Today in most countries of the world almost 50 per cent of patients in hospital for a cardiac condition began their treatment as emergency cases: chest pain at home... a cardiac arrest in the street. Thus, according to Dr Peter Clemmensen, local chairman of this year's Acute Cardiac Care congress which opened in Copenhagen on 16 October, of the 22 million hospital admissions in Europe each year for acute cardiac events, more than 10 million of them would have begun as an emergency and without warning. "Early diagnosis is crucial in these cases for successful treatment and survival," he says, describing acute coronary care as "the most challenging field of cardiology".
Such events - evident as chest pain or at worst a cardiac arrest - are invariably the prelude to one of the most critical episodes of health care. Acute cardiac care, that first emergency phase in which the event is assessed and its cause treated, embraces a broad spectrum of diagnoses ranging from unstable angina to acute heart failure, from myocardial infarction to other life-threatening disorders of the heart.
Dealing with these cases - and importantly as quickly as possible - is the theme of Acute Cardiac Care 2010, this year's congress of the ESC's Working Group on Acute Cardiac Care, which is taking place in Copenhagen from 16 -19 October.
1. Diagnosis as early as possible
While there has been progress in improving overall mortality rates following acute myocardial infarction (AMI), survival rates when the arrest takes place outside hospital are poor - and no better than 5 per cent in some European countries. The key to improving survival rates are early and accurate diagnosis; once in hospital and undergoing acute cardiac care, patients have a much better chance of survival.
So, much depends on immediate intervention, which can be much more efficiently introduced if diagnosis can be made in the ambulance. "Two-thirds of European ambulances are now able to transmit digitalised ECG recordings," says Dr Clemmensen. "If we can reopen the occluded arteries - by angioplasty, surgery or thrombolysis - within the first hour, we can usually prevent damage to the heart muscle and improve the chance of survival. Timing is crucial, so we'll be considering at the congress how a more efficient paramedical service with telemonitoring ECG can shorten the time delay between the onset of symptoms and treatment."
2. The risk-benefit of early thrombolytic therapy
The latest ESC guidelines on the treatment of acute coronary syndromes emphasise the importance of therapies to prevent thrombosis and maximise the effect of other treatments (PCI, percutaneous coronary intervention with balloon angioplasty and stent, or coronary artery by-pass surgery). However, it is now clear that the administration of some of these antithrombotic treatments is also associated with a high risk of gastric bleeding. The guidelines state: "Since the vast majority of PCI procedures eventually conclude with stent implantation, every patient scheduled for PCI should be considered for pre-treatment with clopidogrel, regardless of whether stent implantation is intended or not." However, therapies like clopidogrel or prasugrel are also associated with a risk of (gastric) bleeding and a variation in response. "This is important," says Dr Clemmensen, "and the congress will consider the most effective dose and the most effective treatment for each individual patient. There's a delicate balance between beneficial effect and risk of bleeding." Finding a way to find this balance remains a major challenge in acute coronary care.
3. Intensive care units
Surveys indicate that there is a shortage of intensive coronary care beds in European hospitals. One in 20 patients admitted to hospital with an acute coronary syndrome are in a state of "cardiogenic shock", a condition in which the heart fails to pump adequately and which is the leading cause of death for acute heart attack patients. Again, PCI is the standard treatment, but these patients, says Dr Clemmensen, are most efficiently treated in intensive care units. Several presentations at the congress will consider the most effective way of dealing with patients with cardiogenic shock and in less than ideal circumstances.
Acute Cardiac Care 2010 will present new data on the way acute cardiac patients are managed, particularly in accordance (or not) with the latest guidelines. There have been significant improvements in mortality rates in acute patients admitted to hospital. The challenge raised at this congress is how to improve survival rates in that short period of time between onset of symptoms and first medical contact.
среда, 22 июня 2011 г.
вторник, 21 июня 2011 г.
Manufacturer Removes Remaining Stocks Of Trasylol
Background: On Nov. 5, 2007, the U.S. Food and Drug Administration announced that Bayer Pharmaceuticals Corp. agreed to an FDA-requested marketing suspension of Trasylol, a drug used to control bleeding during heart surgery. At that time, preliminary results from a Canadian study suggested an increased risk for death compared to two other drugs used to control bleeding.
Bayer HealthCare Pharmaceuticals Inc. has notified the FDA that the company will begin removing the remaining Trasylol stock from the U.S. market, most of which is in warehouses and hospital or physician's stock. The FDA will work with Bayer to ensure a smooth and complete process.
Under a limited use agreement, access to Trasylol is limited to investigational use of the drug according to the procedures described in a special treatment protocol. The protocol allows treatment for certain patients who are at increased risk of blood loss and transfusions during coronary artery bypass graft surgery and who have no acceptable alternative therapy. Physicians using Trasylol in this situation must also verify that the benefits of the drug clearly outweigh the risks for their patients.
FDA limits access to certain drugs to patients with serious or immediately life-threatening disease or conditions who lack other therapeutic options and may benefit from such therapies. This type of access requires the submission of a protocol, which is reviewed and approved by the agency. Bayer has agreed to provide Trasylol through this mechanism for the limited use described above.
Trasylol is an antifibrinolytic drug approved to reduce blood loss during surgery and the need for blood transfusion in certain patient undergoing cardiopulmonary bypass in the course of coronary artery bypass graft surgery. Antifibrinolyitc drugs help slow the breakdown of blood clots and subsequent excessive bleeding.
Results from a randomized Canadian study that prompted last November's marketing suspension of Trasylol are expected to be published this week. The data contained in this article suggest that Trasylol appears to increase the risk for death compared to two other antifibrinolytic drugs used in the study.
The findings from this randomized study are similar to those from an observational study that was discussed at a September 2007 FDA advisory committee meeting. Based upon the data available at the time, the advisory committee recommended continued marketing of Trasylol. However, FDA requested the marketing suspension in the interest of patient safety based on the serious nature of the outcomes suggested in the preliminary data. The committee also advised that a large, randomized clinical study was needed to further assess Trasylol's safety compared to other drugs. This recently published Canadian study helps address this need for additional information.
The FDA has not yet received full study data from the study's researchers at the Ottawa Health Research Institute but supports Bayer's decision to completely remove Trasylol from regular use in the U.S. market. FDA is also reviewing the available Canadian study data to reassess the currently active special treatment protocol that provides access to Trasylol.
FDA oversight requires comprehensive and thorough studies of a drug not only during the pre-market review phase but throughout the drug's life cycle. As studies and data on Trasylol emerged over the years, FDA actions included labeling changes, safety communications to physicians and other health care professionals, public discussion and review of study data at two Advisory Committee meetings, as well as close scrutiny of the ongoing studies.
The agency will consider a variety of study designs to support the review process for future antifibrinolytics, and will incorporate into these considerations information from the recently published Canadian study. FDA will continue to publicly disseminate safety information.
Additional Information
Feb. 8, 2006-FDA Press Release on Public Health Advisory for Trasylol
Sep. 29, 2006-FDA Statement Regarding New Trasylol Data
Dec. 15, 2006-FDA Press Release Announcing Trasylol Label Changes
Oct. 25, 2007-FDA Early Communication on Trasylol Safety
Nov. 5, 2007-FDA Press Release Announcing Marketing Suspension of Trasylol
Treatment Use of an Investigational New Dug-21 Code of Federal Regulations
fda
Bayer HealthCare Pharmaceuticals Inc. has notified the FDA that the company will begin removing the remaining Trasylol stock from the U.S. market, most of which is in warehouses and hospital or physician's stock. The FDA will work with Bayer to ensure a smooth and complete process.
Under a limited use agreement, access to Trasylol is limited to investigational use of the drug according to the procedures described in a special treatment protocol. The protocol allows treatment for certain patients who are at increased risk of blood loss and transfusions during coronary artery bypass graft surgery and who have no acceptable alternative therapy. Physicians using Trasylol in this situation must also verify that the benefits of the drug clearly outweigh the risks for their patients.
FDA limits access to certain drugs to patients with serious or immediately life-threatening disease or conditions who lack other therapeutic options and may benefit from such therapies. This type of access requires the submission of a protocol, which is reviewed and approved by the agency. Bayer has agreed to provide Trasylol through this mechanism for the limited use described above.
Trasylol is an antifibrinolytic drug approved to reduce blood loss during surgery and the need for blood transfusion in certain patient undergoing cardiopulmonary bypass in the course of coronary artery bypass graft surgery. Antifibrinolyitc drugs help slow the breakdown of blood clots and subsequent excessive bleeding.
Results from a randomized Canadian study that prompted last November's marketing suspension of Trasylol are expected to be published this week. The data contained in this article suggest that Trasylol appears to increase the risk for death compared to two other antifibrinolytic drugs used in the study.
The findings from this randomized study are similar to those from an observational study that was discussed at a September 2007 FDA advisory committee meeting. Based upon the data available at the time, the advisory committee recommended continued marketing of Trasylol. However, FDA requested the marketing suspension in the interest of patient safety based on the serious nature of the outcomes suggested in the preliminary data. The committee also advised that a large, randomized clinical study was needed to further assess Trasylol's safety compared to other drugs. This recently published Canadian study helps address this need for additional information.
The FDA has not yet received full study data from the study's researchers at the Ottawa Health Research Institute but supports Bayer's decision to completely remove Trasylol from regular use in the U.S. market. FDA is also reviewing the available Canadian study data to reassess the currently active special treatment protocol that provides access to Trasylol.
FDA oversight requires comprehensive and thorough studies of a drug not only during the pre-market review phase but throughout the drug's life cycle. As studies and data on Trasylol emerged over the years, FDA actions included labeling changes, safety communications to physicians and other health care professionals, public discussion and review of study data at two Advisory Committee meetings, as well as close scrutiny of the ongoing studies.
The agency will consider a variety of study designs to support the review process for future antifibrinolytics, and will incorporate into these considerations information from the recently published Canadian study. FDA will continue to publicly disseminate safety information.
Additional Information
Feb. 8, 2006-FDA Press Release on Public Health Advisory for Trasylol
Sep. 29, 2006-FDA Statement Regarding New Trasylol Data
Dec. 15, 2006-FDA Press Release Announcing Trasylol Label Changes
Oct. 25, 2007-FDA Early Communication on Trasylol Safety
Nov. 5, 2007-FDA Press Release Announcing Marketing Suspension of Trasylol
Treatment Use of an Investigational New Dug-21 Code of Federal Regulations
fda
понедельник, 20 июня 2011 г.
New Analysis Showed That High Dose Lipitor Can Reduce The Risk Of Cardiovascular Events In Bypass Surgery Patients
Pfizer Inc announced that Lipitor® (atorvastatin calcium) 80 mg significantly reduced the risk of major cardiovascular events, including heart attack and stroke, by 27 percent in patients with heart disease who had previous coronary bypass surgery compared with patients taking the 10 mg dose of Lipitor. This analysis, designed and completed following the closure of the five-year Treating to New Targets (TNT) study, was published in the "Journal of the American College of Cardiology."
Intensive Lipitor therapy also provided a significant 30 percent reduction in the need for either repeat coronary bypass surgery or angioplasty, another type of interventional heart surgery, compared with Lipitor 10 mg.
Each year in the U.S., approximately 470,000 bypass surgeries are performed on 270,000 people. Patients in the TNT study who had undergone previous bypass surgery had a much higher likelihood of cardiovascular events than those who did not have prior bypass surgery. This especially high risk population tends to be under-treated with lipid-lowering therapy.
"Patients may be under the impression that once they have had coronary bypass surgery, they are no longer at high risk for heart attacks and strokes," said Dr. Rochelle Chaiken, vice president of Pfizer's global cardiovascular and metabolic medical team. "Although these patients continue to be at an increased risk for major cardiovascular events and repeat heart surgery, statins are considerably underused. This analysis highlights not only the importance of treating, but also treating aggressively with Lipitor 80 mg."
Both doses of Lipitor (80 mg and 10 mg) were well-tolerated in patients with prior coronary bypass surgery, and the safety profile of Lipitor 80 mg was comparable to Lipitor 10 mg, a finding that was consistent with the overall TNT population.
About the TNT Study
The TNT study was an investigator-led trial coordinated by an independent steering committee and funded by Pfizer. The primary endpoint was the reduction of major cardiovascular events, including death from heart disease, non-fatal heart attacks, resuscitated cardiac arrest, and fatal or non-fatal strokes.
The study enrolled 10,001 men and women with coronary heart disease aged 35 years to 75 years in 14 countries and followed them for an average of five years. In this analysis, 4,654 patients who had previous coronary bypass surgery were compared with 5,347 patients who did not. Lipitor 80 mg is not a starting dose.
About Coronary Bypass Surgery
Coronary bypass surgery is a procedure in which damaged sections of the coronary arteries (arteries that bring blood to the heart muscle) are replaced with healthy blood vessel segments. The surgery reroutes, or "bypasses," blood around clogged arteries to improve blood flow and oxygen to the heart.
This procedure is done because arteries that bring blood to the heart muscle can become clogged by plaque (a buildup of fat, cholesterol and other substances). This can slow or stop blood flow through the heart's blood vessels, leading to chest pain or a heart attack. Increasing blood flow to the heart muscle can relieve chest pain and reduce the risk of heart attack.
About Angioplasty
Angioplasty is a type of interventional heart surgery which encompasses a variety of procedures used to treat patients with diseased arteries of the heart, such as:
- Chest pain caused by a build-up of fats and cholesterol.
- Other substances from the blood (referred to as plaque) that can reduce blood flow to a near trickle.
- A heart attack caused by a large blood clot that completely blocks the artery.
Typically, angioplasty is performed by threading a slender balloon-tipped tube - a catheter - from an artery in the groin to a trouble spot in an artery of the heart. The balloon is inflated, compressing the plaque and widening the narrowed coronary artery so that blood can flow more easily. This is often accompanied by inserting an expandable metal stent (a small mesh tube) to keep the artery open.
About Lipitor
Only Lipitor offers these three benefits important in a statin: FDA approval to reduce the risk of heart attacks, strokes and other cardiovascular events in patients with or without heart disease; the ability to reduce "bad" cholesterol (LDL) by 39 percent to 60 percent; and a well-established safety profile across a broad range of patients.
It is the most prescribed cholesterol-lowering therapy in the world, with nearly 151 million patient-years of experience. Lipitor is supported by a 15-year clinical trial program involving more than 400 ongoing and completed trials with more than 80,000 patients.
Important U.S. Prescribing Information
Lipitor is a prescription medication. It is used in patients with multiple risk factors for heart disease such as family history, high blood pressure, age, low HDL ("good" cholesterol) or smoking to reduce the risk of heart attack, stroke, certain kinds of heart surgery, and chest pain.
Lipitor is used in patients with existing coronary heart disease to reduce the risk of heart attack, stroke, certain kinds of heart surgery, hospitalization for heart failure, and chest pain.
Lipitor is also used in patients with type 2 diabetes and at least one other risk factor for heart disease such as high blood pressure, smoking or complications of diabetes, including eye disease and protein in urine, to reduce the risk of heart attack and stroke.
When diet and exercise alone are not enough, Lipitor is used along with a low-fat diet and exercise to lower cholesterol.
Lipitor is not for everyone. It is not for those with liver problems. And it is not for women who are nursing, pregnant or may become pregnant.
Patients taking Lipitor should tell their doctors if they feel any new muscle pain or weakness. This could be a sign of rare but serious muscle side effects. Patients should tell their doctors about all medications they take. This may help avoid serious drug interactions. Doctors should do blood tests to check liver function before and during treatment and may adjust the dose. The most common side effects are gas, constipation, stomach pain and heartburn. They tend to be mild and often go away.
Lipitor
Intensive Lipitor therapy also provided a significant 30 percent reduction in the need for either repeat coronary bypass surgery or angioplasty, another type of interventional heart surgery, compared with Lipitor 10 mg.
Each year in the U.S., approximately 470,000 bypass surgeries are performed on 270,000 people. Patients in the TNT study who had undergone previous bypass surgery had a much higher likelihood of cardiovascular events than those who did not have prior bypass surgery. This especially high risk population tends to be under-treated with lipid-lowering therapy.
"Patients may be under the impression that once they have had coronary bypass surgery, they are no longer at high risk for heart attacks and strokes," said Dr. Rochelle Chaiken, vice president of Pfizer's global cardiovascular and metabolic medical team. "Although these patients continue to be at an increased risk for major cardiovascular events and repeat heart surgery, statins are considerably underused. This analysis highlights not only the importance of treating, but also treating aggressively with Lipitor 80 mg."
Both doses of Lipitor (80 mg and 10 mg) were well-tolerated in patients with prior coronary bypass surgery, and the safety profile of Lipitor 80 mg was comparable to Lipitor 10 mg, a finding that was consistent with the overall TNT population.
About the TNT Study
The TNT study was an investigator-led trial coordinated by an independent steering committee and funded by Pfizer. The primary endpoint was the reduction of major cardiovascular events, including death from heart disease, non-fatal heart attacks, resuscitated cardiac arrest, and fatal or non-fatal strokes.
The study enrolled 10,001 men and women with coronary heart disease aged 35 years to 75 years in 14 countries and followed them for an average of five years. In this analysis, 4,654 patients who had previous coronary bypass surgery were compared with 5,347 patients who did not. Lipitor 80 mg is not a starting dose.
About Coronary Bypass Surgery
Coronary bypass surgery is a procedure in which damaged sections of the coronary arteries (arteries that bring blood to the heart muscle) are replaced with healthy blood vessel segments. The surgery reroutes, or "bypasses," blood around clogged arteries to improve blood flow and oxygen to the heart.
This procedure is done because arteries that bring blood to the heart muscle can become clogged by plaque (a buildup of fat, cholesterol and other substances). This can slow or stop blood flow through the heart's blood vessels, leading to chest pain or a heart attack. Increasing blood flow to the heart muscle can relieve chest pain and reduce the risk of heart attack.
About Angioplasty
Angioplasty is a type of interventional heart surgery which encompasses a variety of procedures used to treat patients with diseased arteries of the heart, such as:
- Chest pain caused by a build-up of fats and cholesterol.
- Other substances from the blood (referred to as plaque) that can reduce blood flow to a near trickle.
- A heart attack caused by a large blood clot that completely blocks the artery.
Typically, angioplasty is performed by threading a slender balloon-tipped tube - a catheter - from an artery in the groin to a trouble spot in an artery of the heart. The balloon is inflated, compressing the plaque and widening the narrowed coronary artery so that blood can flow more easily. This is often accompanied by inserting an expandable metal stent (a small mesh tube) to keep the artery open.
