"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
среда, 15 июня 2011 г.
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
Подписаться на:
Сообщения (Atom)