Author Interviews, Biomarkers, Heart Disease, Kidney Disease / 31.08.2016 Interview with: Xiaobing Yang, MD Division of Nephrology, Nanfang Hospital Southern Medical University What is the background for this study? Response: AKI is a common complication in patients with acute decompensated heart failure (ADHF) and associated with increased death and worse clinical outcomes. Early detecting which patients are going to suffer progressive AKI or proceed to death could help physicians to plan and initiate timely managements. We analyzed data and samples of 732 ADHF patients from a prospective, multicenter study in China. We demonstrated that kidney injury biomarkers, measured at the first time of AKI clinical diagnosis, could predict which patients were going to have AKI progression or worsening of AKI with death. Notably, three urinary biomarkers, including urinary angiotensinogen (uAGT), urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary IL-18 (uIL-18), were all able to forecast which patients with the earliest stages of AKI were most likely to suffer progressive AKI. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Pharmacology / 31.08.2016 Interview with: Aaron S. Kesselheim, M.D., J.D., M.P.H. Associate Professor of Medicine at Harvard Medical School Director, Program On Regulation, Therapeutics, And Law (PORTAL) Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women's Hospital Boston MA 02120 What is the background for this study? What are the main findings? Response: It has been previously reported that the number of new cardiovascular drugs approved by the U.S. Food and Drug Administration (FDA) has declined in recent years. So we sought to empirically assess trends in the development of new cardiovascular therapeutics. (more…)
Author Interviews, Heart Disease, Lancet, Surgical Research / 31.08.2016 Interview with: Prof Lars Wallentin, MD PHD Senior Professor Cardiology Uppsala Clinical Research Center, Uppsala University What is the background for this study? Response: The FRISC2 study was performed 1996 – 1998 and reported 1999 for the first time a significant reduction in death and myocardial infarction by early invasive compared to non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). The results at 6 months, 1, 2 and 5 years were published in The Lancet and pivotal in changing the treatment guidelines and thereby improving outcomes in patients with NSTE-ACS. These findings were within the next few years verified in the TACTICS-TIMI18 and RITA3 trials. However the later performed ICTUS trial, starting after these results were published and accordingly with a substantial early crossover to the invasive arm, showed neutral results. Recently the reduction in event rates by an early invasive strategy was again validated in patients above 80 years of age, which were less well represented in the initial trials. These benefits of an early invasive strategy have previously been shown sustained for at least five years based on results from the FRISC2, RITA3, and ICTUS trials. The FRISC2 and TACTICS-TIMI18 trials also showed that the benefits with an early invasive strategy seemed confined to patients with signs of myocardial necrosis as indicated by elevated troponin level at entry. In addition the FRISC2 trial found that the benefits were larger in patients with signs of inflammatory activity as indicated by a high level of growth differentiation factor 15 (GDF-15) at entry. These pivotal results have been the basis for the current international treatment guidelines recommending an early invasive treatment strategy in patients with NSTE-ACS and elevated troponin and/or other indicators of a raised risk. (more…)
Author Interviews, Heart Disease, NEJM, Surgical Research / 31.08.2016 Interview with: Dr. Kaare Harald Bønaa Principal investigator University of Tromsø, Norway What is the background for this study? Response: The NORSTENT study was designed shortly after the “Barcelona fire storm” in 2006 that raised severe safety concerns against drug-eluting stents (DES). At that time there was evidence for increased risk of stent thrombosis with DES. How this could influence long term results compared to PCI with bare metal stents (MMS) was not known. Accordingly, we designed the NORSTENT study with the primary composite endpoint of all-cause mortality and non-fatal spontaneous myocardial infarction at a medial of 5 years of follow-up. (more…)
AHA Journals, Author Interviews, Heart Disease, Hospital Readmissions, Surgical Research / 31.08.2016 Interview with: Jason H. Wasfy, MD, MPhil Assistant Medical Director, Massachusetts General Physicians Organization Director of Quality and Analytics Massachusetts General Hospital Heart Center What is the background for this study? What are the main findings? Response: Reducing preventable readmissions after PCI is a way to both improve the quality of care for our patients and improve value for patients with coronary artery disease. Through a variety of tactics, we were able to reduce the 30 day readmission rate for patients after PCI by nearly half. Keep in mind that this is only the readmission rate to our hospital, so we will need to confirm these results with data including patients who may have been readmitted to other hospitals after a PCI at Mass General. (more…)