About Lipitor
Only Lipitor offers these three benefits important in a statin: FDA approval to reduce the risk of heart attacks, strokes and other cardiovascular events in patients with or without heart disease; the ability to reduce "bad" cholesterol (LDL) by 39 percent to 60 percent; and a well-established safety profile across a broad range of patients.
It is the most prescribed cholesterol-lowering therapy in the world, with nearly 151 million patient-years of experience. Lipitor is supported by a 15-year clinical trial program involving more than 400 ongoing and completed trials with more than 80,000 patients.
Important U.S. Prescribing Information
Lipitor is a prescription medication. It is used in patients with multiple risk factors for heart disease such as family history, high blood pressure, age, low HDL ("good" cholesterol) or smoking to reduce the risk of heart attack, stroke, certain kinds of heart surgery, and chest pain.
Lipitor is used in patients with existing coronary heart disease to reduce the risk of heart attack, stroke, certain kinds of heart surgery, hospitalization for heart failure, and chest pain.
Lipitor is also used in patients with type 2 diabetes and at least one other risk factor for heart disease such as high blood pressure, smoking or complications of diabetes, including eye disease and protein in urine, to reduce the risk of heart attack and stroke.
When diet and exercise alone are not enough, Lipitor is used along with a low-fat diet and exercise to lower cholesterol.
Lipitor is not for everyone. It is not for those with liver problems. And it is not for women who are nursing, pregnant or may become pregnant.
Patients taking Lipitor should tell their doctors if they feel any new muscle pain or weakness. This could be a sign of rare but serious muscle side effects. Patients should tell their doctors about all medications they take. This may help avoid serious drug interactions. Doctors should do blood tests to check liver function before and during treatment and may adjust the dose. The most common side effects are gas, constipation, stomach pain and heartburn. They tend to be mild and often go away.
Lipitor
воскресенье, 19 июня 2011 г.
Iron Deficiency In Heart Failure
Iron plays a key role in human homeostasis. It is essential for growth and survival, and is a vital ingredient in numerous processes including erythropoiesis, oxygen transport and storage, oxidative metabolism in the skeletal and heart muscle, synthesis and degradation of lipids, carbohydrates, DNA and RNA. Important though it is, iron metabolism must be precisely controlled because iron is insoluble and excess levels can be toxic.
Iron deficiency is a relatively common nutritional disorder that affects more than one third of the general population, and is often associated with chronic diseases such as inflammatory bowel disease, Parkinson's disease, rheumatoid diseases and renal failure. Until recently, there has been little interest in the linkage between iron deficiency and the natural course of chronic heart failure (CHF) syndrome. Traditionally iron deficiency has been linked with a presence of anaemia in CHF, and its reported prevalence varies from 20 percent to 70 percent. Recent research carried out at the Military Hospital, Medical University of Wroclaw has now demonstrated that iron deficiency must be viewed in a much broader clinical context, as it also affects at least one-third of non-anaemic CHF patients.
The research was led by Doctor Piotr Ponikowski, who said, "Iron deficiency appears to be independent of the severity of CHF symptoms, and occurs irrespective of anaemia. It also seems to be associated with exercise intolerance and leads to a reduced quality of life. Our research shows that it probably constitutes an ominous sign of a poor outcome, independently of the other well-established prognosticators. In light of its high prevalence and clinical consequences, iron deficiency may well be perceived as an attractive therapeutic target in CHF."
Several earlier reports have already shown that, in iron deficient CHF patients, iron repletion can safely improve functional capacity, exercise tolerance and quality of life. Cardiologists should become more aware of the importance of iron deficiency in CHF patients, and be able to evaluate iron status using a combination of simple, clinically relevant parameters of iron metabolism. More studies are needed to evaluate whether correction of iron deficiency in CHF would translate into clinical benefits.
Sources: European Society of Cardiology (ESC), AlphaGalileo Foundation.
Iron deficiency is a relatively common nutritional disorder that affects more than one third of the general population, and is often associated with chronic diseases such as inflammatory bowel disease, Parkinson's disease, rheumatoid diseases and renal failure. Until recently, there has been little interest in the linkage between iron deficiency and the natural course of chronic heart failure (CHF) syndrome. Traditionally iron deficiency has been linked with a presence of anaemia in CHF, and its reported prevalence varies from 20 percent to 70 percent. Recent research carried out at the Military Hospital, Medical University of Wroclaw has now demonstrated that iron deficiency must be viewed in a much broader clinical context, as it also affects at least one-third of non-anaemic CHF patients.
The research was led by Doctor Piotr Ponikowski, who said, "Iron deficiency appears to be independent of the severity of CHF symptoms, and occurs irrespective of anaemia. It also seems to be associated with exercise intolerance and leads to a reduced quality of life. Our research shows that it probably constitutes an ominous sign of a poor outcome, independently of the other well-established prognosticators. In light of its high prevalence and clinical consequences, iron deficiency may well be perceived as an attractive therapeutic target in CHF."
Several earlier reports have already shown that, in iron deficient CHF patients, iron repletion can safely improve functional capacity, exercise tolerance and quality of life. Cardiologists should become more aware of the importance of iron deficiency in CHF patients, and be able to evaluate iron status using a combination of simple, clinically relevant parameters of iron metabolism. More studies are needed to evaluate whether correction of iron deficiency in CHF would translate into clinical benefits.
Sources: European Society of Cardiology (ESC), AlphaGalileo Foundation.
суббота, 18 июня 2011 г.
Grant Received By Heart Researchers To Study Asthma
A research grant program that encourages "thinking outside the box" will allow a team of University of Iowa investigators to apply findings from heart research to the study of asthma.
Specifically, the team has received a three-year, $750,000 grant from the Strategic Program for Asthma Research, known as SPAR, to see if an enzyme known to play a role in heart failure might also affect smooth muscle cells in the airway and thus play a role in asthma. The basic science research focuses on CaM kinase II, which has been under scrutiny in other UI research.
"We are taking a fresh look at the role of calcium signaling in asthma, and are applying some ideas and results from the cardiovascular field that have never before been considered in the field of asthma," said study investigator Isabella Grumbach, M.D., Ph.D., assistant professor of internal medicine in the UI Roy J. and Lucille A. Carver College of Medicine.
The study team includes five UI faculty members, four of whom are based in cardiology and have never studied asthma, and only one whose field of expertise is asthma. The team aims to learn more about airway smooth muscle cells.
Grumbach's lab will grow the cells and monitor their response (for example, for inflammation) to the enzyme. She also will supply mouse models to investigate the response of airway smooth muscle cells to CaM kinase II inhibition.
The study will be led by Mark Anderson, M.D., Ph.D., UI professor of internal medicine and molecular physiology and biophysics, who has previously published, and has other studies underway, on CaM kinase II as it relates to heart issues.
Competition for the award was considerable, noted Anderson, with only 17 projects out of 255 applications funded this year.
"This kind of research is meant to help examine 'holes' in the paradigm of current asthma understanding. We're not asking safe, predictable questions, but getting involved because sometimes people from outside a field can help with a paradigm shift," said Anderson, who also holds the Potter-Lambert Chair in Cardiology.
In addition to Grumbach and Anderson, the team includes Joel Kline, M.D., professor of internal medicine; Peter Mohler, Ph.D., associate professor of internal medicine; and Long-Sheng Song, M.D., assistant professor of internal medicine. Anderson, Grumbach, Mohler and Song also are members of the UI Heart and Vascular Center.
Kline is an asthma expert and provided precursor data to help the team apply for the study. Mohler has expertise in helping determine the mechanical and electrical function of cells, while Song brings expertise in measuring calcium responses.
"It's a great partnership, and another example of what can happen when there is a focus on innovative scientific collaboration by generous funders and motivated researchers," Anderson said.
Learn more about SPAR, which is funded by the American Asthma Foundation, at sandlerresearch/.
Specifically, the team has received a three-year, $750,000 grant from the Strategic Program for Asthma Research, known as SPAR, to see if an enzyme known to play a role in heart failure might also affect smooth muscle cells in the airway and thus play a role in asthma. The basic science research focuses on CaM kinase II, which has been under scrutiny in other UI research.
"We are taking a fresh look at the role of calcium signaling in asthma, and are applying some ideas and results from the cardiovascular field that have never before been considered in the field of asthma," said study investigator Isabella Grumbach, M.D., Ph.D., assistant professor of internal medicine in the UI Roy J. and Lucille A. Carver College of Medicine.
The study team includes five UI faculty members, four of whom are based in cardiology and have never studied asthma, and only one whose field of expertise is asthma. The team aims to learn more about airway smooth muscle cells.
Grumbach's lab will grow the cells and monitor their response (for example, for inflammation) to the enzyme. She also will supply mouse models to investigate the response of airway smooth muscle cells to CaM kinase II inhibition.
The study will be led by Mark Anderson, M.D., Ph.D., UI professor of internal medicine and molecular physiology and biophysics, who has previously published, and has other studies underway, on CaM kinase II as it relates to heart issues.
Competition for the award was considerable, noted Anderson, with only 17 projects out of 255 applications funded this year.
"This kind of research is meant to help examine 'holes' in the paradigm of current asthma understanding. We're not asking safe, predictable questions, but getting involved because sometimes people from outside a field can help with a paradigm shift," said Anderson, who also holds the Potter-Lambert Chair in Cardiology.
In addition to Grumbach and Anderson, the team includes Joel Kline, M.D., professor of internal medicine; Peter Mohler, Ph.D., associate professor of internal medicine; and Long-Sheng Song, M.D., assistant professor of internal medicine. Anderson, Grumbach, Mohler and Song also are members of the UI Heart and Vascular Center.
Kline is an asthma expert and provided precursor data to help the team apply for the study. Mohler has expertise in helping determine the mechanical and electrical function of cells, while Song brings expertise in measuring calcium responses.
"It's a great partnership, and another example of what can happen when there is a focus on innovative scientific collaboration by generous funders and motivated researchers," Anderson said.
Learn more about SPAR, which is funded by the American Asthma Foundation, at sandlerresearch/.
пятница, 17 июня 2011 г.
Cardiac Risk Estimates Differ For Christian And Muslim Patients
In a study of medical students, more serious cardiac risk estimates were given to Christians and less serious estimates for Muslims despite the patients being otherwise identical in their characteristics and symptoms, according to research in an upcoming issue of Medical Decision Making published by SAGE. Risk assessment, the first step in a medical triage process, determines subsequent treatment.
In the study, led by Jamie Arndt, PhD, of the University of Missouri-Columbia, randomly chosen university medical students were asked to answer questions about their own mortality. Afterward, all the study participants inspected fictitious emergency room admittance forms for Muslim and Christian patients complaining of chest pain, and risk assessments were made for each patient. The participants who had been reminded of their personal mortality rendered more serious cardiac risk estimates for Christians and less serious estimates for Muslims despite the patients being otherwise identical in their characteristics and symptoms.
"We should emphasize that there is no reason to suspect intentional biased judgment on the part of medical students, since research indicates that most prejudicial responses occur without people's intent or awareness," write the authors in the article, noting that none of the study participants identified themselves as Muslim. "Still, psychological motivations provoked by concerns with one's mortality can have far-reaching effects in a health care context. Further research is needed because it is vital that these effects be better understood."
The Medical Decision Making article, "The Psychosocial Effect of Thoughts of Personal Mortality on Cardiac Risk Assessment," written by Jamie Arndt, PhD, Matthew Vess, MA, Cathy R. Cox, MA, Jamie L. Goldenberg, PhD, and Stephen Lagle, BA, is free for a limited time at mdm.sagepub/cgi/rapidpdf/0272989X08323300v1.
Medical Decision Making (MDM), the official journal of the Society for Medical Decision Making, publishes articles designed to improve the health and clinical care of individuals and to assist with health policy development. Presenting theoretical, statistical, and modeling methods from a variety of disciplines, including decision psychology, health economics, clinical epidemiology, and evidence synthesis, the journal promotes understanding of human decision-making processes so that individuals can make more informed and satisfying choices regarding their health. mdm.sagepub/
SAGE is a leading international publisher of journals, books, and electronic media for academic, educational, and professional markets. Since 1965, SAGE has helped inform and educate a global community of scholars, practitioners, researchers, and students spanning a wide range of subject areas including business, humanities, social sciences, and science, technology, and medicine. An independent company, SAGE has principal offices in Los Angeles, London, New Delhi, Singapore and Washington DC. sagepublications/
In the study, led by Jamie Arndt, PhD, of the University of Missouri-Columbia, randomly chosen university medical students were asked to answer questions about their own mortality. Afterward, all the study participants inspected fictitious emergency room admittance forms for Muslim and Christian patients complaining of chest pain, and risk assessments were made for each patient. The participants who had been reminded of their personal mortality rendered more serious cardiac risk estimates for Christians and less serious estimates for Muslims despite the patients being otherwise identical in their characteristics and symptoms.
"We should emphasize that there is no reason to suspect intentional biased judgment on the part of medical students, since research indicates that most prejudicial responses occur without people's intent or awareness," write the authors in the article, noting that none of the study participants identified themselves as Muslim. "Still, psychological motivations provoked by concerns with one's mortality can have far-reaching effects in a health care context. Further research is needed because it is vital that these effects be better understood."
The Medical Decision Making article, "The Psychosocial Effect of Thoughts of Personal Mortality on Cardiac Risk Assessment," written by Jamie Arndt, PhD, Matthew Vess, MA, Cathy R. Cox, MA, Jamie L. Goldenberg, PhD, and Stephen Lagle, BA, is free for a limited time at mdm.sagepub/cgi/rapidpdf/0272989X08323300v1.
Medical Decision Making (MDM), the official journal of the Society for Medical Decision Making, publishes articles designed to improve the health and clinical care of individuals and to assist with health policy development. Presenting theoretical, statistical, and modeling methods from a variety of disciplines, including decision psychology, health economics, clinical epidemiology, and evidence synthesis, the journal promotes understanding of human decision-making processes so that individuals can make more informed and satisfying choices regarding their health. mdm.sagepub/
SAGE is a leading international publisher of journals, books, and electronic media for academic, educational, and professional markets. Since 1965, SAGE has helped inform and educate a global community of scholars, practitioners, researchers, and students spanning a wide range of subject areas including business, humanities, social sciences, and science, technology, and medicine. An independent company, SAGE has principal offices in Los Angeles, London, New Delhi, Singapore and Washington DC. sagepublications/
четверг, 16 июня 2011 г.
Updated Guidelines Include New Research, Advances In Stroke Prevention
Healthy lifestyle choices and emergency room interventions can help prevent first-time strokes, according to revised American Heart Association/American Stroke Association guidelines.
The guidelines, last updated in 2006, will be published in Stroke: Journal of the American Heart Association.
"Between 1999 and 2006, there's been over a 30 percent reduction in stroke death rates in the United States and we think the majority of the reduction is coming from better prevention," said Larry B. Goldstein, M.D., chairman of the statement writing committee and director of the Duke Stroke Center in Durham, N.C.
Prior to this, the incidence of stroke may have been increasing, according to the statement that cites a 39 percent rise in hospitalizations between 1988 and 1997. As the population continues to age, the total number of Americans having a stroke is expected to rise.
More than 77 percent of the 795,000 strokes occurring in Americans each year are first events. The third leading cause of death in the United States after heart disease and cancer, stroke is a significant economic and social burden and one of the major causes of disability in adults.
For the first time, the prevention guidelines address stroke as a broad continuum of related events, including ischemic stroke, non-ischemic stroke and transient ischemic attack (TIA). For prevention, there is often little difference along the stroke spectrum, said Goldstein, who is also a professor of medicine and director of Duke's ASA-Bugher Foundation Center for Stroke Prevention Research.
Accounting for 87 percent of all strokes, ischemic stroke happens when a blood vessel in or leading to the brain is blocked. TIA occurs when the blockage is temporary, but is considered a major risk factor for a later, larger stroke. A blood vessel rupture causes non-ischemic, or bleeding stroke, known as a hemorrhagic stroke.
The new guidelines feature several key prevention updates based on recent research:
-- Those who make healthy lifestyle choices such as not smoking, eating a low-fat diet high in fruits and vegetables, drinking in moderation, exercising regularly and maintaining a normal body weight lower risk of a first stroke as much as 80 percent compared with those who don't make such changes. The preventive benefit increases with each positive change adopted.
-- Emergency room doctors should try to identify patients at high risk for stroke and consider making referrals, conducting screenings or beginning preventive therapy.
-- Although genetic screening for stroke among the general population isn't recommended, it may be appropriate in certain circumstances, depending on family history and other factors.
-- The usefulness of stenting in persons who have a narrowing of a carotid artery in the neck as compared to an operation (endarterectomy) is still uncertain. Because of advances in standard medical therapies (including a change in lifestyle factors, treating high blood pressure and using antiplatelet and cholesterol lowering drugs) the usefulness of either procedure in persons who have not had symptoms is unclear. Doctors must decide whether to perform either procedure on a case-by-case basis.
-- General population screening for carotid artery narrowing isn't recommended.
-- Aspirin doesn't prevent a first stroke in low-risk persons or those with diabetes or asymptomatic peripheral artery disease. However, it's recommended for those whose risk is high enough for the reduction in stroke risk to outweigh the bleeding risks of aspirin.
Co-authors are: Cheryl D. Bushnell, M.D., M.H.S.; Robert J. Adams, M.S., M.D.; Lawrence J. Appel, M.D., M.P.H.; Lynne T. Braun, Ph.D., C.N.P.; Seemant Chaturvedi, M.D.; Mark A. Creager, M.D.; Antonio Culebras, M.D.; Robert H. Eckel, M.D.; Robert G. Hart, M.D.; Judith A. Hinchey, M.D., M.S.; Virginia J. Howard, Ph.D.; Edward C. Jauch, M.D., M.S.; Steven R. Levine, M.D.; James F. Meschia, M.D.; Wesley S. Moore, M.D.; J.V. (Ian) Nixon, M.D.; and Thomas A. Pearson, M.D. Individual author disclosures are on the manuscript.
The guidelines, last updated in 2006, will be published in Stroke: Journal of the American Heart Association.
"Between 1999 and 2006, there's been over a 30 percent reduction in stroke death rates in the United States and we think the majority of the reduction is coming from better prevention," said Larry B. Goldstein, M.D., chairman of the statement writing committee and director of the Duke Stroke Center in Durham, N.C.
