What was it like to have a heart attack in 1961?
In 1961 300,000 people in the UK died of heart disease. Heart disease accounted for half of all the deaths in the UK and extremely little was known about it.
Dying of a heart attack was very common. Most people didn’t survive if they had one out of hospital. If you did survive and made it to hospital, you would be given painkillers like morphine and kept in bed for six weeks but survival rates were low.
The causes of heart disease were poorly understood – people didn’t know that heart attacks were caused by blood clots or that high cholesterol and blood pressure increased your risk of a heart attack.
Why was the BHF founded?
We were founded by a group of scientists concerned by the epidemic of heart disease and the woeful amount of money available for cardiac research in the UK. The UK was well behind other western countries.
Our founding committee comprised some of the foremost cardiologists of the day: Dr Maurice Campbell, Dr Paul Wood, Dr Evan Bedford and Dr William Evans.
Some of our breakthroughs in heart attack research through the decades
These are just a few of the huge breakthroughs we’ve helped to fund which helped to reduce the number of people having heart attacks and have changed the way heart attacks are treated.
1960s: Coronary care units
The idea of a coronary care unit might not seem revolutionary – if you were admitted to hospital today, you’d expect to be placed on a specialist ward dedicated to your condition. But in the late fifties and early sixties, this was an unheard of concept.
Heart patients were scattered around a hospital on general wards. If a patient went into cardiac arrest, there was often a lengthy delay before the right staff and equipment could be brought to the scene. These delays cost lives.
Professor Desmond Julian at the Edinburgh Royal Infirmary had a better idea. Just a junior doctor in 1961, he sketched out a plan for a specialist coronary care unit. He wanted to keep all heart patients in the unit, monitor them continuously and have the right equipment – and the right staff – on standby for emergencies.
We helped set up the first coronary care unit, funding equipment and nurses.
In its first year the unit saved the lives of an extra 7 out of every 100 patients admitted compared to the old method. Soon hospitals around the world were following the example set by the man who in 1986 would become our Medical Director until 1993.
1970s: Clots cause heart attacks
If you suffer a heart attack you’ll now be admitted to a coronary care unit. You may be resuscitated with a defibrillator, but for treatment you’ll still only be given painkillers and monitored for abnormal heart rhythms. Very few people believed blood clots in the arteries caused heart attacks. Without this knowledge heart attacks could not be treated effectively.
Before 1976, there were serious doubts about which came first, the clot or the heart attack. Clots were found in patients who had died after a heart attack but some doctors argued they had formed after death.
BHF Professor Michael Davies, undertook painstaking research on post-mortem hearts. In 1976 he published a groundbreaking paper demonstrating that blood clots caused heart attacks and not the other way round.
As a result of his work, researchers finally had a concrete cause of heart attacks to tackle. In time clot-busting drugs and procedures were developed, allowing doctors to treat – and prevent – heart attacks. It was a game-changing moment.
1980s: Clot-busting drugs and statins
In the early 1980s a study at Oxford University set out to determine whether survival after a heart attack could be improved by treatment with clot-busting drugs.
The International Study of Infarct Survival 2 Trial (or ISIS2 for short), led by BHF-funded researchers Peter Sleight and Rory Collins, involved giving some patients a clot-busting drug called streptokinase, along with aspirin. Other patients were given a placebo.
Worldwide, 417 hospitals took part, across 16 countries. The study found that clot-busting drugs cut deaths by nearly 40 per cent compared to no treatment.
Until this point there was some anxiety amongst doctors about the potential risks of using such drugs to dissolve clots, but this study revolutionised treatment for heart attacks. In 1987, a BHF survey showed that only 2 per cent of doctors prescribed clot-busting streptokinase, but by 1989, this had increased to 68 per cent.
Worldwide, the approach to heart attacks is to open up the blocked artery as quickly as possible, most commonly these days by primary angioplasty – a minimally invasive technique that uses a balloon to open up the blocked artery, or with clot busting drugs if this technique is not readily available.
Scientists had established that high cholesterol caused greater risk of a heart attack, but there was still some confusion as to whether a cholesterol lowering drug could help to prevent heart disease.
BHF Professor Stuart Cobbe set up the West of Scotland Coronary Prevention Study in 1989, in an area with high rates of heart disease. The study looked at people who had no evidence of heart disease but who did have high cholesterol. It was the first trial to give statins to a large number of such people and the findings showed that statin treatment was a safe way of lowering cholesterol and preventing heart disease in a high risk group.
1990s: Statins become standard treatment
In the mid-1990s we helped fund another large study that would further show that lowering cholesterol with statins prevents heart attacks.
The Heart Protection Study launched in 1994, led by BHF Professor Sir Rory Collins. The researchers studied 20,000 people who either had, or were at high risk of developing heart disease, in 64 hospitals around the UK. They found that statin treatment, even in people whose cholesterol was not particularly high, reduced the risk of a future heart attack or stroke. Now people who were at risk of heart disease could be put on statins to lower their cholesterol, so fewer people had heart attacks.
Statins are now the most commonly prescribed drug given to those at risk of developing heart disease. It’s estimated that they save around 7,000 lives in England each year alone. Even by the eve of the new millennium, people attending hospital with a minor heart attack or unstable angina were thought to have a good outlook.
But a large international research programmed called the GRACE study, led by BHF Professor Keith Fox in 1999, revealed that many of these people were at risk of having a major heart attack later.
Professor Fox and his team created a scoring system to help doctors identify which patients would benefit from more intensive treatments and more interventions. Today, official guidelines for treating patients with chest pain in the UK, Europe and America include the GRACE scoring system, or similar, and it’s saving lives across the globe.
2000s: Regenerative breakthroughs, but there’s more to do
Largely thanks to BHF research, seven in ten people now survive a heart attack. This statistic was unthinkable just 50 years ago.
However, when someone survives a heart attack, their heart is often permanently damaged causing a disabling condition called heart failure. There is currently no cure for heart failure and in its severest form it has a life expectancy worse than many cancers.
In 2011 we launched our Mending Broken Hearts appeal, with the ambition of finding a cure for heart failure by funding pioneering research into regenerative medicine.
In four years we’ve made great progress. We’ve established three world leading centres of regenerative medicine and researchers from the University of Oxford have already shown mouse hearts contain stem cells that can be stimulated to help repair. This was considered impossible just a few years ago.
These teams of BHF researchers are now determined to translate these findings in to new treatments for heart failure that could save many more lives within a generation.
We still need your help
We can only keep helping to make these great scientific breakthroughs with your help.