Tending broken hearts: How doctors handle the increase in heart disease survivors

Fewer people are dying of cardiac disease, but more people are living with it, creating significant challenges for primary care physicians.

By Victoria Stagg Elliott, AMNews staff. Sept. 5, 2005.

Over the past few years, Kevin Larsen, MD, a Minneapolis internist, has noticed that more and more patients pass through his office who are heart attack survivors.

"I have people in my practice who have died while they're out at the mall, and they are brought back to life," said Dr. Larsen, an assistant professor of internal medicine at the University of Minnesota Medical School. "Now they're a survivor of heart disease in a way that they wouldn't have been just a few years ago."

Still, no clear habits seems to emerge in the aftermath. Some patients become devoted to preventing a second event by changing their lifestyles and taking recommended medications. Others are not quite so dedicated, deferring secondary prevention either because of a lack of interest or money. They also might feel fine, making prevention seem less imperative.

"A number of them we'll see two years later, and they haven't been on any medications because they've felt well and didn't understand how sick they were," he said. "Some pay for it later and some don't."

Thus, what Dr. Larsen and many other physicians are increasingly facing is the downstream impact of the decreasing rates of mortality and increasing rates of morbidity associated with heart disease.

Heart disease is still generally considered the No. 1 killer in the United States for the population as a whole.

But according to "Cancer Statistics 2005," published by the American Cancer Society in the January/February issue of CA: A Cancer Journal of Clinicians, heart disease has been surpassed by cancer in those younger than 85. This statistic heralds the long-predicted shift in which cancer eventually takes over the top spot -- depending on how the numbers are crunched and diseases are defined.