Prior to this, the incidence of stroke may have been increasing, according to the statement that cites a 39 percent rise in hospitalizations between 1988 and 1997. As the population continues to age, the total number of Americans having a stroke is expected to rise.
More than 77 percent of the 795,000 strokes occurring in Americans each year are first events. The third leading cause of death in the United States after heart disease and cancer, stroke is a significant economic and social burden and one of the major causes of disability in adults.
For the first time, the prevention guidelines address stroke as a broad continuum of related events, including ischemic stroke, non-ischemic stroke and transient ischemic attack (TIA). For prevention, there is often little difference along the stroke spectrum, said Goldstein, who is also a professor of medicine and director of Duke's ASA-Bugher Foundation Center for Stroke Prevention Research.
Accounting for 87 percent of all strokes, ischemic stroke happens when a blood vessel in or leading to the brain is blocked. TIA occurs when the blockage is temporary, but is considered a major risk factor for a later, larger stroke. A blood vessel rupture causes non-ischemic, or bleeding stroke, known as a hemorrhagic stroke.
The new guidelines feature several key prevention updates based on recent research:
-- Those who make healthy lifestyle choices such as not smoking, eating a low-fat diet high in fruits and vegetables, drinking in moderation, exercising regularly and maintaining a normal body weight lower risk of a first stroke as much as 80 percent compared with those who don't make such changes. The preventive benefit increases with each positive change adopted.
-- Emergency room doctors should try to identify patients at high risk for stroke and consider making referrals, conducting screenings or beginning preventive therapy.
-- Although genetic screening for stroke among the general population isn't recommended, it may be appropriate in certain circumstances, depending on family history and other factors.
-- The usefulness of stenting in persons who have a narrowing of a carotid artery in the neck as compared to an operation (endarterectomy) is still uncertain. Because of advances in standard medical therapies (including a change in lifestyle factors, treating high blood pressure and using antiplatelet and cholesterol lowering drugs) the usefulness of either procedure in persons who have not had symptoms is unclear. Doctors must decide whether to perform either procedure on a case-by-case basis.
-- General population screening for carotid artery narrowing isn't recommended.
-- Aspirin doesn't prevent a first stroke in low-risk persons or those with diabetes or asymptomatic peripheral artery disease. However, it's recommended for those whose risk is high enough for the reduction in stroke risk to outweigh the bleeding risks of aspirin.
Co-authors are: Cheryl D. Bushnell, M.D., M.H.S.; Robert J. Adams, M.S., M.D.; Lawrence J. Appel, M.D., M.P.H.; Lynne T. Braun, Ph.D., C.N.P.; Seemant Chaturvedi, M.D.; Mark A. Creager, M.D.; Antonio Culebras, M.D.; Robert H. Eckel, M.D.; Robert G. Hart, M.D.; Judith A. Hinchey, M.D., M.S.; Virginia J. Howard, Ph.D.; Edward C. Jauch, M.D., M.S.; Steven R. Levine, M.D.; James F. Meschia, M.D.; Wesley S. Moore, M.D.; J.V. (Ian) Nixon, M.D.; and Thomas A. Pearson, M.D. Individual author disclosures are on the manuscript.
среда, 15 июня 2011 г.
"Listen To Your Heart This Valentines Day" Says GP
"Listen to your heart this Valentines Day" - that is the message from Dr Peter Grunewald, a British based GP, who has developed an exciting new wellbeing programme for your heart.
"HeartSpheres is a new approach to caring for your heart and having a happier and healthier life." He says
"Valentine's Day brings the emotional and physical heart into focus," says Dr Grunewald. "Everyone's heart deserves care and attention, and not just on Valentine's Day."
HeartSpheres is a holistic and scientifically researched heart-based technique, which promotes physical and emotional health, enhancing life by helping overcome stress and negative emotions.
On Valentines Day, Dr Grunewald launches a series of courses, taking in major cities across Britain to take his message and the technique out to the public. "The name HeartSpheres reflects the harmonising of the three spheres of cognition, emotion and will. We want to help people to stay balanced, even under difficult life circumstances. The aim is to ensure you have the lasting capacity to manage extreme emotions and stress, both pro-actively and productively. This gives long-term benefit as well as short-term".
HeartSpheres provides powerful and scientifically-validated self-help techniques, which are intended to transform negative conditions such as stress, anxiety, fatigue and depression into positive emotional states. This in turn, deepens professional and social skills, creativity, intuitive insight and personal development. You can change the way you process stressful events to avoid negative impact on your health and your heart.
"The heart is not just the physical organ that stands in the centre of a network of arteries and veins thousands of miles long. It is also where we feel our most powerful emotions. Many cultures believe it to be the home of our emotions such as love, joy, anger and sadness. It is viewed by many of the integrator of mind and body, spirit and matter".
"Many healthcare practitioners believe that aligning the mind with the heart is therefore a key to greater well-being".
Dr Grunewald's courses are aimed at anyone who has an interest in improving their happiness, health and wellbeing. The first course will be in Bristol on Tuesday 13th March 2009 and others will follow in London, Manchester and Birmingham.
The one-day courses will cover topics such as the Role of the Heart, Physiology of Stress, Heart Rate Variability and Coherence, Neurobiology of Emotions, Transforming Stress, Developing Empathy, as well as core techniques for self-empowerment, personal development and health promotion, such as Breathing Techniques, Focused Relaxation, Review, Inner Dialogue, Intuitive Conversation and Mental Rehearsing.
As a special Valentines Day gift you could buy a HeartSpheres course for your loved one, giving them a present that will last a lifetime.
To learn more about the HeartSpheres technique, or to book a course, visit the website HeartSpheres
Alternatively, you can book by sending a cheque for ??199.75 + VAT, payable to HeartSpheres, to HeartSpheres Ltd. , 17 Stoke Hill, Stoke Bishop, BS9 1JN, telephone number: 0844 800 2433
Dr. Peter Grunewald MD has been working as a General Practitioner in an NHS medical centre providing integrated healthcare. He has been medical advisor to a number of charitable organisations since 1986. For many years he has been involved in the training of health professionals, teachers and care staff and in facilitating professional development workshops. He also works in private practice and is the author of The Quiet Heart.
HeartSpheres
"HeartSpheres is a new approach to caring for your heart and having a happier and healthier life." He says
"Valentine's Day brings the emotional and physical heart into focus," says Dr Grunewald. "Everyone's heart deserves care and attention, and not just on Valentine's Day."
HeartSpheres is a holistic and scientifically researched heart-based technique, which promotes physical and emotional health, enhancing life by helping overcome stress and negative emotions.
On Valentines Day, Dr Grunewald launches a series of courses, taking in major cities across Britain to take his message and the technique out to the public. "The name HeartSpheres reflects the harmonising of the three spheres of cognition, emotion and will. We want to help people to stay balanced, even under difficult life circumstances. The aim is to ensure you have the lasting capacity to manage extreme emotions and stress, both pro-actively and productively. This gives long-term benefit as well as short-term".
HeartSpheres provides powerful and scientifically-validated self-help techniques, which are intended to transform negative conditions such as stress, anxiety, fatigue and depression into positive emotional states. This in turn, deepens professional and social skills, creativity, intuitive insight and personal development. You can change the way you process stressful events to avoid negative impact on your health and your heart.
"The heart is not just the physical organ that stands in the centre of a network of arteries and veins thousands of miles long. It is also where we feel our most powerful emotions. Many cultures believe it to be the home of our emotions such as love, joy, anger and sadness. It is viewed by many of the integrator of mind and body, spirit and matter".
"Many healthcare practitioners believe that aligning the mind with the heart is therefore a key to greater well-being".
Dr Grunewald's courses are aimed at anyone who has an interest in improving their happiness, health and wellbeing. The first course will be in Bristol on Tuesday 13th March 2009 and others will follow in London, Manchester and Birmingham.
The one-day courses will cover topics such as the Role of the Heart, Physiology of Stress, Heart Rate Variability and Coherence, Neurobiology of Emotions, Transforming Stress, Developing Empathy, as well as core techniques for self-empowerment, personal development and health promotion, such as Breathing Techniques, Focused Relaxation, Review, Inner Dialogue, Intuitive Conversation and Mental Rehearsing.
As a special Valentines Day gift you could buy a HeartSpheres course for your loved one, giving them a present that will last a lifetime.
To learn more about the HeartSpheres technique, or to book a course, visit the website HeartSpheres
Alternatively, you can book by sending a cheque for ??199.75 + VAT, payable to HeartSpheres, to HeartSpheres Ltd. , 17 Stoke Hill, Stoke Bishop, BS9 1JN, telephone number: 0844 800 2433
Dr. Peter Grunewald MD has been working as a General Practitioner in an NHS medical centre providing integrated healthcare. He has been medical advisor to a number of charitable organisations since 1986. For many years he has been involved in the training of health professionals, teachers and care staff and in facilitating professional development workshops. He also works in private practice and is the author of The Quiet Heart.
HeartSpheres
вторник, 14 июня 2011 г.
Drug-Releasing Stent Better Than Uncoated Stent For Angioplasty
A study published early online in the journal JAMA
concludes that patients who received angioplasty after a heart attack
and who received stents that released the drug sirolimus were much less
likely to experience major adverse cardiac events in the following 8
months compared to those patients who received uncoated
stents. Marco Valgimigli, M.D., Ph.D., (Cardiovascular
Institute, University of Ferrara, Italy) and colleagues also found that
patients who received the anticoagulants abciximab and tirofiban had
similar outcomes for some cardiac measures within 90 minutes after the
angioplasty.
In order to reduce major adverse cardiac events (MACE) in patients who
undergo angioplasty or percutaneous coronary intervention (PCI) for
ST-segment elevation myocardial infarction (STEMI - a particular
electrocardiogram pattern that follows a heart attack), it is common
for physicians to implant an uncoated stent in the patient and infuse
with the anticoagulant abciximab. The researchers were interested in
testing if using tirofiban instead of abciximab could results in
similar benefits as well as clinical and economic benefits. When using
drug-releasing stents instead of uncoated stents, doctors are less
likely to continually open obstructed blood vessels after elective PCI.
However, drug-releasing stents are often not used due to questionable
efficacy results and other safety concerns.
Valgimigli and colleagues used a sample of 745 patients from Italy,
Spain and Argentina who had STEMI and were undergoing PCI. Between
October 2004 and April 2007, the researchers evaluated the effect of
high-dose tirofiban and sirolimus-releasing stents compared with
abciximab infusion and uncoated-stent implantation.
Results showed that 722 patients (97%) had interpretable
electrocardiograms. Among these, at least a 50% resolution of
ST-segment elevation 90 minutes after PCI was noted in 83.6% (302 of
361 patients) of patients in the abciximab group and 85.3% (308 of 361
patients) of patients in the tirofiban group. The researchers also
noted similar outcomes regarding ischemic and hemorrhagic outcomes in
the two groups.
MACE rates were analyzed 8 months after PCI. For those who received
tirofiban, 9.9% had MACE, and for those who received
abciximab, 12.4% had MACE. Patients who had uncoated stents
had a higher rate of MACE - 54 patients, or 14.5%. Patients who were
treated with the sirolimus-releasing stent had comparatively lower MACE
rate - 29 patients, or 7.8%. Patients who received the
sirolimus-releasing stent were also much less likely to require
revascularization (repeat procedure to unblock a blood vessel) - 10.2%
with the uncoated stent compared with 3.2% with sirolimus-releasing
stent.
The authors conclude: "In summary, our study provides evidence that in
a broad population of largely unselected patients undergoing PCI for
STEMI, tirofiban therapy is associated with a noninferior resolution
from ST-segment elevation at 90 minutes postintervention compared with
abciximab, and at 8-month follow-up, MACE are approximately halved by
sirolimus-eluting stent implantation compared with uncoated stents."
Comparison of Angioplasty With Infusion of Tirofiban or
Abciximab and With Implantation of Sirolimus-Eluting or Uncoated Stents
for Acute Myocardial Infarction: The MULTISTRATEGY Randomized Trial
Marco Valgimigli; Gianluca Campo; Gianfranco Percoco; Leonardo
Bolognese; Corrado Vassanelli; Salvatore Colangelo; Nicoletta de
Cesare; Alfredo E. Rodriguez; Maurizio Ferrario; Raul Moreno; Tommaso
Piva; Imad Sheiban; Giampaolo Pasquetto; Francesco Prati; Marco S.
Nazzaro; Giovanni Parrinello; Roberto Ferrari
JAMA (2008). 299 Vol. 15.
doi:10.1001/jama.299.15.joc80026
Click
Here to View Journal Website
Written by: Peter M Crosta
concludes that patients who received angioplasty after a heart attack
and who received stents that released the drug sirolimus were much less
likely to experience major adverse cardiac events in the following 8
months compared to those patients who received uncoated
stents. Marco Valgimigli, M.D., Ph.D., (Cardiovascular
Institute, University of Ferrara, Italy) and colleagues also found that
patients who received the anticoagulants abciximab and tirofiban had
similar outcomes for some cardiac measures within 90 minutes after the
angioplasty.
In order to reduce major adverse cardiac events (MACE) in patients who
undergo angioplasty or percutaneous coronary intervention (PCI) for
ST-segment elevation myocardial infarction (STEMI - a particular
electrocardiogram pattern that follows a heart attack), it is common
for physicians to implant an uncoated stent in the patient and infuse
with the anticoagulant abciximab. The researchers were interested in
testing if using tirofiban instead of abciximab could results in
similar benefits as well as clinical and economic benefits. When using
drug-releasing stents instead of uncoated stents, doctors are less
likely to continually open obstructed blood vessels after elective PCI.
However, drug-releasing stents are often not used due to questionable
efficacy results and other safety concerns.
Valgimigli and colleagues used a sample of 745 patients from Italy,
Spain and Argentina who had STEMI and were undergoing PCI. Between
October 2004 and April 2007, the researchers evaluated the effect of
high-dose tirofiban and sirolimus-releasing stents compared with
abciximab infusion and uncoated-stent implantation.
Results showed that 722 patients (97%) had interpretable
electrocardiograms. Among these, at least a 50% resolution of
ST-segment elevation 90 minutes after PCI was noted in 83.6% (302 of
361 patients) of patients in the abciximab group and 85.3% (308 of 361
patients) of patients in the tirofiban group. The researchers also
noted similar outcomes regarding ischemic and hemorrhagic outcomes in
the two groups.
MACE rates were analyzed 8 months after PCI. For those who received
tirofiban, 9.9% had MACE, and for those who received
abciximab, 12.4% had MACE. Patients who had uncoated stents
had a higher rate of MACE - 54 patients, or 14.5%. Patients who were
treated with the sirolimus-releasing stent had comparatively lower MACE
rate - 29 patients, or 7.8%. Patients who received the
sirolimus-releasing stent were also much less likely to require
revascularization (repeat procedure to unblock a blood vessel) - 10.2%
with the uncoated stent compared with 3.2% with sirolimus-releasing
stent.
The authors conclude: "In summary, our study provides evidence that in
a broad population of largely unselected patients undergoing PCI for
STEMI, tirofiban therapy is associated with a noninferior resolution
from ST-segment elevation at 90 minutes postintervention compared with
abciximab, and at 8-month follow-up, MACE are approximately halved by
sirolimus-eluting stent implantation compared with uncoated stents."
Comparison of Angioplasty With Infusion of Tirofiban or
Abciximab and With Implantation of Sirolimus-Eluting or Uncoated Stents
for Acute Myocardial Infarction: The MULTISTRATEGY Randomized Trial
Marco Valgimigli; Gianluca Campo; Gianfranco Percoco; Leonardo
Bolognese; Corrado Vassanelli; Salvatore Colangelo; Nicoletta de
Cesare; Alfredo E. Rodriguez; Maurizio Ferrario; Raul Moreno; Tommaso
Piva; Imad Sheiban; Giampaolo Pasquetto; Francesco Prati; Marco S.
Nazzaro; Giovanni Parrinello; Roberto Ferrari
JAMA (2008). 299 Vol. 15.
doi:10.1001/jama.299.15.joc80026
Click
Here to View Journal Website
Written by: Peter M Crosta
понедельник, 13 июня 2011 г.
GRAVITAS Trial Shows That A Uniform Treatment Strategy Of Doubling The Standard Dose Of Plavix Does Not Improve Outcomes Post-PCI
Accumetrics, Inc., developer and marketer of the VerifyNow® System, announced that the GRAVITAS (Gauging Responsiveness With A VerifyNow Assay-Impact On Thrombosis And Safety) Trial found that in patients with high residual platelet reactivity, doubling the maintenance dose of clopidogrel did not reduce the risk of further ischemic events after percutaneous coronary intervention (PCI). The study also reported that patients with high residual platelet reactivity, as measured by the VerifyNow P2Y12 test, demonstrated almost twice the risk of ischemic events compared to patients without high residual platelet reactivity. The VerifyNow P2Y12 Test is used to measure the antiplatelet effect of medications such as clopidogrel or prasugrel (Plavix® and Effient®) that reduce platelet reactivity by blocking the platelet P2Y12 receptor.
Matthew J. Price, MD, of the Scripps Translational Science Institute and Scripps Clinic in La Jolla, CA, and Principal Investigator of the GRAVITAS trial, presented the results during the American Heart Association Scientific Sessions Late-Breaking Clinical Trials in Chicago. "The GRAVITAS findings do not support a uniform treatment strategy of high dose clopidogrel in patients with high residual platelet reactivity based upon a single platelet function test after stent implantation. This is important as currently many physicians utilize a strategy of doubling the dose of clopidogrel the morning after the stent procedure," commented Dr. Price. "Alternative therapies or testing a patient multiple times to treat to a specific target of reactivity deserve consideration."
"The GRAVITAS trial provides further evidence of the association between high residual platelet reactivity, sometimes referred to as non-responsiveness, and the occurrence of cardiovascular events. The trial demonstrated a strong trend towards greater risk of ischemic events in non-responders, which is consistent with prior reports," commented Jeffrey R. Dahlen, PhD, Vice President of Clinical and Regulatory Affairs for Accumetrics. "As we further analyze the data, we expect to release additional information that continues to support the value of platelet function testing."
"GRAVITAS continues to position Accumetrics as a diagnostic leader that invests in furthering clinical understanding of individualized treatment for cardiovascular patients," said Timothy I. Still, President and CEO of Accumetrics. "This trial highlights the importance of continually assessing response to antiplatelet therapy as physicians consider various treatment strategies."