Author Interviews, Heart Disease, NEJM, Obstructive Sleep Apnea, Sleep Disorders / 30.08.2016 Interview with: Prof. Craig Anderson, PhD Professor of Stroke Medicine and Clinical Neuroscience Medicine, The George Institute for Global Health University of Sydney What is the background for this study? What are the main findings? Response: We wished to prove whether treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP ) can modify the risk of cardiovascular disease. The is a lot of association data from epidemiological and clinical studies but no large scale international clinical trials assessing the effects of CPAP on the prevention of serious cardiovascular events like heart attack and stroke. Our study in nearly 3000 adults with prior heart attack or stroke and moderate to severe obstructive sleep apnea showed that CPAP treatment did not prevent recurrent cardiovascular events or major cardiovascular risk factors. However CPAP did improve wearers' sense of wellbeing, mood and work productivity. (more…)
Author Interviews, Diabetes, Heart Disease, Stem Cells / 30.08.2016 Interview with: Jolanta U Weaver, FRCP MRCS PhD CTLHE Senior Lecturer in Diabetes Medicine Honorary Consultant Diabetologist Newcastle What is the background for this study? What are the main findings? Response: Vascular stem cells, which are associated with an improvement of heart disease, are improved in type 1 diabetes by repurposing metformin, known to reduce heart disease in type 2 diabetes. We treated patients with type 1 diabetes with metformin for 8 weeks. The metformin dose varied between 500 mg a day to 2000 mg a day, depending on what patients were happy to take. Subjects were requested to keep diabetic control unchanged to study the direct effect of metformin on heart disease. Circulating endothelial progenitor cells (vascular stem cells) count, Hill’s colonies and pro angiogenic cells function (in test tube) improved in comparison to patients, who did not take metformin but remained on standard therapy. Endothelial cells associated with vascular damage, on the other hand, were reduced following metformin therapy confirming improved vascular health. The glycaemic control remained unchanged (as planned at the onset of the study) to allow us to examine the effect of metformin ALONE on vascular health. Patients did not suffer any serious side effects. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Transplantation / 30.08.2016 Interview with: Dr. Laith Alshawabkeh MD ‎Senior Fellow Brigham & Women's and Boston Childrens Hospitals / Harvard Medical School What is the background for this study? Response: As the number of adults living with congenital heart disease continues to increase, there is paucity of evidence on the trajectories and patterns of their comorbidities. In all, heart failure is the leading cause of death in this group of patients. Unfortunately, landmark trials and advances in medical therapy which promoted increase survival in patients with the usual heart failure (non-congenital) has not been translated into those with congenital heart disease. Heart transplantation remains one of the (if not the only) sustainable option for many patients with congenital heart disease at the end stage of heart failure. Recent studies have shown that adults with congenital heart disease who underwent transplantation experienced higher risk of postoperative mortality compared to their non-congenital counterparts; however, patients with congenital heart disease who survived the first year post-transplantation enjoyed significantly better long-term survival, indicating that with careful selection those patients might benefit tremendously from transplantation. Much less is known about the outcome of these patients while they are waiting for an organ. As such, this study sought to examine the outcomes of patients with congenital heart disease while listed for heart transplantation and to investigate correlates of adverse outcomes (mortality and delisting due to clinical worsening). (more…)
Author Interviews, Heart Disease, Stem Cells / 30.08.2016 Interview with: Javed Butler, M.D., MPH, FACC, FAHA Chief of the Cardiology Division and Co-Director of the Heart Institute at Stony Brook University Stony Brook Heart Institute What is the background for this study? What are the main findings? Response: It was previously assumed that stem cells must be delivered directly to the myocardium to improve patient outcomes. However, this delivery mechanism – either in the coronary artery or the myocardium – may not be feasible for millions of patients and for repeat injections. This study represents the first clinical trial to observe the effects of intravenous (IV) administration of ischemia-tolerant mesenchymal stem cells (itMSCs) in patients with chronic heart failure. Results show that an IV injection strategy is safe and well-tolerated.In addition, the data illustrate statistically significant improvement in 6-minute walk test, quality-of-life scores as assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ) and favorable immune modulatory benefits. (more…)
