[HN Gopher] Heart attacks aren't as fatal as they used to be
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Heart attacks aren't as fatal as they used to be
Author : lr0
Score : 70 points
Date : 2025-07-05 15:27 UTC (7 hours ago)
(HTM) web link (www.vox.com)
(TXT) w3m dump (www.vox.com)
| oncallthrow wrote:
| The article should really have a picture of a cath lab at the
| top, not an AED. Advances in catheterization technology are the
| key factor in reducing heart attack deaths, not AEDs
| deadbabe wrote:
| Explain
| AnimalMuppet wrote:
| There is a procedure called a "catheterization" (hence "cath
| lab").
|
| I have two stents in my heart. They went in with a catheter
| through an artery in my wrist. They found the places in my
| heart where the arteries were 80% to 90% blocked, and placed
| stents there. They said I was five years from a heart attack.
|
| This was an _outpatient_ procedure. I went home that night.
|
| The worst part of it, for me, was that they put a serious
| tourniquet on my wrist, because once they took the catheter
| out, I had an open artery. My wrist felt like I lost a bar
| fight. It ached for a month.
|
| This is _so much better_ than having a heart attack.
|
| How did they know I needed this? I talked to a cardiologist.
| He told me that, as you age, your athletic performance drops
| slowly, over decades. That's normal. What's abnormal is when
| you suddenly can't do something you were able to do a month
| ago.
|
| So I paid attention when I realized, hey, a month ago I
| didn't get this winded playing ultimate frisbee. A month ago
| I recovered faster when I was winded.
|
| So I told that to my GP. He ordered a cardiac stress test for
| me. This basically is hooking you up to an EKG, putting you
| on a treadmill, running the treadmill faster and harder until
| you drop, and watching what your EKG does. If the shape stays
| the same except faster, you're good. If the shape changes,
| that's part of your heart not getting enough blood under
| load. My shape changed. So they ordered the catheterization
| for me.
|
| So cath labs are about preventing the heart attack, not
| keeping you from dying once you have one. Not dying is good.
| But not having it at all is better. I think that may have
| been the GP's point.
| khuey wrote:
| > So cath labs are about preventing the heart attack, not
| keeping you from dying once you have one.
|
| Cath labs *are* (also) about keeping you from dying once
| you have one. Inserting a stent into someone with an active
| MI can restore blood flow and minimize tissue damage.
| duskwuff wrote:
| Catheterization is the mode of access to the heart, not the
| entire procedure. Stenting is one procedure that can be
| carried out that way, but there are other procedures which
| can be performed that way as well, such as imaging, cardiac
| ablation, pacemaker or defibrillator installation, or valve
| replacement.
| pfannkuchen wrote:
| Which part needs to be explained? I think I understood the
| comment and I'm not in the industry. AED is an initialism for
| the electrical shock device you can use to (maybe) reboot the
| heart's OS when it locks up. Catheters are some kind of tube
| that gets implanted to bypass a non-functional part of the
| heart. Catheter procedures improving caused the change, not
| AEDs (apparently), so it's somewhat misleading to show an AED
| instead of something about catheters.
| roryirvine wrote:
| PCI (Percutaneous Coronary Intervention, performed in a
| catheterization laboratory) has become the usual first-line
| treatment for acute heart attacks.
|
| It's much more effective than previous treatments
| (essentially clot-busting drugs, blood thinners, and
| bedrest), particularly since Drug-Eluting Stents arrived in
| the early 2000s.
| FireBeyond wrote:
| Critical care paramedic here. The answer is "both".
|
| AEDs are a key factor in ensuring patient survival _until_ we
| can get them to the cath lab and get them ballooned.
|
| "High quality compressions, early access to defibrillation".
| For every minute you do not have an effective pulse, your
| chance of survival goes down about 10%.
|
| Airway management takes a distant back seat. Most meds we give
| are only mildly, or questionably effective.
|
| But being able to defibrillate a dysrhythmia early is the key
| to getting the heart working itself - chest compressions are
| the best we have, but still. It takes us minutes of
| compressions to get to a suitable arterial pressure for
| effective perfusion, but ten seconds or less to lose it.
|
| AEDs won't improve volume and arterial flow, but it'll give you
| a fighting chance of getting to the lab. Compressions alone are
| not going to do that - they will just preserve tissue.
| pipes wrote:
| What are AEDs? Aspirin? Blood thinners? I'm from the UK, so
| probably a naming difference!
| Eavolution wrote:
| AED: Automatic External Defibrillator, a defibrillator that
| doesn't need a trained operator
|
| Aspirin: a blood thinner and painkiller
|
| Blood thinners: given to people at risk of a heart attack
| to thin the blood and reduce the chance of blood flow being
| obstructed
| 5555624 wrote:
| AED - Automated External Defibrillator. They're portable
| device defibrillator which can deliver an electric shock.
