Heart attack

Cerebrovascular diseases have become number one cause of mortality and morbidity
even in developing countries like India. Heart attack or acutemyocardial infarction (AMI)
represents one of the most disastrous conditions in this area associated with significant morbidity
and high mortality (Aggarwal & Mishra, 2017). Although patients who have experienced a
stroke are at heightened risk of recurrence, the majority of strokes (≈80%) are first events rather
than recurrent events. To reduce stroke rates, vulnerable populations must therefore be identified
for preventive interventions. Patients with uncontrolled hypertension and atrial fibrillation are
clearly at heightened risk. Among the remaining vulnerable groups, patients with symptomatic
atherosclerosis in any territory, including prior myocardial infarction (MI), are at heightened risk
of atherothrombotic stroke (Abed, Khalil, & Moser, 2015).

As one of the cadre of hospitals around the country participating in CMS’s voluntary
Bundled Payment for Care Improvement program, Loyola University Health System
(loyolamedicine.org) is a head of the curve on adapting to this new model of payment for heart
attacks. Loyola has not developed specific care plans for myocardial infarction or its other
bundles. Instead, it is focusing on improving post–acute care for patients, which is a key driver
of care costs, Whelan said. So, the hospital has worked to build relation- ships with skilled
nursing facilities and home health agencies to better coordinate post–acute care (Luscher &
Obeid, 2017).

The SWEDEHEART registry is particularly remarkable as—in contrast to most other

registries—it reports the results of every single patient managed within the Swedish healthcare
system, thus avoiding any recruitment bias; this registry really reflects real-world practice. In
their quest to identify the impact of changes of treatment on outcomes in this population, the
authors compared standard of care, be it medical, reperfusion, or primary percutaneous therapy ,
at 2-year intervals between 1995 and 2014 as regards 1-year cardiovascular and all cause
mortality (Kuehn, 2016).
 REFERENCE LIST

Abed, M. A., Khalil, A. A., & Moser, D. K. (2015). Awareness of modifiable acute myocardial infarction
risk factors has little impact on risk perception for heart attack among vulnerable patients. Heart
Lung, 44(3), 183-188. doi: 10.1016/j.hrtlng.2015.02.008
Aggarwal, K. K., & Mishra, S. (2017). Heart attack guidance for physicians: When to suspect, how to
diagnose, what to do? Indian Heart J, 69 Suppl 1, S6-S7. doi: 10.1016/j.ihj.2017.03.003
Bischof, T. R., & Kurz, D. J. (2015). [Follow-up care of patients after heart attack]. Praxis (Bern 1994),
104(16), 841-846. doi: 10.1024/1661-8157/a002086
Kuehn, B. M. (2016). Post-Acute Care Takes Center Stage in CMS (Centers for Medicare and Medicaid
Services) Plan to Expand Use of Bundled Payments for Heart Attack. Circulation, 134(19), 1503-
1504. doi: 10.1161/CIRCULATIONAHA.116.025796
Luscher, T. F., & Obeid, S. (2017). From Eisenhower's heart attack to modern management: a true
success story! Eur Heart J, 38(41), 3066-3069. doi: 10.1093/eurheartj/ehx569