The VerifyNow System is the first rapid and easy-to-use point-of-care system for measuring platelet reactivity to multiple antiplatelet agents. The System is widely used in various clinical settings where antiplatelet medications are prescribed to reduce the occurrence of future thrombotic events such as heart attack and stroke. Clopidogrel is an oral antiplatelet agent sold under the brand name Plavix.
About the GRAVITAS Study
The concept of variability in response to antiplatelet therapy has been well established. Also being demonstrated with increased frequency is that high residual platelet reactivity is associated with poor patient outcomes. Accumetrics recognized the need for a study specifically designed to explore possible treatment strategies for those patients who are poor responders to antiplatelet therapy. As a result, the GRAVITAS study is the first multi-center, placebo-controlled study to determine whether high maintenance dose of clopidogrel therapy based on the results of the company's VerifyNow P2Y12 Test reduces ischemic events post- PCI. The trial was coordinated by Scripps Advanced Clinical Trials.
Matthew J. Price, MD, of the Scripps Translational Science Institute and Scripps Clinic in La Jolla, CA, and Principal Investigator of the GRAVITAS trial, presented the results during the American Heart Association Scientific Sessions Late-Breaking Clinical Trials in Chicago. "The GRAVITAS findings do not support a uniform treatment strategy of high dose clopidogrel in patients with high residual platelet reactivity based upon a single platelet function test after stent implantation. This is important as currently many physicians utilize a strategy of doubling the dose of clopidogrel the morning after the stent procedure," commented Dr. Price. "Alternative therapies or testing a patient multiple times to treat to a specific target of reactivity deserve consideration."
"The GRAVITAS trial provides further evidence of the association between high residual platelet reactivity, sometimes referred to as non-responsiveness, and the occurrence of cardiovascular events. The trial demonstrated a strong trend towards greater risk of ischemic events in non-responders, which is consistent with prior reports," commented Jeffrey R. Dahlen, PhD, Vice President of Clinical and Regulatory Affairs for Accumetrics. "As we further analyze the data, we expect to release additional information that continues to support the value of platelet function testing."
"GRAVITAS continues to position Accumetrics as a diagnostic leader that invests in furthering clinical understanding of individualized treatment for cardiovascular patients," said Timothy I. Still, President and CEO of Accumetrics. "This trial highlights the importance of continually assessing response to antiplatelet therapy as physicians consider various treatment strategies."
The VerifyNow System is the first rapid and easy-to-use point-of-care system for measuring platelet reactivity to multiple antiplatelet agents. The System is widely used in various clinical settings where antiplatelet medications are prescribed to reduce the occurrence of future thrombotic events such as heart attack and stroke. Clopidogrel is an oral antiplatelet agent sold under the brand name Plavix.
About the GRAVITAS Study
The concept of variability in response to antiplatelet therapy has been well established. Also being demonstrated with increased frequency is that high residual platelet reactivity is associated with poor patient outcomes. Accumetrics recognized the need for a study specifically designed to explore possible treatment strategies for those patients who are poor responders to antiplatelet therapy. As a result, the GRAVITAS study is the first multi-center, placebo-controlled study to determine whether high maintenance dose of clopidogrel therapy based on the results of the company's VerifyNow P2Y12 Test reduces ischemic events post- PCI. The trial was coordinated by Scripps Advanced Clinical Trials.
воскресенье, 12 июня 2011 г.
Life Saving Implantable Device That Continuously Monitors Electrical Changes That Signal Cardiac Problems
St. Jude Medical, Inc. (NYSE:STJ), a global medical device company, announced regulatory approval from the Japanese Ministry of Health, Labour and Welfare (MHLW) of its AnalyST™ implantable cardioverter defibrillator (ICD) with ST Monitoring, a revolutionary device that not only provides life-saving therapy for dangerously fast heart rhythms, but also continuously monitors electrical changes (called ST segments) to help physicians monitor for cardiac problems. This new monitoring capability may allow physicians to intervene earlier to help reduce patient risks. The AnalyST ICD is not approved for use in the United States.
The AnalyST ICD with ST Monitoring is the industry's first device to continuously monitor specific changes in the heart's electrical system that can indicate conditions such as ischemia (which occurs when the flow of oxygenated blood to the heart muscle is obstructed). Learning about these conditions earlier may lead to more timely diagnosis and therapy for patients, and possibly improve patient prognosis.
With the device's monitoring diagnostic, small changes in ST segment are continuously and precisely recorded and plotted, and then retrieved for the physician to review during patient follow-up visits. Because many cardiac episodes are transient in nature, continuous ST Monitoring is important as it gives physicians more comprehensive ST segment information over time rather than a sporadic, hit-or-miss diagnostic report. In the near future, physicians also will be able to monitor patients' ST segment changes via remote transmissions from the St. Jude Medical Merlinhome™ transmitter (a wireless remote monitoring system in patients' homes), and will receive alerts through the Merlin™ patient care network.
"The AnalyST ICD is the only implantable device that provides ST segment monitoring reports via high-quality, intracardiac electrograms, as well as additional ST segment diagnostic reports," said Morio Shoda, M.D., Associate Professor, Department of Cardiology, Tokyo Women's Medical University. "I look forward to accessing this new and valuable information for more insight into the condition of my ICD patients with ischemia or idiopathic VF, including Brugada syndrome."
The surface electrocardiogram (ECG) has been the gold standard for diagnosing risk for heart tissue damage and arrhythmias. However, surface ECG has limitations: it provides only a few seconds of information at a time, it cannot be used to continuously monitor the patient over a long period, and it is susceptible to poor signal quality. The AnalyST ICD not only provides continuous information, but it also provides high-fidelity electrograms from the inside of the heart for accurate detection of a wide range of ST segment changes. When combined with other data available to physicians, ST segment information helps physicians make better-informed, evidence-based decisions for patient care.
In addition to the ST Monitoring diagnostic, the AnalyST ICD includes therapy-enhancing St. Jude Medical features, such as:
- DeFT Response® technology - which is designed to help devices meet the needs of patients who may have high or varying thresholds for the amount of energy required to defibrillate the heart. This enables the physician to tailor device therapy for individual patients, offering them added protection in the event of a life-threatening arrhythmia.
- VIP® (Ventricular Intrinsic Preference) algorithm - provides a delay in device stimulation of the lower chambers of the heart (ventricles) to allow the patient's own heart rhythm to prevail when possible. The VIP technology is designed to provide device stimulation only when needed, which has been shown to be better for patients' overall heart health.
- SenseAbility® technology - which is designed to optimize sensing to help protect against inappropriate shocks.
- Vibrating patient notifier - The industry's only notifier that gently vibrates - instead of issuing the standard audio alert - to notify patients if the device is not performing as designed; this can be especially beneficial for people with hearing loss.
An ICD delivers potentially life-saving therapy to the patient's heart through an insulated wire or lead. It is a small device implanted near the collarbone to treat potentially lethal, abnormally fast heart rhythms (ventricular tachycardias or VF), which often lead to sudden cardiac death. Idiopathic VF, which is ventricular fibrillation without a known cause, is particularly prevalent in Japan, especially as a result of Brugada syndrome (a genetic disorder that can result in sudden cardiac arrest).
Source
St. Jude Medical
The AnalyST ICD with ST Monitoring is the industry's first device to continuously monitor specific changes in the heart's electrical system that can indicate conditions such as ischemia (which occurs when the flow of oxygenated blood to the heart muscle is obstructed). Learning about these conditions earlier may lead to more timely diagnosis and therapy for patients, and possibly improve patient prognosis.
With the device's monitoring diagnostic, small changes in ST segment are continuously and precisely recorded and plotted, and then retrieved for the physician to review during patient follow-up visits. Because many cardiac episodes are transient in nature, continuous ST Monitoring is important as it gives physicians more comprehensive ST segment information over time rather than a sporadic, hit-or-miss diagnostic report. In the near future, physicians also will be able to monitor patients' ST segment changes via remote transmissions from the St. Jude Medical Merlinhome™ transmitter (a wireless remote monitoring system in patients' homes), and will receive alerts through the Merlin™ patient care network.
"The AnalyST ICD is the only implantable device that provides ST segment monitoring reports via high-quality, intracardiac electrograms, as well as additional ST segment diagnostic reports," said Morio Shoda, M.D., Associate Professor, Department of Cardiology, Tokyo Women's Medical University. "I look forward to accessing this new and valuable information for more insight into the condition of my ICD patients with ischemia or idiopathic VF, including Brugada syndrome."
The surface electrocardiogram (ECG) has been the gold standard for diagnosing risk for heart tissue damage and arrhythmias. However, surface ECG has limitations: it provides only a few seconds of information at a time, it cannot be used to continuously monitor the patient over a long period, and it is susceptible to poor signal quality. The AnalyST ICD not only provides continuous information, but it also provides high-fidelity electrograms from the inside of the heart for accurate detection of a wide range of ST segment changes. When combined with other data available to physicians, ST segment information helps physicians make better-informed, evidence-based decisions for patient care.
In addition to the ST Monitoring diagnostic, the AnalyST ICD includes therapy-enhancing St. Jude Medical features, such as:
- DeFT Response® technology - which is designed to help devices meet the needs of patients who may have high or varying thresholds for the amount of energy required to defibrillate the heart. This enables the physician to tailor device therapy for individual patients, offering them added protection in the event of a life-threatening arrhythmia.
- VIP® (Ventricular Intrinsic Preference) algorithm - provides a delay in device stimulation of the lower chambers of the heart (ventricles) to allow the patient's own heart rhythm to prevail when possible. The VIP technology is designed to provide device stimulation only when needed, which has been shown to be better for patients' overall heart health.
- SenseAbility® technology - which is designed to optimize sensing to help protect against inappropriate shocks.
- Vibrating patient notifier - The industry's only notifier that gently vibrates - instead of issuing the standard audio alert - to notify patients if the device is not performing as designed; this can be especially beneficial for people with hearing loss.
An ICD delivers potentially life-saving therapy to the patient's heart through an insulated wire or lead. It is a small device implanted near the collarbone to treat potentially lethal, abnormally fast heart rhythms (ventricular tachycardias or VF), which often lead to sudden cardiac death. Idiopathic VF, which is ventricular fibrillation without a known cause, is particularly prevalent in Japan, especially as a result of Brugada syndrome (a genetic disorder that can result in sudden cardiac arrest).
Source
St. Jude Medical
суббота, 11 июня 2011 г.
Emergency Angioplasty Patients Do Best At Hospitals Where It's The 'default' Treatment
Lower risk of death, faster treatment seen at hospitals where majority of heart attack patients get artery-opening procedures instead of drugs
Across America, hospitals large and small have been racing to offer angioplasty and other minimally invasive treatments to open blocked heart arteries. But not all of them have the ability to do it on an emergency basis, performing angioplasty around the clock on heart attack patients. So, during evenings and weekends, many hospitals use clot-busting drugs instead.
Now, a national study based on data from 37,233 patients casts a shadow on this practice of "part-time" emergency angioplasty.
In the Jan. 17 Circulation, a team led by University of Michigan and Yale University cardiologists reports that patients are less likely to die during their hospital stay, and will receive faster treatment, if they have their emergency angioplasty at hospitals where it is the "default" treatment, used on the vast majority of heart attack patients.
By contrast, the in-hospital death risk and risk of delayed treatment were both higher for angioplasty patients treated at hospitals where emergency angioplasty was used in a minority of heart-attack patients. On the whole, they were significantly more likely to die before leaving the hospital, and waited an average of 20 minutes longer for treatment, than those treated at hospitals where most heart attack patients received angioplasty. Many waited far longer than the 90 minute "window" during which emergency angioplasty is thought to have an edge over clot-busting drugs.
Surprisingly, the study also suggests that hospitals' level of "specialization" in emergency angioplasty has more to do with patient survival than the sheer number of emergency angioplasties performed there each year. Previous studies have shown that patients do better when they receive angioplasties and other such treatments at hospitals where many such procedures take place each year.
"In the case of emergency angioplasty, for hospitals it seems that it's not just how many you do, but how used to doing them you are," says lead author Brahmajee Nallamothu, M.D., MPH, an assistant professor of internal medicine at the U-M Medical School, researcher at the VA Ann Arbor Healthcare System and member of the U-M Cardiovascular Center. "The overall commitment to doing emergency angioplasties, and the protocols and staffing that come out of that commitment, appear to be key." The bottom line for anyone having a heart attack, he adds, is still to call 911 and let the emergency medical staff decide which hospital to choose.
The study was funded by a National Heart, Lung and Blood Institute grant led by Harlan Krumholz, M.D., a professor at Yale University School of Medicine, and used data from the National Registry of Myocardial Infarction collected from 2000 to 2002.
"This study has direct policy implications for hospitals trying to decide what services to provide," says Krumholz. "It seems best to decide on a single approach to the care of patients with heart attacks and stick to it."
The new paper, the authors say, suggests that hospitals where the "default" emergency heart attack treatment is clot-busting drugs (fibrinolytics) may want to focus on optimizing that approach, or determine better ways to institute emergency angioplasty protocols and staffing for around-the-clock care.
Nallamothu notes that public policy can also play a role - such as the state of Michigan's recent requirement that hospitals newly licensed to perform emergency angioplasty without on-site cardiac surgery be able to do it around the clock, 7 days a week. Increasingly in Michigan, small and mid-sized hospitals are making the effort to get a state license for emergency angioplasty without having a heart surgeon available as backup - which brings with it regular monitoring of patient outcomes.
The authors stress that their findings bolster prior findings by teams at U-M, Yale and other institutions showing that angioplasty patients do better if treated at hospitals, and by doctors, that perform many of the procedures each year. Says Nallamothu, however, "Procedure volume is only a surrogate for other measures of quality, and we hope this study helps illuminate the role of specialization."
Funding for the NRMI study that yielded the data for the new paper was provided by Genentech, which makes two fibrinolytic drugs used to treat acute heart attack. The company provided access to the NRMI data at no charge, and approved the study protocol before the analysis.
Further information on the study:
The patients were treated at 463 hospitals, which the authors divided into four categories. Hospitals in the most-specialized group performed emergency angioplasty on more than 88.5 percent of the heart attack patients. Those in the least-specialized group provided emergency angioplasty to less than 34 percent of their heart attack emergency patients. The other two groups were in between.
The biggest difference in survival and time-to-treatment for angioplasty patients was seen between the highest and lowest groups. But there was a noticeable, though not statistically significant, difference between the highest group and the next two groups. There were no significant differences among the groups in death risk or treatment time for patients given clot-busting drugs.
All the patients had a form of heart attack known as STEMI, and all had arrived at the hospital within 12 hours of the start of their symptoms. None were transferred from an acute-care hospital, or had conditions that would have kept them from getting either angioplasty or clot-busting drugs.
Emergency angioplasty and other catheter-based treatments are known as primary percutaneous coronary interventions, or PPCI, and have become the "default" treatment at most major medical centers. In order to offer such treatments around the clock, many large hospitals have created standard protocols to determine quickly if a patient is having the type of heart attack for which angioplasty works best, give medications that can help improve their response, and get them to a fully-staffed procedure room called a cardiac catheterization lab within minutes of their arrival.
The time from hospital arrival to the inflation of the angioplasty balloon within the blocked artery is called "door to balloon" time, and national guidelines currently recommend that hospitals aim for times under 90 minutes. Angioplasty can be performed on most patients, but a sizable fraction of heart attack patients have medical conditions or take drugs that keep them from receiving the other standard artery-opening treatment, fibrinolytics. For patients without these underlying factors, fibrinolytics do work well - especially if given within 30 minutes of arrival at the hospital, an interval known as "door to needle" time. And nearly any hospital can offer fibrinolytics around the clock.
Kara Gavin
kegavinumich
University of Michigan Health System
med.umich/prmc/media/relarch.cfm
Across America, hospitals large and small have been racing to offer angioplasty and other minimally invasive treatments to open blocked heart arteries. But not all of them have the ability to do it on an emergency basis, performing angioplasty around the clock on heart attack patients. So, during evenings and weekends, many hospitals use clot-busting drugs instead.
Now, a national study based on data from 37,233 patients casts a shadow on this practice of "part-time" emergency angioplasty.
In the Jan. 17 Circulation, a team led by University of Michigan and Yale University cardiologists reports that patients are less likely to die during their hospital stay, and will receive faster treatment, if they have their emergency angioplasty at hospitals where it is the "default" treatment, used on the vast majority of heart attack patients.
By contrast, the in-hospital death risk and risk of delayed treatment were both higher for angioplasty patients treated at hospitals where emergency angioplasty was used in a minority of heart-attack patients. On the whole, they were significantly more likely to die before leaving the hospital, and waited an average of 20 minutes longer for treatment, than those treated at hospitals where most heart attack patients received angioplasty. Many waited far longer than the 90 minute "window" during which emergency angioplasty is thought to have an edge over clot-busting drugs.
Surprisingly, the study also suggests that hospitals' level of "specialization" in emergency angioplasty has more to do with patient survival than the sheer number of emergency angioplasties performed there each year. Previous studies have shown that patients do better when they receive angioplasties and other such treatments at hospitals where many such procedures take place each year.
"In the case of emergency angioplasty, for hospitals it seems that it's not just how many you do, but how used to doing them you are," says lead author Brahmajee Nallamothu, M.D., MPH, an assistant professor of internal medicine at the U-M Medical School, researcher at the VA Ann Arbor Healthcare System and member of the U-M Cardiovascular Center. "The overall commitment to doing emergency angioplasties, and the protocols and staffing that come out of that commitment, appear to be key." The bottom line for anyone having a heart attack, he adds, is still to call 911 and let the emergency medical staff decide which hospital to choose.
The study was funded by a National Heart, Lung and Blood Institute grant led by Harlan Krumholz, M.D., a professor at Yale University School of Medicine, and used data from the National Registry of Myocardial Infarction collected from 2000 to 2002.
"This study has direct policy implications for hospitals trying to decide what services to provide," says Krumholz. "It seems best to decide on a single approach to the care of patients with heart attacks and stick to it."
The new paper, the authors say, suggests that hospitals where the "default" emergency heart attack treatment is clot-busting drugs (fibrinolytics) may want to focus on optimizing that approach, or determine better ways to institute emergency angioplasty protocols and staffing for around-the-clock care.
Nallamothu notes that public policy can also play a role - such as the state of Michigan's recent requirement that hospitals newly licensed to perform emergency angioplasty without on-site cardiac surgery be able to do it around the clock, 7 days a week. Increasingly in Michigan, small and mid-sized hospitals are making the effort to get a state license for emergency angioplasty without having a heart surgeon available as backup - which brings with it regular monitoring of patient outcomes.