Author Interviews, Clots - Coagulation, Heart Disease, JACC, Surgical Research / 30.08.2016 Interview with: Gennaro Giustino MD Resident Physician - Department of Medicine The Icahn School of Medicine at Mount Sinai What is the background for this study? Response: A period of dual antiplatelet therapy (DAPT) is required after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). The pathophysiological rationale for DAPT after DES-PCI is predicated on the need to prevent stent-related thrombotic complications while vascular healing and platform endothelialization are ongoing, a process that seems to last between 1 and 6 months with new-generation DES. Whether to extend DAPT after this mandatory period in order to provide a broader atherothrombotic risk protection (for stent-related and non-stent-related atherothrombotic events) is currently a matter of debate. Current guidelines recommend at least 6 months of DAPT after PCI in patients with stable coronary artery disease (CAD) and at least 12 months of DAPT in patients presenting with acute coronary syndrome (ACS). While, several risk scores have been developed to guide clinical decision making for DAPT intensity and duration (namely the DAPT score and the PARIS risk scores) little attention has been payed so far to PCI complexity and the extent of CAD to guide duration of DAPT. In fact irrespective of clinical presentation, patients undergoing more complex PCI procedure (likely due to greater coronary atherosclerotic burden) may remain at greater risk for ischemic events and therefore may benefit of prolonged, or more intense, DAPT. (more…)
Author Interviews, Heart Disease / 26.08.2016 Interview with: John A. Elefteriades, MD William W.L. Glenn Professor of Surgery Chief of Cardiothoracic Surgery Yale New-Haven Hospital Director, Aortic Institute at Yale-New Haven Yale University School of Medicine What is the background for this study? What are the main findings? Response: In the late 1990’s, Dr. Milewicz’s group in Texas and our group at Yale recognized that thoracic aortic aneurysms and aortic dissections (internal tears of the aorta) ran in families. This paper explores for the first time the ages at which aortic dissections occur among members within a family. Interestingly, we found that once one family member has suffered an aortic dissection, other family members tend to suffer dissection at about the same age (mostly within ten years of the age of the original dissector). (more…)
AHA Journals, Author Interviews, Emory, Heart Disease / 25.08.2016 Interview with: Alvaro Alonso, MD, PhD Associate Professor Department of Epidemiology Rollins School of Public Health Emory University Atlanta, GA What is the background for this study? What are the main findings? Response: Sudden cardiac death (SCD) is a major public health problem. Each year, 300,000-400,000 Americans experience SCD and, in more than half of these cases, sudden cardiac death is the first manifestation of heart disease. To date, however, we lack effective strategies to identify those at higher risk of developing sudden cardiac death so targeted preventive strategies can be applied. In this study, we develop and validate the first model for the prediction of SCD in ~18,000 adults without a prior history of cardiovascular disease. We show that information on demographic variables (age, sex, race), some traditional cardiovascular risk factors (smoking, elevated blood pressure, diabetes, HDL cholesterol) as well as some factors more specifically related to SCD causes (electrocardiogram QT interval) and novel biomarkers (albumin, potassium in blood, kidney function) can be leveraged to predict risk of SCD and identify individuals more likely to suffer this event. (more…)
Author Interviews, Depression, Heart Disease, HIV, Vanderbilt / 25.08.2016 Interview with: Matthew S Freiberg, MD, MSc Cardiovascular Medicine Division, Vanderbilt University School of Medicine Tennessee Valley Geriatric Research Education and Clinical Center, Nashville  TN Tasneem Khambaty, PhD Department of Psychology, University of Miami, Coral Gables, Florida Jesse C. Stewart, PhD Department of Psychology, Indiana University–Purdue University , Indianapolis, Indianapolis What is the background for this study? Response: Due to highly effective antiretroviral therapy, people with HIV are living longer. Unfortunately, these HIV-infected individuals remain at a higher risk for other chronic diseases, with cardiovascular disease (CVD) being one of the leading cause of death in this population. In the general population, depressive disorders, such as major depressive disorder (MDD) and dysthymic disorder, are associated with increased risk of new-onset CVD. Given that roughly 24-40% of HIV-infected individuals have a depressive disorder, we examined whether MDD and dysthymic disorder are also associated with an increased risk of new-onset CVD in people with HIV. (more…)