| As I understand it, it detects an abnormal heart rhythm and
| shocks the rhythm back to normal. Note that there are some
| situations where they will not work. (For example,
| Pulseless Electrical Activity or PEA is "non-shockable.")
| dreamcompiler wrote:
| Correct. The shockable rhythms are ventricular
| fibrillation and ventricular tachycardia (racing heart).
| Fortunately these rhythms occur in many heart attacks.
|
| Unfortunately PEA and asystole (flatline) do too, and
| shocking won't fix those -- despite what movies and TV
| would often have you believe.
| FireBeyond wrote:
| Precisely. Well, when you're talking about AEDs - VF and
| VT.
|
| Defib is more like rebooting a malfunctioning heart,
| versus jump starting it.
|
| Paramedics with a manual defibrillator can do other
| things with other rhythms, but AEDs are limited to those.
| 5555624 wrote:
| > despite what movies and TV would often have you
| believe.
|
| Yeah, I found out the hard way, suffering PEA. AEDs are
| great; but, people should still learn CPR.
| khuey wrote:
| IIRC in the King's English:
|
| aspirin = acetylsalicylic acid
|
| blood thinners = anticoagulants
| oncallthrow wrote:
| They are called AEDs in the UK too
| paulpauper wrote:
| Yeah cancer is the big killer nowadays. Survival rates for stage
| 4 cancer still poor after many decades of research. Worse yet, in
| many instances there are no obvious risk factors, such as people
| in their 30s or 40s who get colon cancer and were not eligible
| for screening .
| yieldcrv wrote:
| that's to be expected, after we do the adequate screening for
| one older population and mitigate many of the advanced versions
| of that, then the previously edge case becomes more prevalent
| amongst all cases
|
| there is still a limited resource for the screening at this
| point, so that's a friction to expanding screening
| zahlman wrote:
| It's not just a question of scaling up the screening effort.
| Doctors are also concerned with potential harms caused by
| false positives.
| greedo wrote:
| What false positive would come out of a colonoscopy? You
| are visually looking for masses, and removing suspect
| polyps that are sent in for evaluation. The major potential
| harm of a colonoscopy is a bowel perforation. Serious
| complications occur roughly 0.3% of the time.
| Someone wrote:
| > Serious complications occur roughly 0.3% of the time.
|
| https://www.cancer.org/cancer/types/colon-rectal-
| cancer/abou..., _"the lifetime risk of developing
| colorectal cancer is about 1 in 24 for men and 1 in 26
| for women."_
|
| So, it's a 4% lifetime risk versus a 0.3% per colonoscopy
| risk. The outcomes for the two risks also are different,
| but I would think that for many healthy people (e.g.
| those under 40 years old), the risk of doing such a check
| are greater than that of not taking it.
|
| Reading https://en.wikipedia.org/wiki/Colorectal_cancer#S
| creening, that's one of the reasons frequent
| colonoscopies aren't advised.
| accrual wrote:
| > not eligible for screening
|
| Is this a thing? I thought I could walk into my PCP's office
| and schedule a screening any time, provided I may need to pay
| more out of pocket or something.
| BobbyTables2 wrote:
| PCP is certainly not going to be the one doing the
| colonoscopy.
|
| _maybe_ they'd do the stool sample or some silly blood test
| if you are extremely insistent and can somehow demonstrate a
| risk factor.
|
| I've dealt with a few PCPs and they seem less informed about
| their own area than a 30 sec google search.
|
| They're basically L6 tech support...
| exhilaration wrote:
| I read here (on Hacker News) that the stool test is
| actually really valuable and cheap enough to pay out of
| pocket prior to trying to justify an out-of-schedule
| colonoscopy.
| OptionOfT wrote:
| Not to mention the prepare for a colonoscopy is not
| pleasant.
| SoftTalker wrote:
| And colonoscopies are invasive procedures that have their
| own risks. Perforated bowel can turn this "routine"
| procedure into an emergency.
| TimorousBestie wrote:
| Colonoscopies here (midwestern US) are upwards of a couple
| thousand outside of the usual schedules enforced by insurance
| companies.
|
| If there's a complication they can easily skyrocket into the
| tens of thousands.
|
| Most people around here can't soak that.
| adwi wrote:
| Grandfather died of colon cancer at 43.
|
| Went into my PCP at 40 asking for a colonoscopy, he said
| insurance wouldn't cover it until I was 50.
|
| ...
| giardini wrote:
| Ask him to do a hemoccult (done in the office - doc sticks
| his finger up your a** and dabs it on a test material) or
| request a cologuard test (shit in a box at home and mail it
| to the lab! - loads of laughs driving cautiously to FEDEX!)
