You are only as young as your arteries is a familiar adage to doctors. While most people worry about cancer, it’s the state of their circulation that is most likely to determine their quality of life, or send them to an early grave, “furring up of the pipes” being the underlying cause of illnesses from impotence to stroke and heart attack. About a third of people in the UK still die from cardiovascular disease, which means it just pips cancer to take the “biggest killer” title. Despite the widespread perception that we are a nation of slothful fatties heading for an early grave, arterial disease has plummeted during my lifetime.
Today is the 50th birthday of the British Heart Foundation — and there is much to celebrate. When the organisation was formed in 1961, nearly 200,000 British men and women died from heart disease every year. Today, that figure has dropped to 80,000. And the fall in deaths among the middle aged is even more pronounced, suggesting the outlook is rosy.
There are a number of factors behind the drop, including falling smoking rates, better health education and improved living standards. But it’s the modern medical approach to managing risk factors, such as high blood pressure and cholesterol, and treating heart attacks that has changed the most.
Fifty years ago, heart attacks were often managed at home by GPs, not least because those who were admitted to hospital were unlikely to be offered anything different, standard protocol then being little more than pain relief (morphine) and bed rest (six weeks). There were no coronary care units, and cardiopulmonary resuscitation (CPR) and defibrillators were in their infancy. Little wonder that as many as a third of patients died on the ward.
Today, any decent first aider can do CPR, there are defibrillator units in supermarkets and every big hospital has a specialised cardiac unit where survival rates can be as high as 95 per cent or more; 19 out of 20 patients admitted with a heart attack will be discharged. And hospital stays have fallen from six weeks to a few days.
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But time is of the essence. Back in the Sixties it wasn’t unusual for a GP to see a patient complaining of severe chest pain hours, or even days, after their symptoms had started. These days chest pain is regarded as a medical emergency and people are encouraged to bypass their GP, dial 999 and get into hospital as soon as possible. There they will receive treatment to clear the blockage in their coronary artery that is starving their heart of essential nutrients, causing the pain and endangering their life.
There are two ways to restore normal coronary blood flow — using clot-busting drugs that dissolve the blockage, or passing a small balloon into the artery to stretch it and open it up (angioplasty). The trick is to remove the obstruction before any permanent damage is done. For clot-busting drugs, this means administering them within an hour of the onset of symptoms and within a couple of hours for angioplasty. It is a logistical nightmare, but one that the NHS is embracing.
When I visited the London Chest Hospital a couple of years ago, its angioplasty team was managing an average door-to-balloon time (from when the ambulance wheels stop to when the artery is dilated) of just 52 minutes. Four hundred staff managed to maintain this service 24 hours a day, seven days a week. Not every hospital can match that, and there is still great variation in access to such units across the UK, but strides are being made.
Even so, it’s no good having a super- efficient hospital service if there is delay in getting there. And this is why it is so important that the public treat chest pain as an emergency and dial 999. Minutes really can mean the difference between life and death.
For more information on heart attack and its treatment visit bhf.org.uk
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Act fast to survive a heart attack
Heart attack symptoms vary, but typically include central chest pain — often described as a heaviness or “crushing” — that lasts for ten minutes or more and may spread to the neck, jaw or arms.
Victims may appear pale and clammy, feel sick and/or faint, and complain of shortness of breath If in doubt, dial 999.
If you have aspirin to hand and are not allergic to the drug, crush one 300mg tablet in your mouth and swallow it.