The authors stress that their findings bolster prior findings by teams at U-M, Yale and other institutions showing that angioplasty patients do better if treated at hospitals, and by doctors, that perform many of the procedures each year. Says Nallamothu, however, "Procedure volume is only a surrogate for other measures of quality, and we hope this study helps illuminate the role of specialization."
Funding for the NRMI study that yielded the data for the new paper was provided by Genentech, which makes two fibrinolytic drugs used to treat acute heart attack. The company provided access to the NRMI data at no charge, and approved the study protocol before the analysis.
Further information on the study:
The patients were treated at 463 hospitals, which the authors divided into four categories. Hospitals in the most-specialized group performed emergency angioplasty on more than 88.5 percent of the heart attack patients. Those in the least-specialized group provided emergency angioplasty to less than 34 percent of their heart attack emergency patients. The other two groups were in between.
The biggest difference in survival and time-to-treatment for angioplasty patients was seen between the highest and lowest groups. But there was a noticeable, though not statistically significant, difference between the highest group and the next two groups. There were no significant differences among the groups in death risk or treatment time for patients given clot-busting drugs.
All the patients had a form of heart attack known as STEMI, and all had arrived at the hospital within 12 hours of the start of their symptoms. None were transferred from an acute-care hospital, or had conditions that would have kept them from getting either angioplasty or clot-busting drugs.
Emergency angioplasty and other catheter-based treatments are known as primary percutaneous coronary interventions, or PPCI, and have become the "default" treatment at most major medical centers. In order to offer such treatments around the clock, many large hospitals have created standard protocols to determine quickly if a patient is having the type of heart attack for which angioplasty works best, give medications that can help improve their response, and get them to a fully-staffed procedure room called a cardiac catheterization lab within minutes of their arrival.
The time from hospital arrival to the inflation of the angioplasty balloon within the blocked artery is called "door to balloon" time, and national guidelines currently recommend that hospitals aim for times under 90 minutes. Angioplasty can be performed on most patients, but a sizable fraction of heart attack patients have medical conditions or take drugs that keep them from receiving the other standard artery-opening treatment, fibrinolytics. For patients without these underlying factors, fibrinolytics do work well - especially if given within 30 minutes of arrival at the hospital, an interval known as "door to needle" time. And nearly any hospital can offer fibrinolytics around the clock.
Kara Gavin
kegavinumich
University of Michigan Health System
med.umich/prmc/media/relarch.cfm
пятница, 10 июня 2011 г.
Boston Scientific Comments On Positive Results With The FLEX(TM) Microwave Ablation System
Boston Scientific
Corporation (NYSE: BSX) today commented on data released on May 9th at the
American Association for Thoracic Surgery (AATS) conference in Washington,
D.C. Dudley A. Hudspeth, M.D., of Desert Cardiothoracic Surgeons in Mesa,
Arizona, reported positive results from his single-center clinical
investigation of 79 patients treated with the FLEX 10(R) and FLEX 10(R) XE
Microwave Ablation Probes. Patients in the study achieved greater than 95
percent conversion to sinus rhythm based on electrocardiograms and 30-day
event monitoring. Significantly, 82 percent of patients at one-year
follow-up were off anti-arrhythmic medications and 68 percent of patients
at one-year follow-up were off anti-coagulant medications.
Following the presentation, Dr. Hudspeth stated, "Standard medical
therapy often fails to treat AF patients' symptoms. These data look
promising for a minimally invasive ablation procedure for appropriate AF
patients." Most procedures in the series were performed through a few small
incisions (
Corporation (NYSE: BSX) today commented on data released on May 9th at the
American Association for Thoracic Surgery (AATS) conference in Washington,
D.C. Dudley A. Hudspeth, M.D., of Desert Cardiothoracic Surgeons in Mesa,
Arizona, reported positive results from his single-center clinical
investigation of 79 patients treated with the FLEX 10(R) and FLEX 10(R) XE
Microwave Ablation Probes. Patients in the study achieved greater than 95
percent conversion to sinus rhythm based on electrocardiograms and 30-day
event monitoring. Significantly, 82 percent of patients at one-year
follow-up were off anti-arrhythmic medications and 68 percent of patients
at one-year follow-up were off anti-coagulant medications.
Following the presentation, Dr. Hudspeth stated, "Standard medical
therapy often fails to treat AF patients' symptoms. These data look
promising for a minimally invasive ablation procedure for appropriate AF
patients." Most procedures in the series were performed through a few small
incisions (
четверг, 9 июня 2011 г.
Two-thirds Of Heart Attack Survivors Miss Out On Life-saving Service
Two-thirds of heart attack patients failed to receive a life-saving service, according to a report released by the British Heart Foundation (BHF) today.
The 2009 National Audit of Cardiac Rehabilitation (NACR) (1) found that only 34% of 83,540 heart attack sufferers took part in a cardiac rehabilitation programme. Just 30% of those who underwent an angioplasty procedure and 68% of those who had coronary artery bypass operations received the essential service. Overall the audit found that only 38% of heart patients attended cardiac rehabilitation (2).The audit covered England, Wales and Northern Ireland.
Cardiac rehabilitation gives heart attack patients a 26% greater chance of surviving in the five years following their diagnosis by providing them with the vital skills to manage their condition and significantly improves their quality of life (3).
The NACR, commissioned by the BHF, also found that women were significantly underrepresented in the programme. While women made up 37% of heart attack survivors, only 28% of patients that took part in cardiac rehabilitation were women.
The report indicates the service is falling short of the goals outlined in the National Service Framework for Coronary Heart Disease in England (2000), which set a target for 85% of cardiac patients to be invited to participate in cardiac rehabilitation. There has been no significant increase in the proportion of patients referred to rehabilitation programmes since last year's audit.
Dr Mike Knapton, Associate Medical Director at the BHF, was disappointed with the results.
"The number of heart patients taking part in cardiac rehabilitation hasn't increased since the last report. The audit shows that progress on making this life-saving service available to patients is flat-lining."
"Recovery from a heart attack isn't over when a patient leaves hospital and heart patients should be receiving the ongoing support they need. Referral to cardiac rehabilitation should be a routine part of treating heart patients, and until this happens they will continue to miss out."
In addition, the report did not find a single cardiac rehabilitation programme which met minimum staffing requirements (4). Only 1% of programmes meet the staffing guideline for pharmacy, 8% met the guideline for dieticians and 9% for psychological support.
Professor Bob Lewin at the BHF Cardiac Care and Education Research Group, who wrote the report, said "Patient referral is one of the main reasons why people are not attending. Many patients are simply not aware that it exists or that they should be doing it. "
"It is worrying that a third of patients who were offered the service said they weren't interested. Why wouldn't you be interested in a service that could prolong and improve your life? It is important that all of the staff within the health service understand the benefits of cardiac rehabilitation and communicate how important it is to their patients."
Cardiac rehabilitation involves nurses, physiotherapists, dieticians, psychologists and occupational therapists who work with their patients both one-to-one and in groups. At the end of the programme, patients are able to understand their condition, have greater confidence and are able to regain a high quality of life again (5).
The BHF and British Association for Cardiac Rehabilitation (BACR) are part of the Cardio and Vascular Coalition (CVC), a collaboration of over 40 organisations with an interest in heart and circulatory disease. The CVC is calling on the Westminster Government to commit to a renewed planned approach to cardiovascular conditions, as the National Service Framework for Coronary Heart Disease reaches its 10th anniversary. The CVC recently published Destination 2020 - a voluntary sector vision for change, which highlighted cardiac rehabilitation as a major area of unfinished business, including provision and uptake of cardiac rehabilitation, requiring ongoing prioritisation for the next decade.
Campaigns in Scotland, Wales and Northern Ireland are also asking for specific action by national governments.
Join the campaign for cardiac rehab by going to bhf.uk/cardiacrehab.
For a copy of the executive summary click here and for a full copy of the report click here.
Notes
(1) The audit examined data on the provision of cardiac rehabilitation in a 12 month period from 2007 - 2008. Data was collected from England, Wales and Northern Ireland.
(2) 38% of heart attack, angioplasty and coronary artery bypass patients were referred to cardiac rehabilitation.
(3) Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004;116:682 - 92.
(4) Guidelines outlined in the Scottish Intercollegiate Guideline Network (2002).
(5) Cardiac rehabilitation involves nurses, physiotherapists, dieticians, psychologists and occupational therapists who work with their patients both one-to-one and in groups. Quality programmes will include:
- ongoing advice and support from medical professionals
- advice on improving lifestyle and diet
- a structured exercise programme
- counselling
At the end of the average 12 week programme, patients will understand their condition, have greater confidence and be able to regain a high quality of life again.
Rehabilitation programmes teach people with heart disease to become more expert and active at self-managing their conditions - an aim which is high on the UK Government's wish list. It is also recommended by NICE (the National Institute for Health and Clinical Excellence).
Source
The British Heart Foundation
The 2009 National Audit of Cardiac Rehabilitation (NACR) (1) found that only 34% of 83,540 heart attack sufferers took part in a cardiac rehabilitation programme. Just 30% of those who underwent an angioplasty procedure and 68% of those who had coronary artery bypass operations received the essential service. Overall the audit found that only 38% of heart patients attended cardiac rehabilitation (2).The audit covered England, Wales and Northern Ireland.
Cardiac rehabilitation gives heart attack patients a 26% greater chance of surviving in the five years following their diagnosis by providing them with the vital skills to manage their condition and significantly improves their quality of life (3).
The NACR, commissioned by the BHF, also found that women were significantly underrepresented in the programme. While women made up 37% of heart attack survivors, only 28% of patients that took part in cardiac rehabilitation were women.
The report indicates the service is falling short of the goals outlined in the National Service Framework for Coronary Heart Disease in England (2000), which set a target for 85% of cardiac patients to be invited to participate in cardiac rehabilitation. There has been no significant increase in the proportion of patients referred to rehabilitation programmes since last year's audit.
Dr Mike Knapton, Associate Medical Director at the BHF, was disappointed with the results.
"The number of heart patients taking part in cardiac rehabilitation hasn't increased since the last report. The audit shows that progress on making this life-saving service available to patients is flat-lining."
"Recovery from a heart attack isn't over when a patient leaves hospital and heart patients should be receiving the ongoing support they need. Referral to cardiac rehabilitation should be a routine part of treating heart patients, and until this happens they will continue to miss out."
In addition, the report did not find a single cardiac rehabilitation programme which met minimum staffing requirements (4). Only 1% of programmes meet the staffing guideline for pharmacy, 8% met the guideline for dieticians and 9% for psychological support.
Professor Bob Lewin at the BHF Cardiac Care and Education Research Group, who wrote the report, said "Patient referral is one of the main reasons why people are not attending. Many patients are simply not aware that it exists or that they should be doing it. "
"It is worrying that a third of patients who were offered the service said they weren't interested. Why wouldn't you be interested in a service that could prolong and improve your life? It is important that all of the staff within the health service understand the benefits of cardiac rehabilitation and communicate how important it is to their patients."
Cardiac rehabilitation involves nurses, physiotherapists, dieticians, psychologists and occupational therapists who work with their patients both one-to-one and in groups. At the end of the programme, patients are able to understand their condition, have greater confidence and are able to regain a high quality of life again (5).
The BHF and British Association for Cardiac Rehabilitation (BACR) are part of the Cardio and Vascular Coalition (CVC), a collaboration of over 40 organisations with an interest in heart and circulatory disease. The CVC is calling on the Westminster Government to commit to a renewed planned approach to cardiovascular conditions, as the National Service Framework for Coronary Heart Disease reaches its 10th anniversary. The CVC recently published Destination 2020 - a voluntary sector vision for change, which highlighted cardiac rehabilitation as a major area of unfinished business, including provision and uptake of cardiac rehabilitation, requiring ongoing prioritisation for the next decade.
Campaigns in Scotland, Wales and Northern Ireland are also asking for specific action by national governments.
Join the campaign for cardiac rehab by going to bhf.uk/cardiacrehab.
For a copy of the executive summary click here and for a full copy of the report click here.
Notes
(1) The audit examined data on the provision of cardiac rehabilitation in a 12 month period from 2007 - 2008. Data was collected from England, Wales and Northern Ireland.
(2) 38% of heart attack, angioplasty and coronary artery bypass patients were referred to cardiac rehabilitation.
(3) Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004;116:682 - 92.
(4) Guidelines outlined in the Scottish Intercollegiate Guideline Network (2002).
(5) Cardiac rehabilitation involves nurses, physiotherapists, dieticians, psychologists and occupational therapists who work with their patients both one-to-one and in groups. Quality programmes will include:
- ongoing advice and support from medical professionals
- advice on improving lifestyle and diet
- a structured exercise programme
- counselling
At the end of the average 12 week programme, patients will understand their condition, have greater confidence and be able to regain a high quality of life again.
Rehabilitation programmes teach people with heart disease to become more expert and active at self-managing their conditions - an aim which is high on the UK Government's wish list. It is also recommended by NICE (the National Institute for Health and Clinical Excellence).
Source
The British Heart Foundation
среда, 8 июня 2011 г.
Cardiac Arrhythmias May Be Responsible For Sudden Death In People With High Cholesterol
Cholesterol can affect the flow of the electrical currents that generate the heart beat, according to a study from two UBC cardiovascular researchers funded by the Heart and Stroke Foundation of BC & Yukon. The research team has just published the important discovery about the causes of cardiac arrhythmias (abnormal heartbeats) in one of the world's leading scientific journals.
Together with a group from Paris, France, UBC researchers David Fedida and Jodene Eldstrom found that too much cholesterol can affect the electrical currents, perhaps causing the heart to start beating out of rhythm or even stop beating. In contrast, reducing the cholesterol normalized the structures underlying the electrical activity, thus promoting a regular and healthy heartbeat.
The researchers discovered that the key mechanism by which this happens is the Kv1.5 potassium channel, a protein that facilitates the flow of electrical charges through heart cells. Cholesterol blocks the functioning of these proteins while lowering of cholesterol levels enhances their function.
Prior to this research, scientists already knew that cholesterol plays an important role in regulating the heart's electrical system. However, they didn't know how.
"There is recent clinical and experimental evidence that lipid-lowering therapy, such as statins, can restore normal heart rhythms, thus helping to prevent sudden death," Dr. David Fedida said. "However, these pharmacological effects of statins are poorly understood and could involve other effects than their well-understood reduction of the cholesterol in blood vessels. Here we show that cholesterol regulates the submembrane pool of ion channels readily available for recruitment into the surface membranes of heart cells. This process could be a major mechanism for the tuning of the heartbeat and might contribute to the reduction in the incidence of abnormal and fatal heart rhythms during treatment with lipid-lowering drugs."
"Arrhythmias are a serious problem," said Dr. Jeff Sommers, Manager, Research and Science, Heart and Stroke Foundation of BC & Yukon. "Although they affect people of all ages, this is especially so with an aging population. This is a really exciting development that moves us well along the road of understanding how to target heart rhythm disorders for prevention and treatment."
This discovery points toward a new path for developing therapies that can directly target the causes of arrhythmia both before and after they start. Presently, anti-arrhythmic drugs are non-specific and may have significant side-effects. About 40% of Canadians have high blood cholesterol.
This research is published in the current issue of the Proceedings of the National Academy of Sciences, a top global journal. As well, the researchers will present their findings next week at a plenary session of the European Society of Cardiology in Barcelona.
Together with a group from Paris, France, UBC researchers David Fedida and Jodene Eldstrom found that too much cholesterol can affect the electrical currents, perhaps causing the heart to start beating out of rhythm or even stop beating. In contrast, reducing the cholesterol normalized the structures underlying the electrical activity, thus promoting a regular and healthy heartbeat.
The researchers discovered that the key mechanism by which this happens is the Kv1.5 potassium channel, a protein that facilitates the flow of electrical charges through heart cells. Cholesterol blocks the functioning of these proteins while lowering of cholesterol levels enhances their function.
Prior to this research, scientists already knew that cholesterol plays an important role in regulating the heart's electrical system. However, they didn't know how.
"There is recent clinical and experimental evidence that lipid-lowering therapy, such as statins, can restore normal heart rhythms, thus helping to prevent sudden death," Dr. David Fedida said. "However, these pharmacological effects of statins are poorly understood and could involve other effects than their well-understood reduction of the cholesterol in blood vessels. Here we show that cholesterol regulates the submembrane pool of ion channels readily available for recruitment into the surface membranes of heart cells. This process could be a major mechanism for the tuning of the heartbeat and might contribute to the reduction in the incidence of abnormal and fatal heart rhythms during treatment with lipid-lowering drugs."
"Arrhythmias are a serious problem," said Dr. Jeff Sommers, Manager, Research and Science, Heart and Stroke Foundation of BC & Yukon. "Although they affect people of all ages, this is especially so with an aging population. This is a really exciting development that moves us well along the road of understanding how to target heart rhythm disorders for prevention and treatment."
This discovery points toward a new path for developing therapies that can directly target the causes of arrhythmia both before and after they start. Presently, anti-arrhythmic drugs are non-specific and may have significant side-effects. About 40% of Canadians have high blood cholesterol.
This research is published in the current issue of the Proceedings of the National Academy of Sciences, a top global journal. As well, the researchers will present their findings next week at a plenary session of the European Society of Cardiology in Barcelona.
вторник, 7 июня 2011 г.
Exercise does more than burn calories
Physical activity not only lowers body weight, it cuts cardiovascular risk and blood pressure, improves lipid profiles, has positive effects on the immune system and can reduce the risk of certain cancers. It strengthens the heart, helps the lungs function better, enables the blood to carry more oxygen, makes muscles stronger and improves motion in the joints.
There is some evidence that exercise can enhance mood and even counter mild to moderate depression. Active people have a lower risk of stroke. [15]
Starting an exercise program at any point in life boosts health. Activity helps older people remain active longer. Walking three to four hours a week reduces death by any cause by 54 percent even among people who have diabetes. [16]
All these benefits vanish quickly once people stop exercising.
The Centers for Disease Control and Prevention and the American College of Sports Medicine set the standard for physical activity in 1995, recommending at least 30 minutes a day of moderate exercise on most or all days of the week, in increments as short as 10 minutes. [17]
" From the 1970s up to the 1990s, 'exercise' was geared to improving fitness and was based on the model of an athletic male college student," says Harvard's I-Min Lee, M.D. "Today, the new model is health, not athletic training."