|
| The hemoccult (FIT or FOBT) tests are <$100 and the
| cologuard ~$700. Your insurance will likely cover (esp. the
| hemoccult test) all the more if you tell doctor of your
| family background. Hemoccult tests were part of my routine
| annual physical for decades and there are no familial
| tendencies.
|
| There are some caveats: e.g., avoid bloody foods in the
| days preceding these test (Chinese pigs' blood cubes,
| yummm!)
| gosub100 wrote:
| You shouldn't have to do this, but have you tried calling
| the colonoscopy practice and asking for a cash price? It
| might not be as expensive as you think.
| SoftTalker wrote:
| Screenings are not risk-free. There are always some false
| positives which then may lead to more invasive and
| unnecessary tests or treatment. There are a lot of rare
| conditions (based on age and/or history) that we don't screen
| for on a routine basis.
| tonyedgecombe wrote:
| Would screening improve the outcomes or just create more
| patients getting unnecessary treatment?
| greedo wrote:
| Catching colorectal cancer at an early stage improves
| survival rates tremendously. You have to weigh the risk of
| complications from the colonoscopy (primarily bowel
| perforation) with the improved outcomes. There's a cost
| element as well, since colonoscopies (without complications)
| can be several thousand dollars.
| ak217 wrote:
| Yes, colorectal cancer screening is estimated to reduce
| colorectal cancer mortality by 50% to 73%.
|
| https://pmc.ncbi.nlm.nih.gov/articles/PMC10093633/
|
| https://www.nejm.org/doi/full/10.1056/NEJMoa2208375
|
| Progressive screening using non-invasive assays like
| Cologuard and FIT is a valuable screening mode. The non-
| invasive assays are not perfect but they are improving.
| lostmsu wrote:
| What about overall mortality?
| jvanderbot wrote:
| My father didn't die of a heart attack, he died of an aneurysm.
| However, he had a massive "widow maker" heart attack and had to
| be revived from arrest in the ER, more than once.
|
| He had a heart beat, unconscious, for a few days, before the
| blood thinners caused the aneurysm, I'm told.
|
| So, is this a heart attack? Is this "less deadly?" No, it's a
| proximal classification. Maybe their cardiac care center has a
| metric to hit.
| VeninVidiaVicii wrote:
| Anecdotally I worked in the emergency department and ICU for
| 2.5 years as a scribe and translator in undergrad (ending about
| 7 years ago) and never saw a single person successfully
| revived. In the sense that everybody who ever got revived to
| the point that your dad did, in my experience, died.
| mv wrote:
| this is why american medical care is so expensive. Family's
| and Law make doctors "do everything" even when the doctors
| know there is 0.01% chance such a person even makes it out of
| the icu and that's not saying anything about brain function.
| golergka wrote:
| IMO it's still good that it's family's decision. Even if it
| is an incorrect one.
| KittenInABox wrote:
| I think its good, but I also think that we don't have
| enough education in the US populace about what this means
| realistically. "Pulling out all the stops" means that
| your loved ones last time on this earth is either in
| agony or comatose, neither of which I would tolerate of
| my dog much less my mother.
| kzrdude wrote:
| The biggest reason is probably that you need to fit a
| medical insurance agent, a lawyer and a doctor all around
| the same hospital bed to give care.
| Jare wrote:
| I'm pretty sure that in "socialized medicine" countries
| i.e. the rest of the civilized world pretty much, they also
| "do everything" even if chances are low. AND everyone
| involved (including family) can do their part in it without
| having to deal with papers, money, bills, proof of
| insurance, and the plethora of other likely speed bumps
| that exist in the US.
|
| So no, I don't think that's why. If anything, the amount
| and quality of average care for the average US citizen is
| lower, if life expectancy and my anecdotal observation are
| valid indicators.
|
| It's expensive because it's a business designed to make
| profit every step of the way, and over time has created
| many steps to feed.
| gosub100 wrote:
| Even if they die, reviving them still opens the door for
| organ and tissue donation.
| Calavar wrote:
| Off the top of my mind, I can think of two patients who I
| personally cared for in the days or weeks after CPR who had
| an outcome other than death or vegetative state. One patient
| walked out the door two weeks after admission. The other
| patient regained consciousness and was able to
| speak/communicate, but was bed bound, appeared to have
| sustained some degree of cognitive damage, and had to receive
| feeds through a gastric tube. She was in the hospital for
| about six months before being discharged to a nursing
| facility. That's the numerator. It's hard to quantify the
| denominator. 40 or 50 maybe? But that's a guess.
| mr_toad wrote:
| > heart attack and had to be revived from arrest
|
| Worth pointing out that heart attacks and cardiac arrest are
| not the same. A heart attack (myocardial infarction) is
| insufficient supply of blood to the heart, which causes damage.
