Level 2: Mid-level evidence

In recent years, a number of evidence-based interventions for cardiovascular disease have been incorporated into clinical practice guidelines. A recent nationwide study in Sweden analyzed a cohort of 61,238 consecutive patients (mean age 70 years) with first-time ST-elevation MI (STEMI) from 1996 through 2007. Over this time period, significant increases in the use of evidence-based procedures and medications were accompanied by significant decreases in mortality.

Primary percutaneous coronary intervention rates increased from 12% to 61%, reperfusion rates (either mechanical or pharmacologic) increased from 66% to 79% and revascularization rates increased from 10% to 84%.

Rates of medication use increased from 0% to 82% for clopidogrel, 23% to 83% for statins and 39% to 69% for ACE inhibitors and angiotensin II receptor blockers (P <0.001 for each). Use of aspirin, beta blockers, and calcium channel blockers was also significantly increased.

Over the same period, mortality dropped significantly. In-hospital mortality fell from 12.5% to 7.2%, 30-day mortality from 15% to 8.6% and 1-year mortality from 21% to 13.3% (P for trend <0.001 for each; JAMA. 2011;305:1677-1684).

Alan Ehrlich, MD, is an assistant clinical professor in family medicine at the University of Massachusetts Medical School in Worcester.