Two major clinical trials
- In the UK, someone has a heart attack every two minutes.
- In 2005/06 the BHF invested over £1.2 million in clinical trials to help us find the best treatments for heart patients.
Major clinical trials
Two important British Heart Foundation funded trials investigating how we treat patients suffering threatened or actual heart attacks have shown that changing the way we treat chest pain in hospital could save 5,000 lives in the UK every year.
Action
RITA3, a ground-breaking five-year study led by BHF Professor Keith Fox at the University of Edinburgh, set out to discover the best treatment for sufferers from acute coronary syndrome, or ‘threatened’ heart attack.
To establish this, 1,800 acute coronary syndrome patients were distributed between two groups, both receiving traditional ‘medicine-based’ treatment including aspirin, statins and ACE inhibitors. One group then underwent an angiogram regardless of symptoms. This involves injecting a dye, which can be seen by X-rays, into the patient’s coronary arteries, to show where they are
narrowed or blocked. Guided by these results, doctors decided on appropriate treatment for the patients, such as angioplasty. In the second group, patients only underwent an angiogram if their symptoms suggested a severely narrowed artery.
The REACT trial also aimed to improve care for heart patients by investigating another unknown in the treatment of heart attacks. BHF research had already shown that the sooner a heart attack patient receives clot-busting medication (thrombolysis) the better, but doctors remained unsure of the best course of action when this fails to restore adequate blood flow.
Over 450 patients who suffered heart attacks, but in whom clot-busters failed to clear the blocked blood vessel in 90 minutes, were randomly assigned to three different treatment regimes, receiving either repeated clot-busters, supportive medication, or angioplasty (a technique in which a balloon is used to open up a narrowed or blocked artery) to reopen the blocked artery. After six months, the patients were reassessed to see which regimes had been most beneficial in the long term.
Impact
Both studies produced clear results that will shape future care in cardiology.
RITA3 showed that treatment directed by an early angiogram prevented a heart attack or death in between 3-4% of medium-to-high risk acute coronary syndrome patients in the five years following their first admission to hospital. With at least 155,000 sufferers in the UK, this suggests that this treatment regime could save over 5,000 lives.
In the REACT trial, angioplasty produced the most effective long-term results. Fewer patients had a recurrent heart attack or developed heart failure in the months after angioplasty compared with those who had received the other treatments, even though many had to be transferred to hospitals which had the necessary equipment, leading to an average delay of over 80 minutes.
Next steps
Studies like these will help to improve standards of hospital treatment for people with threatened and actual heart attack. Our autumn 2006 campaign will increase public awareness of the symptoms of a heart attack, helping more patients to seek treatment sooner.
The BHF is committed to emphasising the importance of improving the management of acute coronary syndrome and developing a care network among hospitals that will enable heart attack patients to access specialist centres more quickly.
The BHF will continue to fund important clinical trials to help identify the best treatment and care for heart patients. For example, a five-year study funded by the BHF and the Arthritis Research Campaign began in 2006. This trial aims to clarify whether routine prescription of statins might reduce the incidence of heart problems for rheumatoid arthritis sufferers, who are at higher risk than the general population.
RITA - Randomised Intervention Trial of Unstable Angina REACT - Rescue Angioplasty versus Conservative treatment or repeat |