Overview

A study of electronic healthcare records from the entire population of England has revealed how heart attack affects survivors’ health up to nine years later, and how these effects vary according to their age, sex and social background. This information could help doctors decide on preventative treatments that are tailored to people’s individual risks; empower patients to better understand the health dangers they face; and ultimately save lives.

The challenge

More people than ever are surviving heart attack, thanks to advances in treatments over the past 20 years. But to date, there’s been very little clear, supportive evidence on survivors’ long-term risk of developing different conditions.

“We wanted to be able to give clinicians and patients the information they need about the long-term planning after a heart attack, in terms of prevention steps that they could put in place, such as personal lifestyle changes. But without having data on what the risks are specific to them, they wouldn’t necessarily know what actions to take or what to look out for,” says lead author of the study, Dr Marlous Hall, from the Leeds Institute for Data Analytics and part of HDR UK’s Northern Better Care Partnership.

The solution

With funding from the Wellcome Trust and the British Heart Foundation, Dr Hall and colleagues studied every adult in England who was admitted to hospital with heart attack between 2008 and 2017.

By linking Hospital Episode Statistics data linked with national death records they investigated how many went on to have a second heart attack, heart failure, atrial fibrillation, stroke, peripheral vascular disease (a build-up of fatty deposits in the arteries that restricts blood flow), severe bleeding, dementia, kidney failure, diabetes and depression. They also looked at how many died. Finally, they compared them with other people within the population of the same age, sex and hospital location who’d not had a heart attack. Individuals who had experienced a heart attack and had one of the health outcomes were identified using ICD-10 and OPCS4.5 codes derived from the HDR UK Phenotype Library.

One third of the heart attack survivors went on to develop heart or kidney failure, 7% had another heart attack and 38% had died within the nine years of the study. People who’d had a heart attack were actually at a lower risk of getting some cancers, and their longer-term risk of dementia was similar to people in the non-heart attack population. Women who’d had a heart attack were at a higher risk of depression than men, and people from more deprived backgrounds typically experienced heart failure several years earlier than other heart attack survivors, the findings showed.

The impact

This study provides much-needed, robust evidence on the long-term health impacts of heart attack for the first time, and brand new insights on the risk of depression for women and earlier heart failure for people from more deprived backgrounds.

In the UK, in 2022, there were around 1.4 million heart attack survivors, so if the findings are extrapolated, this suggests there could be 414,400 new diagnoses of heart failure and 529,200 deaths by 2031. Health professionals can use the information from the study to target those at greatest risk and help more heart attack survivors live longer, healthier lives.

The study’s design was shaped by patients with lived experience of heart attack: although they’d been given diet and exercise advice directly after their heart attack, they told the research team that they’d had little information on what else to expect, which informed the long-term nature of the research.

Working with patients, Dr Hall and colleagues have now developed an interactive, open access tool for patients, carers and health professionals to show the absolute risks of different health problems after heart attack and encourage people to ‘act early rather than react late’. They’re also working with patient representatives to develop plain English summaries to spread the word among patient groups via the British Heart Foundation’s Heart Voices network.

“This information empowers patients to have the knowledge they need that’s relevant to them, which is the things that are most likely to impact them following a heart attack, so that they can have that conversation about it with their healthcare providers,” adds Dr Hall.

The next steps will be to broaden the research to include primary care data to better understand some of the health inequalities that were found, such as why women are at higher risk of depression after heart attack than men.

What the impact committee said

The committee were impressed by the study team’s ‘very comprehensive’ and ‘robust’ approach and commended the level of patient and public involvement and engagement, noting the “rare degree of involvement in analysis of this scale.” The study provides an example of the Phenotype Library, a tool developed by HDR UK.