One new study tested various combinations of high and moderate exercise intensity and duration, combined with a 30 percent reduction in calories consumed. The level of intensity produced no significant differences in weight loss. What did make a difference, the researchers say, was time.
Women who exercised 150 minutes a week lost 4.7 percent of their starting weight, while those who spent 200 minutes or more exercising lost 13.6 percent. [18]
Cheap, high-calorie foods and too much time in front of the TV or computer combine to fatten America's children, say many experts. Nearly half of American youths age 12 to 21 get no regular vigorous exercise, says a U.S. Surgeon General's report.[19]
Meanwhile, older people want to exercise to improve their health and appearance, maintain their independence and remain active with their families. But they are discouraged by poor health conditions that interfere with ease of exercise, lack of time and the toll of aging. [20]
Almost any form of physical activity can improve overall health and the cardiovascular system: walking, gardening, pushing a stroller, swimming laps, jumping rope, riding a bike. A "start low and go slow" approach is a good way to begin a personal exercise plan, experts say.
"The point is, at least do something," Lee says. "Something is better than
nothing."
To read the whole article please go to this web page at the Center for the Advancement of Health
There is some evidence that exercise can enhance mood and even counter mild to moderate depression. Active people have a lower risk of stroke. [15]
Starting an exercise program at any point in life boosts health. Activity helps older people remain active longer. Walking three to four hours a week reduces death by any cause by 54 percent even among people who have diabetes. [16]
All these benefits vanish quickly once people stop exercising.
The Centers for Disease Control and Prevention and the American College of Sports Medicine set the standard for physical activity in 1995, recommending at least 30 minutes a day of moderate exercise on most or all days of the week, in increments as short as 10 minutes. [17]
" From the 1970s up to the 1990s, 'exercise' was geared to improving fitness and was based on the model of an athletic male college student," says Harvard's I-Min Lee, M.D. "Today, the new model is health, not athletic training."
One new study tested various combinations of high and moderate exercise intensity and duration, combined with a 30 percent reduction in calories consumed. The level of intensity produced no significant differences in weight loss. What did make a difference, the researchers say, was time.
Women who exercised 150 minutes a week lost 4.7 percent of their starting weight, while those who spent 200 minutes or more exercising lost 13.6 percent. [18]
Cheap, high-calorie foods and too much time in front of the TV or computer combine to fatten America's children, say many experts. Nearly half of American youths age 12 to 21 get no regular vigorous exercise, says a U.S. Surgeon General's report.[19]
Meanwhile, older people want to exercise to improve their health and appearance, maintain their independence and remain active with their families. But they are discouraged by poor health conditions that interfere with ease of exercise, lack of time and the toll of aging. [20]
Almost any form of physical activity can improve overall health and the cardiovascular system: walking, gardening, pushing a stroller, swimming laps, jumping rope, riding a bike. A "start low and go slow" approach is a good way to begin a personal exercise plan, experts say.
"The point is, at least do something," Lee says. "Something is better than
nothing."
To read the whole article please go to this web page at the Center for the Advancement of Health
понедельник, 6 июня 2011 г.
Continued Damage From Banned Obesity Drug Revealed By Study
Fenfluramine, the appetite suppressant drug banned in the US in 1997 due to fears over its links to heart conditions, has been shown to have serious long-term effects. In a report published in the open access journal BMC Medicine, researchers have shown that people who stopped using fenfluramine eleven years ago had damaged heart valves up to seven years later.
Fenfluramine (and the closely related dexfenfluramine) were widely prescribed as half of a so-called 'fen/phen' drug combination used to combat obesity. Since its withdrawal, there have been reports that tens of thousands of lawsuits have been filed against the drug's manufacturers over damage caused. In this study, Charles Dahl from the Central Utah Clinic led a team of researchers who studied the heart condition of 5743 former fenfluramine users. He said, "Valve problems were common in individuals exposed to fenfluramines, more frequent in females and associated with duration of drug use in all valves assessed".
Heart valves, such as the aortic, mitral and tricuspid valves, ensure that blood flows in the correct direction around the heart. When they fail, blood back-flows (termed regurgitation). If the regurgitation is severe enough, congestive heart failure and/or the need for heart valve surgery may occur. Dahl said, "We found clear evidence for a strong, graded association between duration of exposure to fenfluramines and prevalence of aortic regurgitation and for mild or greater mitral and tricuspid regurgitation".
This is the largest study to examine duration of exposure to the drug and the first to estimate the incidence of valvular surgery among prior users. The authors found that 0.44% of former fenfluramine users in this group had valve surgery as a result of the use of fenfluramines. This risk for valve surgery was increased approximately seven fold. They write, "This is probably a conservative estimate, as another study has shown that there exists a 17- to 34-fold excess of clinically apparent (presumably severe), valvular disease in persons who had used fenfluramines for four months or longer".
Notes:
1. Valvular Regurgitation and Surgery Associated with Fenfluramine Use: An Analysis of 5743 Individuals
Charles F Dahl, Marvin R Allen, Paul M Urie and Paul N Hopkins
BMC Medicine (in press)
Article available at the journal website: biomedcentral/bmcmed/
All articles are available free of charge, according to BioMed Central's open access policy.
2. BMC Medicine publishes original research articles, technical advances and study protocols in any area of medical science or clinical practice. To be appropriate for BMC Medicine, articles need to be of special importance and broad interest. BMC Medicine (ISSN 1741-7015) is indexed/tracked/covered by PubMed, MEDLINE, BIOSIS, CAS, Scopus, EMBASE, Thomson Reuters (ISI) and Google Scholar.
3. BioMed Central (biomedcentral/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.
Fenfluramine (and the closely related dexfenfluramine) were widely prescribed as half of a so-called 'fen/phen' drug combination used to combat obesity. Since its withdrawal, there have been reports that tens of thousands of lawsuits have been filed against the drug's manufacturers over damage caused. In this study, Charles Dahl from the Central Utah Clinic led a team of researchers who studied the heart condition of 5743 former fenfluramine users. He said, "Valve problems were common in individuals exposed to fenfluramines, more frequent in females and associated with duration of drug use in all valves assessed".
Heart valves, such as the aortic, mitral and tricuspid valves, ensure that blood flows in the correct direction around the heart. When they fail, blood back-flows (termed regurgitation). If the regurgitation is severe enough, congestive heart failure and/or the need for heart valve surgery may occur. Dahl said, "We found clear evidence for a strong, graded association between duration of exposure to fenfluramines and prevalence of aortic regurgitation and for mild or greater mitral and tricuspid regurgitation".
This is the largest study to examine duration of exposure to the drug and the first to estimate the incidence of valvular surgery among prior users. The authors found that 0.44% of former fenfluramine users in this group had valve surgery as a result of the use of fenfluramines. This risk for valve surgery was increased approximately seven fold. They write, "This is probably a conservative estimate, as another study has shown that there exists a 17- to 34-fold excess of clinically apparent (presumably severe), valvular disease in persons who had used fenfluramines for four months or longer".
Notes:
1. Valvular Regurgitation and Surgery Associated with Fenfluramine Use: An Analysis of 5743 Individuals
Charles F Dahl, Marvin R Allen, Paul M Urie and Paul N Hopkins
BMC Medicine (in press)
Article available at the journal website: biomedcentral/bmcmed/
All articles are available free of charge, according to BioMed Central's open access policy.
2. BMC Medicine publishes original research articles, technical advances and study protocols in any area of medical science or clinical practice. To be appropriate for BMC Medicine, articles need to be of special importance and broad interest. BMC Medicine (ISSN 1741-7015) is indexed/tracked/covered by PubMed, MEDLINE, BIOSIS, CAS, Scopus, EMBASE, Thomson Reuters (ISI) and Google Scholar.
3. BioMed Central (biomedcentral/) is an independent online publishing house committed to providing immediate access without charge to the peer-reviewed biological and medical research it publishes. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science.
воскресенье, 5 июня 2011 г.
Chronic Sleep Loss Affects The Body Differently To Acute Sleep Loss, Researchers Show
We've all experienced that occasional all-too-short night of sleep -- staying out too late at a party on a weeknight, studying into the wee hours for a morning exam or being kept up during the night with a sick child. Our bodies try to catch up by making us sleep more and/or more deeply the following night.
It is well established that following an acute period of sleep loss, the body responds this way in order to maintain a homeostatic balance between sleep and wakefulness. Very little is known, however, about the health consequences of chronic partial sleep loss -- losing a little bit of sleep over a period of days, months or even years.
Now sleep researchers at Northwestern University have discovered that when animals are partially sleep deprived over consecutive days they no longer attempt to catch up on sleep, despite an accumulating sleep deficit. Their study is the first to show that repeated partial sleep loss negatively affects an animal's ability to compensate for lost sleep. The body responds differently to chronic sleep loss than it does to acute sleep loss.
The results, which shed light on a problem prevalent in industrialized nations with 24/7 societies such as the United States, where Americans get nearly an hour less sleep a night than they did 40 years ago, were published online recently by the Proceedings of the National Academy of Sciences (PNAS).
"We now know that chronic lack of sleep has an effect on how an animal sleeps," said Fred W. Turek, professor of neurobiology and physiology and director of Northwestern's Center for Sleep and Circadian Biology and an author of the paper. "The animals are getting by on less sleep but they do not try and catch up. The ability to compensate for lost sleep is itself lost, which is damaging both physically and mentally."
In the study, the researchers kept animals awake for 20 hours per day followed by a four-hour sleep opportunity, over five consecutive days. The team monitored brain wave and muscle activity patterns in order to precisely quantify sleep-wake patterns.
After the first day of sleep loss, animals compensated by increasing their intensity, or depth, of sleep, which is indicative of a homeostatic response. However, on the subsequent days of sleep loss, the animals failed to generate this compensatory response and did not sleep any more deeply or any longer than they did under non-sleep deprived conditions (baseline measurements). At the end of the study, the animals were given three full days to sleep as much as they wanted. Amazingly, they recovered virtually none of the sleep that was lost during the five-day sleep deprivation period.
The findings support what other scientists have discovered in recent experimental studies in humans. Chronic partial sleep loss of even two to three hours per night was found to have detrimental effects on the body, leading to impairments in cognitive performance, as well as cardiovascular, immune and endocrine functions. Sleep-restricted people also reported not feeling sleepy even though their performance on tasks declined.
The Northwestern team's results suggest that animals may undergo a change in their need for sleep, or in their sleep homeostat, in situations where normal sleep time is prohibited or where sleep could be detrimental for survival. An extreme but realistic example of this, says Turek, would be how animals respond to catastrophic environmental conditions, such as Hurricane Katrina. No matter how sleep deprived an animal or human may be, it would not be adaptive for the sleep homeostat to kick in and to make the animal fall sleep when it is in the midst of a flood or forest fire. Therefore, the body undergoes some change that allows it to counter its homeostatic need for sleep and to stay awake to avoid danger.
Turek and his team propose that this change in the sleep regulatory system is reflective of an allostatic response. In the short term, allostatic responses are adaptive, but when sustained on a chronic basis, such as in their study, an allostatic load will develop and lead to negative health outcomes. The allostatic load resulting from the accumulating sleep debt loops back to the sleep regulatory system itself and alters it.
"Even though animals and humans may be able to adapt their sleep system to deal with repeated sleep restriction conditions, there could be negative consequences when this pattern is maintained over a long period of time," said Turek. "This brings us back to the idea that repeated partial sleep restriction in humans has been linked to metabolic dysfunction and cardiovascular disease."
"Our lab is very interested in the interactions between sleep loss and metabolic function," said Aaron D. Laposky, research assistant professor at the Center for Sleep and Circadian Biology and an author of the paper. "As Americans have been getting less sleep per night, there has been a parallel trend for body mass index to significantly increase. We believe that when partial sleep loss occurs repeatedly over a long period of time, individuals are predisposed to alterations in the function of many physiological systems."
In addition to Laposky and Turek, other authors of the PNAS paper, titled "Repeated sleep restriction in rats leads to homeostatic and allostatic responses during recovery sleep," are graduate student Youngsoo Kim (lead author) and visiting scholar Bernard M. Bergmann, both from Northwestern.
It is well established that following an acute period of sleep loss, the body responds this way in order to maintain a homeostatic balance between sleep and wakefulness. Very little is known, however, about the health consequences of chronic partial sleep loss -- losing a little bit of sleep over a period of days, months or even years.
Now sleep researchers at Northwestern University have discovered that when animals are partially sleep deprived over consecutive days they no longer attempt to catch up on sleep, despite an accumulating sleep deficit. Their study is the first to show that repeated partial sleep loss negatively affects an animal's ability to compensate for lost sleep. The body responds differently to chronic sleep loss than it does to acute sleep loss.
The results, which shed light on a problem prevalent in industrialized nations with 24/7 societies such as the United States, where Americans get nearly an hour less sleep a night than they did 40 years ago, were published online recently by the Proceedings of the National Academy of Sciences (PNAS).
"We now know that chronic lack of sleep has an effect on how an animal sleeps," said Fred W. Turek, professor of neurobiology and physiology and director of Northwestern's Center for Sleep and Circadian Biology and an author of the paper. "The animals are getting by on less sleep but they do not try and catch up. The ability to compensate for lost sleep is itself lost, which is damaging both physically and mentally."
In the study, the researchers kept animals awake for 20 hours per day followed by a four-hour sleep opportunity, over five consecutive days. The team monitored brain wave and muscle activity patterns in order to precisely quantify sleep-wake patterns.
After the first day of sleep loss, animals compensated by increasing their intensity, or depth, of sleep, which is indicative of a homeostatic response. However, on the subsequent days of sleep loss, the animals failed to generate this compensatory response and did not sleep any more deeply or any longer than they did under non-sleep deprived conditions (baseline measurements). At the end of the study, the animals were given three full days to sleep as much as they wanted. Amazingly, they recovered virtually none of the sleep that was lost during the five-day sleep deprivation period.
The findings support what other scientists have discovered in recent experimental studies in humans. Chronic partial sleep loss of even two to three hours per night was found to have detrimental effects on the body, leading to impairments in cognitive performance, as well as cardiovascular, immune and endocrine functions. Sleep-restricted people also reported not feeling sleepy even though their performance on tasks declined.
The Northwestern team's results suggest that animals may undergo a change in their need for sleep, or in their sleep homeostat, in situations where normal sleep time is prohibited or where sleep could be detrimental for survival. An extreme but realistic example of this, says Turek, would be how animals respond to catastrophic environmental conditions, such as Hurricane Katrina. No matter how sleep deprived an animal or human may be, it would not be adaptive for the sleep homeostat to kick in and to make the animal fall sleep when it is in the midst of a flood or forest fire. Therefore, the body undergoes some change that allows it to counter its homeostatic need for sleep and to stay awake to avoid danger.
Turek and his team propose that this change in the sleep regulatory system is reflective of an allostatic response. In the short term, allostatic responses are adaptive, but when sustained on a chronic basis, such as in their study, an allostatic load will develop and lead to negative health outcomes. The allostatic load resulting from the accumulating sleep debt loops back to the sleep regulatory system itself and alters it.
"Even though animals and humans may be able to adapt their sleep system to deal with repeated sleep restriction conditions, there could be negative consequences when this pattern is maintained over a long period of time," said Turek. "This brings us back to the idea that repeated partial sleep restriction in humans has been linked to metabolic dysfunction and cardiovascular disease."
"Our lab is very interested in the interactions between sleep loss and metabolic function," said Aaron D. Laposky, research assistant professor at the Center for Sleep and Circadian Biology and an author of the paper. "As Americans have been getting less sleep per night, there has been a parallel trend for body mass index to significantly increase. We believe that when partial sleep loss occurs repeatedly over a long period of time, individuals are predisposed to alterations in the function of many physiological systems."
In addition to Laposky and Turek, other authors of the PNAS paper, titled "Repeated sleep restriction in rats leads to homeostatic and allostatic responses during recovery sleep," are graduate student Youngsoo Kim (lead author) and visiting scholar Bernard M. Bergmann, both from Northwestern.
суббота, 4 июня 2011 г.
Study On CPR During Ambulance Transport Of Cardiac Arrest Patients Named "Best EMS Professional Research Presentation" At NAEMSP Conference
ZOLL Medical Corporation (NasdaqGS: ZOLL) announced that a study entitled, "Increased CPR Variability During Ground Ambulance Transport of Patients in Cardiac Arrest" presented by Ben Bobrow, M.D., Medical Director for the Arizona Department of Health Services, Bureau of Emergency Medical Services & Trauma System and the Maricopa Medical Center Resuscitation Science Center, was named the "Best EMS Professional Research Presentation" at the National Association of EMS Physicians (NAEMSP®) 2010 Conference in Phoenix, Arizona. With data supplied from ZOLL E Series® devices, the study concluded that healthcare providers are able to perform more consistent compressions when treating cardiac arrest patients at the scene as opposed to in the back of a moving ambulance.
This study was conducted with Guardian Medical Transport in Flagstaff, Arizona, and the Mesa Fire Department in Mesa, Arizona, as part of a larger Resuscitation Quality Improvement Program. The aim was to quantify and compare the quality of chest compressions at the scene of a resuscitation attempt and during transport. The research was undertaken in response to questions that had been raised about the safety and efficacy of performing manual chest compressions during the ambulance transport of patients in cardiac arrest.
Dr. Bobrow stated, "We found an increase in the variability of chest compression quality for the rate and depth of compressions in our two EMS agencies during the ground transport of cardiac arrest patients. Further investigation is needed to determine the causes of the increased variability along with the optimal timing and method of delivering manual chest compressions."
The EMS agencies participating in the project utilized ZOLL E Series monitor-defibrillators with an accelerometer to continuously record chest compression quality during resuscitation both at the scene and during ambulance transport. The device's built-in Real CPR Help®, which provides real-time audiovisual feedback on the correct rate and depth of chest compressions, was inactivated. ZOLL's Code Review software was used to collect data on chest compression quality during the time a patient was treated at the scene and in transport. The time during which the patient had spontaneous circulation was excluded from analysis as CPR would not have been required during those minutes. Variability was defined as the average of minute-by-minute standard deviations in depth or rate.
A total of 90 adult cardiac arrest events were electronically recorded, of which 45 included chest compressions both at the scene and in the ambulance. Variability in chest compression rate and chest compression depth was significantly greater during transport compared with at the scene. Absolute chest compression depth and chest compression rate tended to be lower during transport. Although not reaching statistical significance, the percentage of chest compressions in compliance with AHA 2005 guidelines for depth (1.5-2 in) and rate (100?±10 compressions/minute) was nearly double at the scene compared with during transport.
