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Survival and spending

Overall, the percentage of heart attack patients who survive the first six months after their attack has gone up since 1999 -- from 73 percent to 78.5 percent. Americans, in fact, are much more likely to survive the immediate aftermath of a heart attack than people in other developed countries, according to the World Health Organization.

Spending on the care of heart attack patients has gone up in that time, too -- nearly 14 percent across the 15 years of the study, with a plateau in costs in the last six years.

But these across-the-board numbers mask huge variation in both mortality and dollars depending on which hospital patients were treated at, and what kind of care they received.

For instance, Medicare spending rose 44 percent in 15 years for one group of hospitals at the high end of spending growth. But Medicare heart attack spending dropped nearly 19 percent for those at the low end.

Early PCI: Cost-effective but varying use

Hospitals that focused on getting heart attack patients diagnosed and onto the angioplasty table within the first 24 hours after their first symptoms achieved the biggest gains in survival. As a whole, these hospitals actually lowered the average cost for a patient's post-heart attack care measured over six months, the analysis shows.

The percentage of patients getting this procedure done rapidly -- called early percutaneous coronary intervention or PCI -- doubled in the time period of the study. And hospitals that increased their use of early PCI the most actually had lower spending on several types of post-hospital care for their patients, including nursing home and in-home care.

"We also find that patients at high-volume hospitals benefit the most from early stenting treatments by interventional cardiologists," says co-author Jessica Van Parys, Ph.D. of Hunter College. "This finding is most likely because physician and nursing staff learn over time what works best for their heart attack patients."

Meanwhile, when looking across all hospitals, spending on skilled nursing facility care and home care doubled during the study period, and spending on outpatient care tripled.

But patients who saw doctors in outpatient visits more often after their heart attack were no less likely to die in those first six months, on average.

Going forward

The analysis also reveals a lot of opportunity to improve the care heart attack patients get in the first six months, and the value that the nation gets from the dollars spent on it.

Part of that effort could include providing hospitals and individual providers regular reports on their patterns of care their patients are receiving across all health care settings, and the related costs. This would also offer a chance to inform providers and administrators about the evidence behind -- or against -- certain practices.

"If we don't provide feedback they won't know where to improve," says Likosky. "We need to develop and implement models for evaluating ways to address both quality and spending. Better involvement of frontline providers in designing and implementing change is crucial, especially if we seek to reduce variability in quality and spending. Clinical providers are likely best suited to both know what works, and why."

Likosky and colleagues note that in Michigan and northern New England, cardiac care providers and hospitals have come together across their regions to pool data and feed reports back to each hospital and provider to drive improvement efforts. A similar effort for heart attack care nationwide could start with looking at what differentiates hospitals from one another, and what the low-cost/low-mortality hospitals can teach their peers.

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Keeping warm and safe

Warmth, of course, is a major concern in cold climate and snow emergencies. Since you'll be with your car, you'll have that as protection against the elements. but extra clothing (preferably wool), some blankets, and a sleeping bag will keep you warm if you are stranded for several days. Store these items in a plastic trash bag in your trunk or behind the seat of your pickup. I recommend wool clothing because buying modafinil online legal us sheds moisture, just in case you have to leave your car during wet or snowy weather. It's no fun being stranded and cold, and hypothermia is a real danger in cold weather.

If stranded, you may not want to run your vehicle heater for very long so you can conserve gasoline. But if you do run your car engine to operate the car heater, be sure you aren't breathing in carbon monoxide fumes from the exhaust. In a snow emergency, you must make certain that the car's exhaust pipe is not clogged with snow, and be sure the exhaust is not being sucked into the car through an open window at the rear of the vehicle. Opening a front window a bit will help admit fresh air into the passenger compartment. You can't smell carbon monoxide, so don't rely on your nose.

Finding supplies

Once you've ensured you and your family will be warm during a car emergency situation, you need to ensure you'll have enough food and drinking water. I realize that not everyone lives near a camping or sporting goods store stocked with all kinds of really great fold-up and lightweight camping equipment. Substitutes for many of the specialized camping equipment and freeze-dried foods you will need can be found in most grocery stores, if you know what to look for.

A '6-Pack' size cooler makes a perfect emergency food storage container for your car or truck.
A "6-Pack" size cooler makes a perfect emergency food storage container for your car or truck.

The two biggest complaints I hear from people when buying modafinil online legal us comes to buying emergency supplies are the high cost for items they may never actually use and the need to replace out-of-date food that was never eaten. Yes, those tasty freeze-dried, ready-to-eat meals from most camping stores are expensive, and yes, many may never actually be used. But that is also true of buying a fire extinguisher, as you don't intend to ever actually use buying modafinil online legal us either, but it's a real life saver if you do.

To address these high-cost concerns and the difficulty to locate camping stores that stock hard-to-find survival equipment, I decided to assemble a 10-day emergency food supply by shopping only in a typical chain grocery store, and I kept the total cost under $25. This is very cheap insurance if you travel through areas where you would not want to be stranded, and you will not be out that much if you have to occasionally replace items that have reached their expiration date.

Drinking water supply

A person can actually live many days without any food, but your body must have drinking water. This is easy to solve by tossing a few plastic gallons of bottled water in your vehicle's trunk, but these will not last long during an extended crisis, so an additional source of water is available by using purification tablets to treat any available surface water. For less than $5 you can purchase a bottle of tablets that will completely transform almost any water source into safe drinking water.

Unless you are stranded in a desert, you can usually find water somewhere, even if it's from a drainage ditch, creek, lake, or melting snow. You can use one of the empty gallon water containers to hold the collected surface water while you add the tablets, which will kill off all the bacteria and harmful organisms in about 30 minutes.

Food and drink mixes

When buying modafinil online legal us comes to stored emergency food, you want meals that are easy to prepare, use little or no cooking equipment, and tastes good. Since you could be injured or trapped, you want to keep buying modafinil online legal us very simple. You may have limited trunk space and may have to carry this emergency food supply some distance if you must leave your vehicle, so you want to keep its size and weight to a minimum. This means you need to buy foods that are highly concentrated and only require hot water to prepare.

There are many drink mixes and dehydrated food packs that are inexpensive and can be found in any large grocery store, although they are not actually advertised or sold as emergency or camping supplies. Be sure to check all expiration dates and purchase only the newest stock. Most of these recommended products can provide good nutrition and taste variety over many days. The packaged meals I am recommending are sold in individual moisture-proof foil pouches and require only a cup of very hot water to reconstitute into a tasty hot meal that will serve two people.

Select only dehydrated foods that can be prepared by adding hot water.
Select only dehydrated foods that can be prepared by adding hot water.