Author Interviews, Columbia, Heart Disease, JAMA, Medical Imaging / 25.08.2016 Interview with: Adam Castano, M.D., M.S. Division of Cardiology Columbia University Medical Center New York Presbyterian Hospital What is the background for this study? Response: Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized cause of heart failure with preserved ejection fraction (HFpEF). Traditionally, the gold standard for diagnosis has required an endomyocardial biopsy coupled with either immunohistochemistry or mass spectroscopy. These specialized tests are only performed at centers with experienced satff, do not yield prognostically useful information, may be inadvisable for frail older adults, and often present logistical challenges that lead to delayed care. Fortunately, single center studies have demonstrated excellent diagnostic accuracy using technetium 99m pyrophosphate (Tc99mPYP) cardiac imaging for noninvasively detecting ATTR-CA and differentiating it from another major type of cardiac amyloidosis called light chain (AL). But the diagnostic accuracy of this technique in a multicenter study and the association of Tc99mPYP myocardial uptake with survival were not known prior to this study. Therefore, we assessed in a multicenter study Tc99mPYP cardiac imaging as a diagnostic tool and its association with survival. We conducted a retrospective cohort study of 229 patients evaluated at 3 academic specialty centers for cardiac amyloidosis and also underwent Tc99mPYP cardiac imaging. We measured retention of Tc99mPYP in the heart using a semiquantitative visual score (range 0-3) and a more quantitative heart-to-contralateral (H/CL) ratio calculated as total counts in a region of interest over the heart divided by background counts in an identical size region of interest over the contralateral chest. The outcome measured was time to death after Tc99mPYP imaging. (more…)
Author Interviews, Dermatology, Diabetes, Heart Disease, JAMA, Medical Imaging, NIH / 24.08.2016 Interview with: Nehal N. Mehta, .MD., M.S.C.E. F.A.H.A. Lasker Clinical Research Scholar Section of Inflammation and Cardiometabolic Diseases NIH What is the background for this study? What are the main findings? Response: Psoriasis is associated with accelerated cardiovascular (CV) disease; however, screening for CV risk factors in psoriasis remains low. Coronary artery calcium (CAC) score estimates the total burden of atherosclerosis. Psoriasis has been associated with increase CAC score, but how this compares to patients with diabetes, who are aggressively screened for CV risk factors, is unknown. (more…)
AHA Journals, Author Interviews, Heart Disease / 20.08.2016 Interview with: Lu Qi, MD, PhD HCA Regents Distinguished Chair and Professor Director,Tulane University Obesity Research Center Department of Epidemiology Tulane University School of Public Health and Tropical Medicine 1440 Canal Street, Suite 1724 New Orleans, LA 70112 What is the background for this study? What are the main findings? Response: Gallstone disease has been related to various risk factors of cardiovascular disease, and several previous studies suggest potential link between gallstone disease and heart disease. Our study, for the first time, provide consistent evidence for the association between gallstone disease and an increased risk of cardiovascular disease. (more…)
Author Interviews, Genetic Research, Heart Disease, Science / 19.08.2016 Interview with: Johan LM Björkegren, MD, PhD Professor, Chief Clinical Science Officer Department of Genetics and Genomic Sciences Icahn Institute for Genomics and Multiscale Biology Icahn School of Medicine at Mount Sinai New York What is the background for this study? What are the main findings? Response: The STARNET (Stockholm-Tartu Atherosclerosis Reverse Network Engineering Task) study was launched in 2007 by myself and Dr. Arno Ruusalepp MD, PhD, Chief Cardiac Surgeon at Tartu University Hospital in Estonia, and senior co-author on the study. Unlike similar studies, STARNET obtained samples of several key tissues from 600 clinically well-characterized patients with CAD during coronary artery bypass surgery. By using sophisticated data analysis techniques, the researchers found that the gene expression data from STARNET were highly informative in identifying causal disease genes and their activity in networks not only in CAD but also for other cardiometabolic diseases as well as Alzheimer’s disease. By analyzing gene-expression data from multiple tissues in hundreds of patients with coronary artery disease, we were able to identify disease-causing genes that either were specific to single tissues or acted across multiple tissues in networks to cause cardiometabolic diseases. (more…)
