Heart attack risk doubled for people with less education

A new report presents 10 quality and performance measures that are intended to help stakeholders including health systems, legislative bodies, and non-governmental organisations, as well as healthcare practitioners, patients, families and communities – in the effort to prevent sudden cardiac death.

The joint report from the American College of Cardiology and the American Heart Association is published online in the Journal of the American College of Cardiology and Circulation: Cardiovascular Quality and Outcomes.

Sudden cardiac death is an unexpected death due to the sudden cessation of cardiac activity, which is also known as sudden cardiac arrest. The two phrases are often used interchangeably; however, sudden cardiac death should only be used to describe fatal events.

Co-chair of the writing committee and professor of medicine at Duke University, United States, Sana Al-Khatib, said: “This is the first comprehensive measure set in the area of sudden cardiac death prevention.

“Our vision is that these measures will be developed, tested, and implemented in clinical practice and that implementation will improve patient care and outcomes.”

Also, people who leave school without a school certificate are more than twice as likely to have a heart attack as those with a university degree. This was according to groundbreaking new Australian research from the largest ongoing study of healthy ageing in the Southern Hemisphere, the Sax Institute’s 45 and Up Study.

Researchers investigated the links between education and cardiovascular disease events (such as a heart attack or stroke) by following 267,153 men and women in the state of New South Wales aged over 45, who are part of the Sax Institute’s 45 and Up Study, for over five years.

The results were published in the International Journal for Equity in Health and were the subject of discussion at the Cardiovascular Disease Inequalities Partnership Project meeting in the nation’s capital, Canberra.

“The lower your education, the more likely you are to have a heart attack or a stroke – that’s the disturbing but clear finding from our research,” said lead researcher Dr. Rosemary Korda, a Fellow at the National Centre for Epidemiology and Population Health at The Australian National University (ANU).

“Our study found that in adults aged 45-64 years, heart attack rates among those with no educational qualifications were more than double (around 150 per cent higher) those of people with a university degree.

The risk was around two-thirds (70 per cent) higher among those with intermediate levels of education (non-university qualifications).

“Mid-age adults who hadn’t completed high school were 50 per cent more likely to have a first stroke than those with a university degree; those with intermediate levels of education (non-university qualifications) were 20 per cent more likely.”

Korda said a similar pattern of inequality existed between household income and cardiovascular disease events.

“What these differences in cardiovascular disease rates between more and less disadvantaged groups show us is just how much cardiovascular disease in the population can be prevented. The Cardiovascular Disease Inequalities Partnership Project is continuing research in this area to better understand what is driving these socioeconomic differences.”

According to the researchers, in the United States, approximately 356,500 out-of-hospital cardiac arrests occur each year. Implementing evidence-based and guideline-endorsed recommendations for primary or secondary prevention of sudden cardiac death may prevent many of the sudden deaths occurring in the United States.

However, sudden cardiac death can occur in people who do not appear to be at risk for this outcome and accurate risk stratification is not achievable in most people.

“While some people – such as patients with heart failure – are known to be at risk of sudden cardiac death, others are not. We need initiatives to improve the quality of care for those with a known risk, but also for the victims of sudden cardiac arrest,” Al-Khatib said.

Sudden cardiac arrest is one of the leading causes of death. Even when a patient survives, the condition may have a devastating impact on the patient’s quality and length of life. This clinical outcome also imposes a heavy economic burden through healthcare costs.

Although guidelines exist for the prevention of sudden cardiac death, there has been an underutilization of public health initiatives, treatments and device therapies for at-risk patients. The writing committee attempted to identify performance measures that can assess the quality of care for the prevention of sudden cardiac death. Although sudden cardiac arrest and sudden cardiac death can affect people of all ages and demographics, the performance measures focus on adults. No limitations or restrictions for other demographics, such as sex, race/ethnicity, or socioeconomic status, were applied.

The performance measure set is intended to assist clinicians and help them provide better care for their patients at risk of sudden cardiac arrest and thereby to improve care and outcomes.

Performance and Quality Measures for the Prevention of Sudden Cardiac Death
1. Smoking cessation intervention in patients who suffered sudden cardiac arrest, have a life-threatening ventricular arrhythmia, or are at risk for sudden cardiac death

2. Screening for family history of sudden cardiac death

3. Screening for asymptomatic left ventricular dysfunction among individuals who have a strong family history of cardiomyopathy and sudden cardiac death

4. Referring for cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) education those family members of patients who are hospitalised with known heart conditions that increase the risk of sudden cardiac arrest

5. Use of implantable cardioverter defibrillators (ICDs) for prevention of sudden cardiac death in patients with heart failure and reduced ejection fraction who have an anticipated survival of more than one year

6. Use of guideline-directed medical therapy for prevention of sudden cardiac death in patients with heart failure and reduced ejection fraction

7. Use of guideline-directed medical therapy for prevention of sudden cardiac death in patients with heart attack and reduced ejection fraction

8. Documenting the absence of reversible causes of ventricular tachycardia/ventricular fibrillation cardiac arrest and/or sustained ventricular tachycardia before a secondary-prevention ICD is placed

9. Counseling eligible patients about an ICD

10. Counseling first-degree relatives of survivors of sudden cardiac arrest associated with an inheritable condition about the need for screening for the inheritable condition
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