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Can you survive more than one heart attack? Can you survive more than two? The surprising answer to the question of survival after myocardial infarction is answered here.

A heart attack used to be considered something you just weren't likely to survive.

As recently as 1950, almost the only thing a doctor could do for you after you had a heart attack was to give you what was politely called a water pill, a diuretic, such as furosemide (Lasix). Because the diuretic caused the kidneys to remove both fluid and essential electrolytes such as potassium, the inevitable result was fatigue, often severe fatigue. Heart attack patients had to spend much of their time in bed. Simply not getting enough sun led to vitamin-D deficiency diseases such as rickets and osteoporosis. People who survived heart attacks (and about 75 percent didn't) usually had just a year or two left to live, falling victim to a second heart attack if they survived the first.[1]

On the other hand, treating a heart attack was not terribly expensive. Going through my grandmother's trunk after she died, my cousins and I found the bill for four days in the hospital after her heart attack in 1948. It was for $47.25. She lived far longer than most, dying of a second heart attack in 1971.

How Many People Survive Their First Heart Attack?

In the US, in 2011 (the last year for which statistics are available), 725 thousand people had heart attacks. Of that number, 335 thousand died, that is, their first heart attack was also their last. About 40 percent of people who have heart attacks die with the first attack in the United States.[2] Statistics from 2103 show that about 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths [3].
 
Different groups of Americans, however, have very different survival rates after heart attacks. 
 
Sometimes the difference is in the local emergency medical response system. If you have a heart attack in Austin, Round Rock, or Georgetown, Texas, for example, where ambulances are equipped to begin procedures that usually have to wait for the emergency room, you are 10 times more likely to survive a cardiac arrest than you are in rural Tennessee. Sometimes the problem is traffic. You are about twice as likely to die waiting for help after a heart attack in New York City than the national average.

Predictors Of Sudden Death

Researchers at Wake Forest University in North Carolina analyzed data from two of the largest US cardiovascular studies, the ARIC (Atherosclerosis Risk in Communities) and the CHS (Cardiovascular Health Study). Together, these two studies included records for more than 18,000 participants. 
The data showed that in the United States [3]:
  • African-Americans are more likely to die of their first heart attacks than people of other races. However, 
    African-Americans are less likely to suffer from coronary artery disease.
  • People who are obese but not morbidly obese are more likely to die after their first heart attack, but so are people who are thin but not extremely thin.
  • High blood pressure is a better predictor of death than how "clogged" your arteries are on a scan.
  • A fast heart rate predicts death, especially when it is coupled with low blood pressure.
  • Certain abnormalities on an EKG are predictive of sudden death, but not of stable coronary artery disease.
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