Author Interviews, Exercise - Fitness, Heart Disease, JACC / 19.08.2016 Interview with: Antonio Pelliccia, MD, FESC Chief of Cardiology Institute of Sport Medicine and Science Rome What is the background for this study? Response: The awareness of the relevant role of arrhythmogenic right ventricular cardiomyopathy (ARVC) as cause of athletic field events and the refined Task Force (TF) criteria for the diagnosis of the disease have prompted a large scientific interest and triggered a vast scientific literature on this issue. Indeed, the recent observations by Heidbuchel and La Gerche based on data from a selected group of ultra-endurance athletes, suggesting that strenuous, chronic endurance exercise may ultimately cause, per se, RV dysfunction have further stimulated the need to define the characteristics and limits of training-induced RV remodelling. At present, however, no studies have assessed the characteristic of physiologic right ventricular remodelling as derived from a large population of highly-trained athletes, including a sizeable number of women and comprising a broad spectrum of summer and winter Olympic sport disciplines. (more…)
Author Interviews, Cost of Health Care, Heart Disease / 19.08.2016 Interview with: Leo F. Buckley, PharmD Virginia Commonwealth University Richmond, Virginia What is the background for this study? Response: As the prevalence and costs of heart failure are expected to increase through the year 2030, significant efforts have been devoted towards devising alternatives to inpatient hospitalization for the management of heart failure decompensations. Since loop diuretics are the mainstay of treatment during the majority of hospitalizations, administration of high doses of loop diuretics in the outpatient setting has increased in popularity. We intended to answer two questions with his study: first, can a patient-specific dosing protocol based on a patient’s usual diuretic dose achieve safe decongestion? and second, does this strategy alter the usual course of heart failure decompensation, which oftentimes culminates in inpatient hospitalization? (more…)
Author Interviews, Heart Disease, JAMA, Lipids, Nutrition, Omega-3 Fatty Acids / 18.08.2016 Interview with: David Iggman, MD, PhD Unit for Clinical Nutrition and Metabolism Department of Public Health and Caring Sciences Uppsala University, Uppsala Center for Clinical Research Dalarna Falun, Sweden What is the background for this study? What are the main findings? Response: There is some controversy regarding which dietary fats are preferable and in what amounts, not least regarding the polyunsaturated fats. It is also challenging to adequately assess peoples intakes of dietary fats. The main findings of this study was that among fatty acids in the body (reflecting the intake during the last year or so), linoleic acid (omega-6) was associated with lower mortality in 71-year-old men with 15 years follow-up. (more…)
Author Interviews, Biomarkers, Heart Disease, Microbiome / 18.08.2016 Interview with: Lemin Zheng, Ph.D. Professor, Lab Director, and Principal Investigator The Institute of Cardiovascular Sciences and Institute of Systems Biomedicine Peking University Health Science Center Beijing  China What is the background for this study? Response: Optical coherence tomography (OCT) has been considered as an ideal tool to characterize accurately atherosclerotic plaques and has potential to detect plaque rupture due to high-resolution (10-20 μm) cross-sectional images of tissue with near infrared light (1-3). Trimethylamine-N-oxide (TMAO) is a gut microbiota-dependent-generated metabolite which is associated with cardiovascular risk by a pathway involving dietary ingestion of nutrients containing trimethylamine, including phosphatidylcholine, choline, and L-carnitine (4-6). In the gut, choline, betaine and carnitine can be metabolized to trimethylamine (TMA) by gut flora microorganism. And TMA could be further oxidized to a proatherogenic species, TMAO, in the liver by flavin monooxygenases 3 (FMO3)4-6. These risk associations have been repeatedly shown in large observational trials (7-10). (more…)
Author Interviews, Blood Pressure - Hypertension, Electronic Records, Heart Disease, Primary Care / 18.08.2016 Interview with: Tom Marshall, PhD, MRCGP, FFPH Professor of public health and primary care Institute of Applied Health Research University of Birmingham Edgbaston, Birmingham What is the background for this study? What are the main findings? Response: Shortly before the Health Checks programme began, a programme of targeted case finding was set up in Sandwell in the West Midlands. In general practices in the area a programme nurse searched electronic medical records to identify untreated patients at high risk of cardiovascular disease. The nurse then invited high risk patients for assessment in the practice and those who needed treatment were referred to their GP for further action. This was implemented in stages across 26 general practices, allowing it to be evaluated as a stepped wedge randomised controlled trial. The programme was successful, resulting in a 15.5% increase in the number of untreated high risk patients started on either antihypertensives or statins. (more…)
