The 14th Congress of the European Society of Cardiology in Barcelona: Clot-busting drugs 'cut heart deaths'

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The Independent Online
DEATHS from heart attacks could be halved in rural areas if family doctors carried 'clot-busting' drugs and gave them to patients at home immediately they had made the diagnosis.

Results of a new Scottish trial disclosed in Barcelona yesterday showed a 50 per cent reduction in deaths when patients were injected with the drug anistreplase within two hours of their attack.

Professor John Rawles, of the University of Aberdeen, told the congress that rural GPs should carry the drug in any area that was more than 30 minutes from the nearest hospital.

He also warned that in some urban areas lives could be saved even though patients lived closer to hospitals. 'In central inner cities having got to hospital the patient can sit in the accident and emergency department for an hour before being seen,' he said.

'The evidence from this trial is so conclusive that we need to look at all the ways of getting patients into coronary care far quicker.'

The study involved 311 patients and more than 100 GPs and hospital doctors in the Grampian region over two years. Overall, 36 patients died as a result of their attack but there would have been more deaths without the drug.

Professor Rawles said that the study was small and primarily designed to test the feasibility of GPs giving the drug. The number of expected deaths would have been small as well and they had not expected any meaningful results on the efficacy of the drug. But after only three months they could measure its benefit much to their surprise, he said. 'Giving the drug at home results in a reduction of half in mortality.'

The study, which is being formally published today in the British Medical Journal, also found that Scottish GPs were good at diagnosing heart attacks. Only 2 per cent of patients were found to be suffering from a different condition when specialists examined them on arrival in hospital. On average the patients in the trial lived 58 kilometres (36 miles) from Aberdeen Royal Infirmary.

Nearly 500 people die from heart attacks in Britain daily. Coronary heart disease is the biggest cause of death - killing one in three men and one in four women. Professor Douglas Chamberlain, president of the British Cardiac Society, commenting on the results said: 'These are very significant results and highlight the value of giving clot-busting drugs quickly. It is a very exciting study.'

But he warned GPs to be aware of the pitfalls of the drugs, which can cause brain haemorrhages in one in 200 patients.

Results of another study revealed in Barcelona yesterday showed that a drug usually used to treat high blood pressure and heart failure could reduce deaths by more than 20 per cent when given to patients after a heart attack. The drug, captopril, is an Ace inhibitor which works on hormones to make blood vessels dilate. More than 2,230 patients took part in the American trial.