"We are pleased that ZOLL technology was used in this study," said Jonathan A. Rennert, President of ZOLL. "We are very committed to helping agencies conduct research that may ultimately result in improving outcomes from cardiac arrest."
About Sudden Cardiac Arrest
SCA, an abrupt disruption of the heart's function, which causes a lack of blood flow to vital organs, claims more than 1 million lives each year. It is the leading cause of unexpected death in the world and strikes without warning. Currently, only about 5 percent of victims survive; 95 percent will die from SCA.
Source
ZOLL Medical Corporation
This study was conducted with Guardian Medical Transport in Flagstaff, Arizona, and the Mesa Fire Department in Mesa, Arizona, as part of a larger Resuscitation Quality Improvement Program. The aim was to quantify and compare the quality of chest compressions at the scene of a resuscitation attempt and during transport. The research was undertaken in response to questions that had been raised about the safety and efficacy of performing manual chest compressions during the ambulance transport of patients in cardiac arrest.
Dr. Bobrow stated, "We found an increase in the variability of chest compression quality for the rate and depth of compressions in our two EMS agencies during the ground transport of cardiac arrest patients. Further investigation is needed to determine the causes of the increased variability along with the optimal timing and method of delivering manual chest compressions."
The EMS agencies participating in the project utilized ZOLL E Series monitor-defibrillators with an accelerometer to continuously record chest compression quality during resuscitation both at the scene and during ambulance transport. The device's built-in Real CPR Help®, which provides real-time audiovisual feedback on the correct rate and depth of chest compressions, was inactivated. ZOLL's Code Review software was used to collect data on chest compression quality during the time a patient was treated at the scene and in transport. The time during which the patient had spontaneous circulation was excluded from analysis as CPR would not have been required during those minutes. Variability was defined as the average of minute-by-minute standard deviations in depth or rate.
A total of 90 adult cardiac arrest events were electronically recorded, of which 45 included chest compressions both at the scene and in the ambulance. Variability in chest compression rate and chest compression depth was significantly greater during transport compared with at the scene. Absolute chest compression depth and chest compression rate tended to be lower during transport. Although not reaching statistical significance, the percentage of chest compressions in compliance with AHA 2005 guidelines for depth (1.5-2 in) and rate (100?±10 compressions/minute) was nearly double at the scene compared with during transport.
"We are pleased that ZOLL technology was used in this study," said Jonathan A. Rennert, President of ZOLL. "We are very committed to helping agencies conduct research that may ultimately result in improving outcomes from cardiac arrest."
About Sudden Cardiac Arrest
SCA, an abrupt disruption of the heart's function, which causes a lack of blood flow to vital organs, claims more than 1 million lives each year. It is the leading cause of unexpected death in the world and strikes without warning. Currently, only about 5 percent of victims survive; 95 percent will die from SCA.
Source
ZOLL Medical Corporation
пятница, 3 июня 2011 г.
Shands At The University Of Florida Expands Cardiac And Neuro Diagnostic Capabilities Through Utilization Of Toshiba's Aquilion One
Shands at the University of Florida, the primary teaching hospital for the UF College of Medicine and one of the Southeast's premier health centers, has expanded its diagnostic imaging capabilities for both cardiac and neurological diseases through the utilization of two Toshiba America Medical Systems, Inc. AquilionTM ONE CT systems. The systems' ability to capture the entire heart or brain in one rotation has enabled UF physicians at Shands to improve diagnostic accuracy and workflow for patients presenting with stroke and heart attack symptoms, while making imaging safer for patients by limiting radiation doses. Toshiba will be showcasing the Aquilion ONE's advanced cardiac capabilities at this year's American College of Cardiology (ACC) annual meeting in New Orleans, April 2 - 5, 2011 (Booth # 2847).
UF radiologists are using Toshiba's Aquilion ONE CT system for advanced cardiac applications for patients presenting with chest pain in the emergency department, evaluation of coronary artery disease and definitive non-invasive evaluation of congenital heart disease with low radiation dose. Unlike any other CT system available, the Aquilion ONE covers up to 16 cm of anatomy using 320 ultra-high resolution 0.5 mm detector elements and can image the entire heart in less than a single heartbeat.
"Having a system with the ability to capture the entire heart and great vessels with a single gantry rotation allows for imaging with very low dose and can often provide all of the information required for operative planning in the setting of complex congenital heart disease," said Dr. Roger Shifrin, UF College of Medicine radiology clinical assistant professor. "This capability is extremely important for this patient set, as they will likely undergo multiple exams with radiation over the course of their lifetime."
In addition to successfully evaluating cardiac patients, UF physicians at Shands have been able to further develop and elevate the hospital's stroke imaging. Prior to the Aquilion ONE, diagnostic accuracy for stroke with CT was limited, because many strokes were occurring outside of the detector row imaging area. With the Aquilion ONE's ability to cover up to 16 cm of anatomy, the entire brain can be imaged in a single rotation, dramatically improving the identification of stroke. It can show the organ's dynamic blood flow and real-time function, allowing visualization of dynamic function. These capabilities enable the clinicians at Shands at UF to identify stroke in minutes and are critical in developing the best treatment path and improving the life of the patient, as every second counts in stroke diagnosis.
"Whole-brain perfusion imaging on the Aquilion ONE has improved our ability to accurately and efficiently diagnose stroke," said Dr. Keith Peters, UF College of Medicine associate professor of radiology and neurological surgery. "Additionally, having the ability to conduct dynamic CT angiography over a one-minute sequence allows for the detection of a range of neurological diseases such as brain tumors, carotid-cavernous fistulas, patients with trauma or an altered mental state and other subtle abnormalities, such as rapid blood flow."
"Working with the team at Shands at the University of Florida is a clear example of Toshiba's commitment to developing industry-leading technology that helps hospitals improve their patient care," said Joseph Cooper, director, CT Business Unit, Toshiba. "The Aquilion ONE has allowed Shands at UF to enhance both its cardiac and neurology departments' capabilities through the expansion of diagnostic offerings and implementation of training programs, resulting in improved workflow and better patient outcomes."
About Shands at the University of Florida
Shands HealthCare is private, not-for-profit and affiliated with the University of Florida. Located in Gainesville, Fla., the 618-bed Shands at UF medical center specializes in tertiary and quaternary care for critically ill patients and is one of the Southeast's leading referral medical centers. Approximately 800 UF faculty physicians practice in about 100 areas of specialty care. Shands at UF's areas of excellence are cancer, cardiovascular, neurosurgical and transplant services; and pediatric services at Shands Children's Hospital at UF. Shands at UF operates a State-designated Level I Trauma Center, a Level III Neonatal Intensive Care Unit and one of four regional burn centers. Shands at UF also offers a Neuro ICU with highly specialized physician care expertise in neurosurgery, endovascular neurosurgery, vascular, neurology, critical care medicine, epileptology and neuroradiology. Shands at UF continually receives recognition as one of the nation's top hospitals by U.S. News & World Report because of the dedication to patient care, education and research provided by UF and Shands clinical and support teams.
About Toshiba's Aquilion CT Product Line Recognition
The Aquilion CT product line has received numerous accolades including the number one ranking in CT from MD Buyline since 2002 (eight consecutive years). The Aquilion 64 line has also been named Best in KLAS in 2006 and 2007 in CT; Best in KLAS in 2008, 2009 and 2010 for 64-detector row and above; and Frost & Sullivan's "Healthcare Innovation Award in Cardiovascular Imaging" in 2008. Most recently, Toshiba's service was ranked number one in 26 out of 40 attributes in the IMV, Ltd. ServiceTrakTM Imaging 2010 report on CT system service.
UF radiologists are using Toshiba's Aquilion ONE CT system for advanced cardiac applications for patients presenting with chest pain in the emergency department, evaluation of coronary artery disease and definitive non-invasive evaluation of congenital heart disease with low radiation dose. Unlike any other CT system available, the Aquilion ONE covers up to 16 cm of anatomy using 320 ultra-high resolution 0.5 mm detector elements and can image the entire heart in less than a single heartbeat.
"Having a system with the ability to capture the entire heart and great vessels with a single gantry rotation allows for imaging with very low dose and can often provide all of the information required for operative planning in the setting of complex congenital heart disease," said Dr. Roger Shifrin, UF College of Medicine radiology clinical assistant professor. "This capability is extremely important for this patient set, as they will likely undergo multiple exams with radiation over the course of their lifetime."
In addition to successfully evaluating cardiac patients, UF physicians at Shands have been able to further develop and elevate the hospital's stroke imaging. Prior to the Aquilion ONE, diagnostic accuracy for stroke with CT was limited, because many strokes were occurring outside of the detector row imaging area. With the Aquilion ONE's ability to cover up to 16 cm of anatomy, the entire brain can be imaged in a single rotation, dramatically improving the identification of stroke. It can show the organ's dynamic blood flow and real-time function, allowing visualization of dynamic function. These capabilities enable the clinicians at Shands at UF to identify stroke in minutes and are critical in developing the best treatment path and improving the life of the patient, as every second counts in stroke diagnosis.
"Whole-brain perfusion imaging on the Aquilion ONE has improved our ability to accurately and efficiently diagnose stroke," said Dr. Keith Peters, UF College of Medicine associate professor of radiology and neurological surgery. "Additionally, having the ability to conduct dynamic CT angiography over a one-minute sequence allows for the detection of a range of neurological diseases such as brain tumors, carotid-cavernous fistulas, patients with trauma or an altered mental state and other subtle abnormalities, such as rapid blood flow."
"Working with the team at Shands at the University of Florida is a clear example of Toshiba's commitment to developing industry-leading technology that helps hospitals improve their patient care," said Joseph Cooper, director, CT Business Unit, Toshiba. "The Aquilion ONE has allowed Shands at UF to enhance both its cardiac and neurology departments' capabilities through the expansion of diagnostic offerings and implementation of training programs, resulting in improved workflow and better patient outcomes."
About Shands at the University of Florida
Shands HealthCare is private, not-for-profit and affiliated with the University of Florida. Located in Gainesville, Fla., the 618-bed Shands at UF medical center specializes in tertiary and quaternary care for critically ill patients and is one of the Southeast's leading referral medical centers. Approximately 800 UF faculty physicians practice in about 100 areas of specialty care. Shands at UF's areas of excellence are cancer, cardiovascular, neurosurgical and transplant services; and pediatric services at Shands Children's Hospital at UF. Shands at UF operates a State-designated Level I Trauma Center, a Level III Neonatal Intensive Care Unit and one of four regional burn centers. Shands at UF also offers a Neuro ICU with highly specialized physician care expertise in neurosurgery, endovascular neurosurgery, vascular, neurology, critical care medicine, epileptology and neuroradiology. Shands at UF continually receives recognition as one of the nation's top hospitals by U.S. News & World Report because of the dedication to patient care, education and research provided by UF and Shands clinical and support teams.
About Toshiba's Aquilion CT Product Line Recognition
The Aquilion CT product line has received numerous accolades including the number one ranking in CT from MD Buyline since 2002 (eight consecutive years). The Aquilion 64 line has also been named Best in KLAS in 2006 and 2007 in CT; Best in KLAS in 2008, 2009 and 2010 for 64-detector row and above; and Frost & Sullivan's "Healthcare Innovation Award in Cardiovascular Imaging" in 2008. Most recently, Toshiba's service was ranked number one in 26 out of 40 attributes in the IMV, Ltd. ServiceTrakTM Imaging 2010 report on CT system service.
четверг, 2 июня 2011 г.
Institute Of Medicine Makes Recommendations On Producing Trustworthy Guidelines
Few issues are more important to the American College of Cardiology and the American Heart Association than translating scientific evidence into guidelines and performance measures for healthcare providers, a process we have been engaged in for several decades. The use of these evidence-based guidelines has been proven to improve the quality of care and actual outcomes for patients. We applaud the IOM for its new report and share its position that it is critical that no commercial or any other bias can be allowed to influence the development of clinical practice guidelines.
The new Institutes of Medicine report, "Clinical Guidelines Practices We Can Trust," published March 23, 2011, cites the American College of Cardiology and American Heart Association's standards for guideline development as being almost perfectly aligned with their recommendations.
Both the AHA and ACC also appreciate the focus on the issue in the Archives of Internal Medicine article by Mendelson et al, which analyzes the disclosure of relationships with industry in joint guidelines developed by the American College of Cardiology and American Heart Association between 2004 and 2008.
Both the American College of Cardiology and the American Heart Association have long had strict policies for preventing any undue influence of industry. In 2004-2008, these policies relating to practice guidelines included the requirements that:
- All writing panel members must verbally disclose all relevant relationships with industry at every meeting and conference call.
- Individual panelists with a relationship with industry were held responsible to recuse themselves from any matter relevant to their relationship.
- All disclosures would be published as an appendix to each guideline.
- Multiple tiers of reviewers assured the lack of bias of each guideline document.
As the Archives article states, the American College of Cardiology and the American Heart Association refined their policies in 2010 to require even more stringent management of relationships with industry, to align with the Council of Medical Specialty Societies (CMSS). Thus the data within and the conclusions drawn by the article do not reflect the reality of the guidelines development process today.
Updated practices include these additions:
- The Chair of the guidelines writing panel may not have any relevant relationships with industry.
- In addition to the Chair, a majority (at least 50 percent) of guidelines writing committee members must not have any relevant relationships with industry.
- A writing committee member may not draft a recommendation nor any text nor vote on any recommendation that is relevant to any of their industry relationships.
- Members of the final approving bodies of ACC and AHA, Science Advisory Coordinating Committee and the Board of Trust respectively, also must recuse themselves from voting if they have a relevant relationship with industry.
For determining eligibility to serve on a writing committee, a person is considered to have a relevant relationship IF:
- The relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; or
- The company/entity (with whom the relationship exists) makes a drug, drug class, or device addressed in the document, or makes a competing drug or device addressed in the document; or
- The person or a member of the person's household has a reasonable potential for financial, professional or other personal gain or loss as a result of the issues/content addressed in the document.
The American College of Cardiology and the American Heart Association remain fully committed to transparency in the development of all our guidelines. We will continue to look closely at our policies regarding relationships with industry and welcome public dialogue that may help us continue to enhance our practices in the future.
The new Institutes of Medicine report, "Clinical Guidelines Practices We Can Trust," published March 23, 2011, cites the American College of Cardiology and American Heart Association's standards for guideline development as being almost perfectly aligned with their recommendations.
Both the AHA and ACC also appreciate the focus on the issue in the Archives of Internal Medicine article by Mendelson et al, which analyzes the disclosure of relationships with industry in joint guidelines developed by the American College of Cardiology and American Heart Association between 2004 and 2008.
Both the American College of Cardiology and the American Heart Association have long had strict policies for preventing any undue influence of industry. In 2004-2008, these policies relating to practice guidelines included the requirements that:
- All writing panel members must verbally disclose all relevant relationships with industry at every meeting and conference call.
- Individual panelists with a relationship with industry were held responsible to recuse themselves from any matter relevant to their relationship.
- All disclosures would be published as an appendix to each guideline.
- Multiple tiers of reviewers assured the lack of bias of each guideline document.
As the Archives article states, the American College of Cardiology and the American Heart Association refined their policies in 2010 to require even more stringent management of relationships with industry, to align with the Council of Medical Specialty Societies (CMSS). Thus the data within and the conclusions drawn by the article do not reflect the reality of the guidelines development process today.
Updated practices include these additions:
- The Chair of the guidelines writing panel may not have any relevant relationships with industry.
- In addition to the Chair, a majority (at least 50 percent) of guidelines writing committee members must not have any relevant relationships with industry.
- A writing committee member may not draft a recommendation nor any text nor vote on any recommendation that is relevant to any of their industry relationships.
- Members of the final approving bodies of ACC and AHA, Science Advisory Coordinating Committee and the Board of Trust respectively, also must recuse themselves from voting if they have a relevant relationship with industry.
For determining eligibility to serve on a writing committee, a person is considered to have a relevant relationship IF:
- The relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; or
- The company/entity (with whom the relationship exists) makes a drug, drug class, or device addressed in the document, or makes a competing drug or device addressed in the document; or
- The person or a member of the person's household has a reasonable potential for financial, professional or other personal gain or loss as a result of the issues/content addressed in the document.
The American College of Cardiology and the American Heart Association remain fully committed to transparency in the development of all our guidelines. We will continue to look closely at our policies regarding relationships with industry and welcome public dialogue that may help us continue to enhance our practices in the future.
среда, 1 июня 2011 г.
Adhering To Guidelines For Acute Coronary Syndromes Benefits Even Very Elderly Patients
Some say age 90 is the new age 70. If so, there's never been a better time for elderly patients to discuss with family and physicians just how aggressive medical care should be in case of a threatened or definite heart attack.
According to a study published in the May 1, 2007 issue of the Journal of the American College of Cardiology (JACC), patients age 90 and older who came to the emergency room with acute coronary syndromes were less likely than younger patients to receive recommended treatments - but for those who did, survival was much better.
"Having an acute coronary syndrome, even over the age of 90, is not as dire as it once was," said David J. Cohen, M.D., M.Sc., F.A.C.C., director of cardiovascular research at Saint Luke's Mid America Heart Institute, Kansas City, MO. "With optimal medical therapy and invasive care, the outcomes were nearly as good as in a somewhat younger group of patients."
Acute coronary syndrome is an umbrella diagnosis that encompasses both a type of heart attack known as non ST-segment elevation myocardial infarction (NSTEMI) and unstable angina, or chest pain. It is usually caused by a blood clot that temporarily or partially blocks the coronary artery.
Therapies recommended by American College of Cardiology/American Heart Association guidelines include: aspirin, which prevents blood clotting by interfering with platelets; heparin, a "blood thinner" that interferes at a different point in the blood clotting cascade; and beta blockers, which slow the heart rate, reduce the force of the heart's contraction and prevent rhythm abnormalities.
In addition, the guidelines recommend that, within 48 hours, high-risk patients have cardiac catheterization, a procedure that allows cardiologists to see inside the coronary arteries using x-rays, catheters and high-contrast dye, and helps to determine the need for angioplasty, stenting or surgery. These patients should also be treated with glycoprotein IIb/IIIa inhibitors, which interfere with blood platelets and, therefore, prevent clotting inside the artery during or after the invasive procedure.