| Cardiac arrest is when the heart stops completely (and is much
| more serious).
|
| Heart attacks can cause cardiac arrest (especially if not
| treated), but the most common outcome is not immediate death.
| With proper treatment maybe 95% of MCI patients will survive.
| The prognosis for cardiac arrest is much worse - ~90% of
| patients experiencing a cardiac arrest will not survive, even
| if temporarily revived.
| dreamcompiler wrote:
| _Out-of-hospital_ arrests are that deadly. Those that occur
| in a hospital are somewhat more survivable.
|
| Not a whole lot more, but if you're going to arrest you want
| to do it in a hospital with lots of nurses nearby.
| DarknessFalls wrote:
| Many heart attacks occur because people don't get enough
| exercise and overeat. This is often the result of clinical
| depression. Is the killer depression or is it heart disease?
|
| Same with the hyperlipidemia. It leads to eventual plaques in
| the arteries, which leads to heart attacks. But that's a
| genetic abnormality in the liver. The liver is pulling the
| trigger, the heart is taking the bullet.
| al_borland wrote:
| Preventative care also seems to be an issue. Medicare denied
| a test for my dad to check the state of his heart, because it
| wasn't really having any symptoms. When he found out the test
| was only about $100, he just paid for it himself. He'll be
| going in for a quintuple bypass next week. I guess Medicare
| was content to wait for a heart attack.
| kelseyfrog wrote:
| No doubt a decrease of smoking, availability of satins,
| cpr/defibrillators, and stents has led to a massive increase in
| prevention and survival.
|
| However, the diagnostic and treatment side has improved
| considerably in that time too. Troponin assays became widely
| available in the late 1990s/early 2000s, and dual antiplatelet
| therapy (aspirin + clopidogrel) around 2000s. These are part of
| the standard toolkit for detecting and treating MIs that simply
| didn't exist when I was young and are part of the story of making
| MIs catastrophic events to a more survivable disease.
|
| The article isn't wrong per se, but I do want to point out that
| it isn't comprehensive when it comes to listing the reasons.
| There are interesting advances that it left out.
| tuatoru wrote:
| Your point generalises. For instance, homicide rates have
| fallen in large part because many wounds that used to be fatal
| are now survived. Breast cancer death rates also are down
| because of better diagnosis and treatment.
| nurettin wrote:
| And transportation, electronic communication, beta blockers,
| blood diluters...
| loloquwowndueo wrote:
| *statins, not satins. Satin is nice though.
| exhilaration wrote:
| I would just like to recommend this excellent Radiolab episode
| about saving lives during heart attacks:
| https://radiolab.org/podcast/how-to-save-a-life
| thro230-0 wrote:
| Also as result of long covid, more young healthy people get
| hearth attack. They have better chance to survive hearth attack,
| than older people. It improves survival stats!
| southernplaces7 wrote:
| I as a relatively young man also hate it when my hearth is
| attacked. One can't even be secure before their own fireplace,
| in their own home any more.
|
| Hearth= area in home where fire is kept, usually for cooking.
|
| Heart= that sometimes unfortunate little knot of pumping muscle
| under your rib cage.
| rectang wrote:
| > _A sudden cardiac death is the disease equivalent of homicide
| or a car crash death. It meant someone's father or husband, wife
| or mother, was suddenly ripped away without warning._
|
| Now ever increasing numbers of people avoid an abrupt death and
| live long enough that misery and terrible quality of life extend
| for decades. Hooray for all of those who emphasize preventing
| death above all else, whether they are motivated by extracting
| medical fees during life's long slow twilight, or by more pure
| considerations.
| mr_toad wrote:
| Most people who recover from a heart attack will not suffer a
| terrible quality of life. Depending on the severity and the
| treatment many will live quite normal lives for decades, and
| die from something completely unrelated.
| dreamcompiler wrote:
| CAC tests are not without risk. Every CAC test is a CAT scan
| which means X-ray radiation.
|
| It is certainly the case that for a great many people the
| benefits of a CAC test outweigh the risks, but talk to your
| doctor before you rush out and get one.
|
| I wish it were possible to do a CAC test using MRI (and thus
| without ionizing radiation) but to the best of my knowledge it's
| not.
| Razengan wrote:
| Wish it was the case for some of my family :(
| randcraw wrote:
| "[...] people who undergo CPR outside of a hospital setting
| survive only 10 percent of the time. Within a hospital setting,
| CPR survival rates are only a bit higher -- about 17 percent."
|
| https://www.discovermagazine.com/health/contrary-to-popular-...
|
| So it seems CPR has contributed little to the survivability of
| heart attacks.
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