What Other People's Heart Attacks Taught Me About Life


Heart disease is the number one cause of death in America. It is also one of the major reasons people are hospitalized. A huge chunk of medical training is centered on taking care of heart disease and keeping people alive after heart attack. But what if we weren't saving lives like we thought? Shortly after I started my medical training a study revealed that we weren't doing such a good job of saving lives after all! It also taught me a lesson about life that has lasted a lifetime.

One of the greatest dangers after a heart attack is an irregular heartbeat, especially when the extra beat begins in the ventricle, the bottom of the heart. If it occurs at the wrong instant the electrical impulse that initiates these beats can lead to a heart rate so rapid that the heart just wiggles instead of pumps, resulting in death. These extra beats, called Premature Ventricular Contractions (PVC's) are more common, and more dangerous, in the damaged heart muscle of patients after a heart attack.

To combat this problem, medications were developed to stop these PVCs. And stop the PVC's they did, decreasing the frequency of these beats by over 90%. These medications caught on rapidly and were soon being prescribed to all heart attack patients.
Until someone asked an important question- “We know that these drugs stop PVC's, and we assume this will save lives, but what if they don't?”
Enter the Coronary Arrhythmia Suppression Trial. Patients after heart attack were randomly assigned to one of two groups. One group received a PVC killer, the other group a sugar pill. The study was called off early due to a surprising result- people on the PVC drugs were dying at a rate three times higher than those on the sugar pills. There were fewer PVC's, but the meds changed the impact of the ones that were left, making them more deadly. The drugs were quickly pulled from the market.
There is a life lesson to be learned from the CAST project- make sure you are measuring the right thing. It is so easy to focus on the wrong thing, on things that do not help us achieve our ultimate goal.
I have made this mistake too many times. As a parent, I have at times focused on specific behaviors instead of the heart of my child. As a leader in the church, I have gotten caught up in making a sermon perfect, writing a great Sunday school lesson, or organizing a successful event instead of caring about people. As a doctor I have seen how easy it is to treat symptoms and diseases and forget the person sitting in front of me.
In my home, in my practice and in ministry it is possible to succeed in small meaningless areas and fail in the ultimate objective. The CAST study reminds me to pay attention to what is most important.