Each of these therapies has been shown to improve clinical outcomes in patients with acute coronary syndromes, but the studies proving their value have generally been conducted in younger patients. Their effectiveness in the extreme elderly - one of the most rapidly growing segments of the U.S. population - has not been tested.
"The elderly have different responses to medications and treatments than younger patients," said Dr. Cohen. "One of the major goals of our study was to find out whether proven therapies for acute coronary syndromes would work in the extreme elderly."
To do that, Dr. Cohen and his colleagues analyzed data from the CRUSADE National Quality Improvement Initiative, which recruited nearly 52,000 patients age 75 and older with acute coronary syndromes. Of these, more than 5,500 were at least 90 years old, and 112 were at least 100 years old. On January 1, 2007, the CRUSADE registry was replaced by the American College of Cardiology's NCDR-ACTION Registry - (Acute Coronary Treatment & Intervention Outcomes Network). The ACC's NCDR- Registry - now collects myocardial infarction data from hundreds of hospitals across the country into one unified platform with standardized clinical data elements to facilitate benchmark outcomes, and analyze treatment regimens.
Researchers found that extremely elderly patients were often considered unsuitable for recommended therapies. For example, doctors noted that cardiac catheterization was inadvisable in nearly 60 percent of patients age 90 and above, as compared to 27 percent of patients age 75 to 89. The reason most often cited was age itself. Even when there was no apparent reason to consider therapy inadvisable, extreme elderly patients were significantly less likely to receive recommended treatments.
Doctors may have acted out of caution, rather than age bias. CRUSADE researchers found that anticlotting medications and cardiac catheterization were more likely to cause bleeding complications in extremely elderly patients. In fact, as the number of therapies increased from one to five, the risk of major bleeding complications climbed from 3.5 percent to 17.3 percent. Nonetheless, survival was also better with increasing adherence to recommended therapies, particularly aspirin, beta blockers and cardiac catheterization.
"The data are telling us that that the balance favors survival, and we have to be willing to tolerate some increased bleeding," Dr. Cohen said. "We shouldn't simply, on the basis of age, say a person is too high-risk. We should discuss these therapies with patients and their families."
Robert J. Applegate, M.D., F.A.C.C., a professor of cardiology at Wake Forest University School of Medicine, Winston-Salem, NC, said the results of the CRUSADE analysis were encouraging but not definitive. "These results indicate that use of treatments recommended for younger patients with threatened or definite heart attacks was also effective in older patients, but at a cost of more bleeding. Although these findings are encouraging, it is not clear whether the better outcomes simply reflected treatment of healthier patients," he said. "Treatment of threatened or definite heart attacks in very elderly patients should still be made on a case-by-case basis until further studies confirm these results."
In the meantime, bleeding risk may be minimized by adjusting the dosage of anticlotting medications, based on a more careful assessment of kidney function, Dr. Cohen noted. In extremely elderly patients, a normal blood creatinine may give false assurance that kidney function is normal. Calculating creatinine clearance, which takes into account age, gender, and body size, often paints a more accurate picture.
"One of the things we've learned over the last several years from the CRUSADE registry is the importance of checking kidney function and adjusting medication dosage," Dr. Cohen said. "Neglecting to do that really does seem to be associated with worse outcomes."
Dr. Cohen reports receiving research grants from Bristol-Myers Squibb, Sanofi-Aventis, and Eli Lilly, all companies that manufacture anticlotting medications.
Also in this issue of JACC
Researchers from Israel, India and Germany evaluated a special hourglass-shaped stent that reduces blood flow in the coronary sinus, the main vein that drains blood from the heart. In patients with severe coronary artery disease, reduced drainage from - and, therefore, increased pressure in - the coronary sinus has the potential to redirect blood to new vessels the body naturally develops in oxygen-starved, or ischemic, areas of the heart.
In this study, the first of its kind in humans, researchers experienced no procedural complications with the Coronary Sinus Reducer (Neovasc Medical, Inc.). During follow-up, patients reported improvement in the severity of angina, or chest pain, and in the quality of life. In addition, at six months, the shortfall in blood flow to the heart was at least partially reversed.
According to investigators: "These findings, along with the clinical improvement observed, support further evaluation of the Coronary Sinus Reducer in a randomized placebo-controlled trial, as an alternative tool for treating patients with refractory angina who are not candidates for or are at high risk for revascularization."
Contact: Amy Murphy
American College of Cardiology
According to a study published in the May 1, 2007 issue of the Journal of the American College of Cardiology (JACC), patients age 90 and older who came to the emergency room with acute coronary syndromes were less likely than younger patients to receive recommended treatments - but for those who did, survival was much better.
"Having an acute coronary syndrome, even over the age of 90, is not as dire as it once was," said David J. Cohen, M.D., M.Sc., F.A.C.C., director of cardiovascular research at Saint Luke's Mid America Heart Institute, Kansas City, MO. "With optimal medical therapy and invasive care, the outcomes were nearly as good as in a somewhat younger group of patients."
Acute coronary syndrome is an umbrella diagnosis that encompasses both a type of heart attack known as non ST-segment elevation myocardial infarction (NSTEMI) and unstable angina, or chest pain. It is usually caused by a blood clot that temporarily or partially blocks the coronary artery.
Therapies recommended by American College of Cardiology/American Heart Association guidelines include: aspirin, which prevents blood clotting by interfering with platelets; heparin, a "blood thinner" that interferes at a different point in the blood clotting cascade; and beta blockers, which slow the heart rate, reduce the force of the heart's contraction and prevent rhythm abnormalities.
In addition, the guidelines recommend that, within 48 hours, high-risk patients have cardiac catheterization, a procedure that allows cardiologists to see inside the coronary arteries using x-rays, catheters and high-contrast dye, and helps to determine the need for angioplasty, stenting or surgery. These patients should also be treated with glycoprotein IIb/IIIa inhibitors, which interfere with blood platelets and, therefore, prevent clotting inside the artery during or after the invasive procedure.
Each of these therapies has been shown to improve clinical outcomes in patients with acute coronary syndromes, but the studies proving their value have generally been conducted in younger patients. Their effectiveness in the extreme elderly - one of the most rapidly growing segments of the U.S. population - has not been tested.
"The elderly have different responses to medications and treatments than younger patients," said Dr. Cohen. "One of the major goals of our study was to find out whether proven therapies for acute coronary syndromes would work in the extreme elderly."
To do that, Dr. Cohen and his colleagues analyzed data from the CRUSADE National Quality Improvement Initiative, which recruited nearly 52,000 patients age 75 and older with acute coronary syndromes. Of these, more than 5,500 were at least 90 years old, and 112 were at least 100 years old. On January 1, 2007, the CRUSADE registry was replaced by the American College of Cardiology's NCDR-ACTION Registry - (Acute Coronary Treatment & Intervention Outcomes Network). The ACC's NCDR- Registry - now collects myocardial infarction data from hundreds of hospitals across the country into one unified platform with standardized clinical data elements to facilitate benchmark outcomes, and analyze treatment regimens.
Researchers found that extremely elderly patients were often considered unsuitable for recommended therapies. For example, doctors noted that cardiac catheterization was inadvisable in nearly 60 percent of patients age 90 and above, as compared to 27 percent of patients age 75 to 89. The reason most often cited was age itself. Even when there was no apparent reason to consider therapy inadvisable, extreme elderly patients were significantly less likely to receive recommended treatments.
Doctors may have acted out of caution, rather than age bias. CRUSADE researchers found that anticlotting medications and cardiac catheterization were more likely to cause bleeding complications in extremely elderly patients. In fact, as the number of therapies increased from one to five, the risk of major bleeding complications climbed from 3.5 percent to 17.3 percent. Nonetheless, survival was also better with increasing adherence to recommended therapies, particularly aspirin, beta blockers and cardiac catheterization.
"The data are telling us that that the balance favors survival, and we have to be willing to tolerate some increased bleeding," Dr. Cohen said. "We shouldn't simply, on the basis of age, say a person is too high-risk. We should discuss these therapies with patients and their families."
Robert J. Applegate, M.D., F.A.C.C., a professor of cardiology at Wake Forest University School of Medicine, Winston-Salem, NC, said the results of the CRUSADE analysis were encouraging but not definitive. "These results indicate that use of treatments recommended for younger patients with threatened or definite heart attacks was also effective in older patients, but at a cost of more bleeding. Although these findings are encouraging, it is not clear whether the better outcomes simply reflected treatment of healthier patients," he said. "Treatment of threatened or definite heart attacks in very elderly patients should still be made on a case-by-case basis until further studies confirm these results."
In the meantime, bleeding risk may be minimized by adjusting the dosage of anticlotting medications, based on a more careful assessment of kidney function, Dr. Cohen noted. In extremely elderly patients, a normal blood creatinine may give false assurance that kidney function is normal. Calculating creatinine clearance, which takes into account age, gender, and body size, often paints a more accurate picture.
"One of the things we've learned over the last several years from the CRUSADE registry is the importance of checking kidney function and adjusting medication dosage," Dr. Cohen said. "Neglecting to do that really does seem to be associated with worse outcomes."
Dr. Cohen reports receiving research grants from Bristol-Myers Squibb, Sanofi-Aventis, and Eli Lilly, all companies that manufacture anticlotting medications.
Also in this issue of JACC
Researchers from Israel, India and Germany evaluated a special hourglass-shaped stent that reduces blood flow in the coronary sinus, the main vein that drains blood from the heart. In patients with severe coronary artery disease, reduced drainage from - and, therefore, increased pressure in - the coronary sinus has the potential to redirect blood to new vessels the body naturally develops in oxygen-starved, or ischemic, areas of the heart.
In this study, the first of its kind in humans, researchers experienced no procedural complications with the Coronary Sinus Reducer (Neovasc Medical, Inc.). During follow-up, patients reported improvement in the severity of angina, or chest pain, and in the quality of life. In addition, at six months, the shortfall in blood flow to the heart was at least partially reversed.
According to investigators: "These findings, along with the clinical improvement observed, support further evaluation of the Coronary Sinus Reducer in a randomized placebo-controlled trial, as an alternative tool for treating patients with refractory angina who are not candidates for or are at high risk for revascularization."
Contact: Amy Murphy
American College of Cardiology
вторник, 31 мая 2011 г.
Fabio Cannavaro Supports World Heart Day, Sunday 24 September, 2006
Controlling major risk factors such as physical inactivity, an unhealthy diet and tobacco use could prevent 80% of heart disease and stroke1and help keep the heart healthy. This is why this year's World Heart Day campaign asks: "How Young is Your Heart?"
"I know my heart is the strongest, most important muscle in my body and a winning performance depends on its vitality," explains Fabio Cannavaro, Italian Captain of FIFA World Cup Champions. "Having a healthy diet and taking regular exercise will help to keep my heart young and my career long."
World Heart Day is run by the World Heart Federation's member organizations in more than 100 countries. Activities on the day include health checks, walks, runs, jump rope, fitness sessions, public talks, stage shows, scientific forums, exhibitions, concerts and sports tournaments. Last year in Singapore for example, a World Heart Day heart fair attracted over 60,000 participants who took part in health screenings, aerobics classes, health quizzes, exhibits, school performances, nutritional counselling and food sampling. Similar events will be taking place this year asking participants: "How Young is Your Heart?"
"Heart disease and stroke is the world's largest killer, claiming 17.5 million lives a year. Eighty per cent of these lives are from populations in low- and middle-income countries, many amongst people of working age" said Professor Sidney Smith, University of North Carolina and Chairman Scientific Advisory Board, World Heart Federation.
Physical activity is vitally important to maintain a healthy heart. Running for one hour or more each week could reduce the risk of heart disease by 42%. A brisk walking of
30 minutes each day has been found to reduce the risk of heart disease by about 18%2 and stroke by about 11%. Commuting to work by foot is a practical way of achieving this level of physical activity.
Physical inactivity increases the risk of obesity and overweight, diabetes and hypertension which make heart age run faster. The heart needs regular exercise to keep it pumping blood efficiently with every heart beat. Regular activity and its impact on associated risk factors helps to slow down the narrowing of the arteries to the heart and brain, encourages the body to use up excess stored fat, can help to reduce high blood pressure, improves "good" cholesterol levels (HDL cholesterol) and maintains normal blood glucose levels.
It is also important to balance calories consumed with calories burned to help maintain a healthy heart for life. A balanced diet includes plenty of fruits and vegetables, whole grain products, lean meat, fish and pulses, alongside low-fat and fat-free products. Unsaturated soft margarines and oils such as sunflower, corn, rape-seed and olive oil are preferred to saturated fats.
Tobacco use is one of the most important risk factors to control. Quitting will help to keep the heart young as it helps maintain "good" cholesterol levels, reduces the levels of blood clotting and overall, decreases the chance of a sudden blockage of a blood vessel. According to the Framingham Heart Study, life duration is substantially shortened by tobacco users. Non-smokers may live about 8 years longer than smokers.4
"If you are a smoker, try to quit or avoid smoking in the presence of your children. Allow them to live in a smoke-free environment," said Professor Smith. "Smokers put their own lives at risk, but they also endanger the lives of those around them, with passive smoking increasing the risk of coronary heart disease by 25-30%.5 Breathing second-hand smoke for even a short time can have adverse effects on the cardiovascular system, increasing the risk of heart attack.6
"Controlling major risk factors can prevent heart disease and stroke and thereby keep the heart healthy," said Dr Sania Nishtar, Chair, Foundations' Advisory Board, World
Heart Federation. "The good news is that it's never too late to adopt a heart healthy lifestyle. By asking everyone to think about the age of their hearts on World Heart Day we're encouraging the world's population to adopt a heart-healthy lifestyle."
To find out what activities will be taking place in each country on World Heart Day visit: worldheartday.
About the World Heart Federation
The World Heart Federation, a nongovernmental organization based in Geneva, Switzerland, is committed to helping the global population achieve a longer and better life through prevention and control of heart disease and stroke, with a particular focus on low- and middle-income countries. It is comprised of 189 member societies of cardiology and heart foundations from over 100 countries covering the regions of Asia-Pacific, Europe, the Americas and Africa. For further information visit: worldheart
1 Preventing Chronic Disease, a Vital Investment: WHO Report published 2005
2 Tanasescu M et al. JAMA 2002 October 23, 288: 1994-2000
3 Hu et al Stroke 2005;36:1994-1999
4 Mamun AA et al. Eur Heart J. 2004 Mar;25(5):409-15
5 Law et al BMJ 1997 October 18, 315:973-980
6 Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General US Department of Health and Human Services. June 2006
"I know my heart is the strongest, most important muscle in my body and a winning performance depends on its vitality," explains Fabio Cannavaro, Italian Captain of FIFA World Cup Champions. "Having a healthy diet and taking regular exercise will help to keep my heart young and my career long."
World Heart Day is run by the World Heart Federation's member organizations in more than 100 countries. Activities on the day include health checks, walks, runs, jump rope, fitness sessions, public talks, stage shows, scientific forums, exhibitions, concerts and sports tournaments. Last year in Singapore for example, a World Heart Day heart fair attracted over 60,000 participants who took part in health screenings, aerobics classes, health quizzes, exhibits, school performances, nutritional counselling and food sampling. Similar events will be taking place this year asking participants: "How Young is Your Heart?"
"Heart disease and stroke is the world's largest killer, claiming 17.5 million lives a year. Eighty per cent of these lives are from populations in low- and middle-income countries, many amongst people of working age" said Professor Sidney Smith, University of North Carolina and Chairman Scientific Advisory Board, World Heart Federation.
Physical activity is vitally important to maintain a healthy heart. Running for one hour or more each week could reduce the risk of heart disease by 42%. A brisk walking of
30 minutes each day has been found to reduce the risk of heart disease by about 18%2 and stroke by about 11%. Commuting to work by foot is a practical way of achieving this level of physical activity.
Physical inactivity increases the risk of obesity and overweight, diabetes and hypertension which make heart age run faster. The heart needs regular exercise to keep it pumping blood efficiently with every heart beat. Regular activity and its impact on associated risk factors helps to slow down the narrowing of the arteries to the heart and brain, encourages the body to use up excess stored fat, can help to reduce high blood pressure, improves "good" cholesterol levels (HDL cholesterol) and maintains normal blood glucose levels.
It is also important to balance calories consumed with calories burned to help maintain a healthy heart for life. A balanced diet includes plenty of fruits and vegetables, whole grain products, lean meat, fish and pulses, alongside low-fat and fat-free products. Unsaturated soft margarines and oils such as sunflower, corn, rape-seed and olive oil are preferred to saturated fats.
Tobacco use is one of the most important risk factors to control. Quitting will help to keep the heart young as it helps maintain "good" cholesterol levels, reduces the levels of blood clotting and overall, decreases the chance of a sudden blockage of a blood vessel. According to the Framingham Heart Study, life duration is substantially shortened by tobacco users. Non-smokers may live about 8 years longer than smokers.4
"If you are a smoker, try to quit or avoid smoking in the presence of your children. Allow them to live in a smoke-free environment," said Professor Smith. "Smokers put their own lives at risk, but they also endanger the lives of those around them, with passive smoking increasing the risk of coronary heart disease by 25-30%.5 Breathing second-hand smoke for even a short time can have adverse effects on the cardiovascular system, increasing the risk of heart attack.6
"Controlling major risk factors can prevent heart disease and stroke and thereby keep the heart healthy," said Dr Sania Nishtar, Chair, Foundations' Advisory Board, World
Heart Federation. "The good news is that it's never too late to adopt a heart healthy lifestyle. By asking everyone to think about the age of their hearts on World Heart Day we're encouraging the world's population to adopt a heart-healthy lifestyle."
To find out what activities will be taking place in each country on World Heart Day visit: worldheartday.
About the World Heart Federation
The World Heart Federation, a nongovernmental organization based in Geneva, Switzerland, is committed to helping the global population achieve a longer and better life through prevention and control of heart disease and stroke, with a particular focus on low- and middle-income countries. It is comprised of 189 member societies of cardiology and heart foundations from over 100 countries covering the regions of Asia-Pacific, Europe, the Americas and Africa. For further information visit: worldheart
1 Preventing Chronic Disease, a Vital Investment: WHO Report published 2005
2 Tanasescu M et al. JAMA 2002 October 23, 288: 1994-2000
3 Hu et al Stroke 2005;36:1994-1999
4 Mamun AA et al. Eur Heart J. 2004 Mar;25(5):409-15
5 Law et al BMJ 1997 October 18, 315:973-980
6 Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General US Department of Health and Human Services. June 2006
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