my medicine residency (these long, fatigue-inducing work weeks are no longer allowed – but that is another blog topic) and trying to make a career decision about what I wanted to do for the rest of my medical life, specialized fellowship training in interventional cardiology at the UVM Medical Center was officially certified by the American Board of Internal Medicine. It was the first program in New England with this privilege.
Around the time I was hunched over the TV and worrying about the Y2K computer virus, there was a paradigm shift in the treatment of heart attack. Instead of receiving clot-busting drugs, patients were doing better when they underwent emergency stenting. This soon became the standard of care, and the heart attack mortality rate dropped again.
When I was born, the era of “doing something” for coronary artery disease was just beginning. Today, we can treat your heart attack with stents, going through the small artery in your wrist, in less than one hour after you walk through the door, with a low emergency surgery rate (less than 1 in 1000). The risk of dying from any given heart attack is now less than 5 percent at the University of Vermont Medical Center!
Moreover, the Centers for Disease Control (CDC) has estimated that if the 1970 mortality rate for coronary disease had gone unchanged, more than 1.4 million Americans would be dying every year from it. Instead, they estimate that 425,000 Americans die from coronary disease each year, and the rate continues to fall. About half of this fall is secondary to better treatments for coronary artery disease, and the other half is due to prevention.
Thus, don’t be taken aback about the lecture on smoking cessation, exercise, and low-calorie diets from your cardiologist or your primary care physician. This stuff works!
Prospero B. Gogo, MD, is Director of the Cardiac Catheterization Laboratory at the University of Vermont Medical Center and Interventional Cardiologist. He is an Associate Professor at the Larner College of Medicine at UVM.