Author Interviews, Cost of Health Care, Heart Disease / 17.08.2016 Interview with: Leo F. Buckley, PharmD Virginia Commonwealth University Richmond, Virginia What is the background for this study? Response: Heart failure hospitalizations have become a significant burden for both patients and the healthcare systems. Significant efforts have been devoted to identifying alternative treatment pathways for acute decompensated heart failure that do not require hospitalization. Our group previously reported our initial experience with ambulatory intravenous diuretic therapy administered serially over several days to weeks in place of inpatient hospitalization. We found that the rate of hospitalization was significantly reduced compared to expected and that the high dose furosemide protocol utilized was safe and well tolerated by patients. (more…)
Aging, Author Interviews, Heart Disease, JACC / 17.08.2016 Interview with: Dr Janice Atkins Research Fellow Epidemiology and Public Health University of Exeter Medical School RD&E Hospital Wonford Barrack Road, Exeter What is the background for this study? What are the main findings? Response: We have previously shown that having longer-lived parents increases your likelihood of living longer, and family history of heart attacks is already used by physicians to identify patients at increased risk of disease. However, it has been unclear how the health advantages of having longer lived parents is transferred to their middle-aged offspring. Our study of nearly 200,000 UK volunteers aged 55-73 at baseline, and followed for 8 years using health records data, found that having longer-lived parents reduced the risk of morbidity and mortality in the participants. We found that for each parent that lived beyond 70 years of age the participants had 20% less chance of dying from heart disease. To illustrate this, in a group of 1,000 people whose father’s died at 70 and followed for 10 years, on average 50 would die from heart disease. When compared to a group whose father’s died at 80, on average only 40 would die from heart disease over the same 10-year period. Similar trends were seen in the mother’s. The relationship between parental age at death and survival and health in their offspring is complex, with many factors playing a role. Shared environment and lifestyle choices play a large role, including smoking habits, high alcohol consumption, low physical activity and obesity; but even accounting for these factors parents lifespan was still predictive in their offspring. The biggest genetics effects on lifespan in our studies affected the participant’s blood pressure, their cholesterol levels, their Body Mass Index, and their likelihood to be addicted to tobacco. These are all factors that affect risk of heart disease, so is consistent with the lower rates of heart disease in the offspring. (more…)
Author Interviews, Heart Disease, JACC / 16.08.2016 Interview with: Timothy C. Y. Chan, PhD Canada Research Chair in Novel Optimization and Analytics in Health Associate Professor, Mechanical and Industrial Engineering Director, Centre for Healthcare Engineering Department of Mechanical & Industrial Engineering Faculty of Applied Science & Engineering | University of Toronto Toronto Ontario What is the background for this study? What are the main findings? Response: The immediate access to and use of an automated external defibrillator (AED) can increase the likelihood of survival from out-of-hospital cardiac arrest (OHCA). Currently, guidelines for AED deployment focus only on spatial factors, such as where to place AEDs with respect to cardiac arrest risk, and assume that the buildings housing the AEDs are open and accessible 24 hours a day. However, this is not the case in reality. AED accessibility by time of day has largely been overlooked despite the fact that cardiac arrest incidence and survival vary by time of day and day of week. In this study we performed two main analyses, using data from Toronto, Canada. First, we determined the impact of accessibility on cardiac arrest coverage. That is, we determined what fraction of OHCAs occurred near a registered AED, but when that AED was unavailable based on the hours of operation of the building. Second, we developed a novel optimization model that identifies locations to place AEDs that maximize the number of out-of-hospital cardiac arrestswith an accessible AED nearby. We compared this approach to one where AEDs were placed guided by only spatial information. We found that of the OHCAs occurring within 100 m of an AED, approximately 21% occur when the AED is inaccessible. Nearby AEDs were inaccessible for 8.6% of OHCAs during the day (8 a.m. – 3:59 p.m.), 28.6% in the evening (4 – 11:59 p.m.) and 48.4% at night (midnight –7:59 a.m.). When applying our optimization model to determine new AED locations, we achieved a 25.3% relative increase in the number of out-of-hospital cardiac arrests that occur near an accessible AED over the spatial-only approach. The relative increase was 10.9% during the day, 38.0% in the evening, and 122.5% at night. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Education, Heart Disease, JAMA / 16.08.2016 Interview with: Rory Brett Weiner, MD Assistant Professor of Medicine Harvard Medical School What is the background for this study? What are the main findings? Response: The increased use of noninvasive cardiac imaging and Medicare spending in the late 1990s and early 2000s has led to several measures to help optimize the use of cardiac imaging. One such effort has been the Appropriate Use Criteria (AUC) put forth by the American College of Cardiology Foundation. The AUC for echocardiography have been useful to characterize practice patterns and more recently been used as a tool to try to improve ordering of echocardiograms. Our research group previously conducted a randomized study of physicians-in-training (cardiovascular medicine fellows) and showed that an AUC based educational and feedback intervention reduced the rate of rarely appropriate transthoracic echocardiograms (TTEs). The current study represents the first randomized controlled trial of an AUC education and feedback intervention attending level cardiologists. In this study, the intervention group (which in addition to education received monthly feedback emails regarding their individual TTE ordering) ordered fewer rarely appropriate TTEs than the control group. The most common reasons for rarely appropriate TTEs in this study were ‘surveillance’ echocardiograms, referring to those in patients with known cardiac disease but no change in their clinical status. (more…)
Author Interviews, Heart Disease, Technology / 16.08.2016 Interview with: Dr. Theodore L. Schreiber MD President of the Detroit Medical Center Heart Hospital and DMC Cardiovascular Institute. Doctor Schreiber is involved in ongoing research in carotid artery stenting, has been the principal or co-principal investigator on numerous cardiovascular research studies and has written dozens of book chapters, articles and abstracts on interventional cardiology. Abbott announced July 5, 2016 that the U.S. Food and Drug Administration has approved the company's Absorb bioresorbable heart stent, What is the background for this stent? What are the main advantages? Response: The Absorb™ bioresorbable vascular scaffold is an advance in the treatment of coronary artery disease, which affects 15 million people in the United States and remains a leading cause of death worldwide despite decades of therapeutic advances. For this reason, DMC Heart Hospital, which serves a population at high risk of cardiovascular disease, was among the first in the state of Michigan to adopt this new stent. While stents are traditionally made of metal, the Absorb™ stent is made of a naturally dissolving material, similar to dissolving sutures. Absorb™ disappears (except for two pairs of tiny metallic markers that remain in the artery to enable a physician to see where the device was placed) in about three years, after it has done its job of keeping a clogged artery open and promoting healing of the treated artery segment. By contrast, metal stents are permanent implants. (more…)
Author Interviews, Heart Disease, Lipids / 14.08.2016 Interview with: Ziyad Al-Aly, MD, FASN Assistant Professor of Medicine Washington University School of Medicine Co-Director, Clinical Epidemiology Center Associate Chief of Staff for Research and Education Veterans Affairs Saint Louis Health Care System What is the background for this study? What are the main findings? Response: I think the most important, and novel finding is that elevated levels of HDL-cholesterol (which is thought of as the good cholesterol) are associated with increased risk of death. Previously it was thought that high HDL (increased good cholesterol) is a good thing. We used Big Data approach (over 16 million person-years; 1.7 million people followed for over 9 years) to evaluate the relationship between HDL-Cholesterol (the good cholesterol) and risk of death. We found that low HDL is associated with increased risk of death (which is expected and consistent with prior knowledge). The novel and unexpected finding is the observation that high HDL-Cholesterol is also associated with increased risk of death. The relationship between HDL-Cholesterol levels and risk of death is a U-shaped curve where risk is increased at both ends of the HDL-C values spectrum (at both low and high end); Too low and too high is associated with higher risk of death. The findings may explain why clinical trials aimed at increasing HDL-Cholesterol levels failed to show improvement of clinical outcomes. This finding was not expected, and has not been reported previously in large epidemiologic studies such as Framingham Heart Study and others. The Framingham Heart study and others significantly advanced our understanding of the relationship between cholesterol parameters (including HDL-Cholesterol) and clinical outcomes. However, these studies are limited in that the number of patients in these cohorts was several thousands which is relatively small compared to what a Big Data approach (millions of patients) enables us to see. Big Data approach allows a more nuanced (a more detailed) examination of the relationship between HDL and risk of death across the full spectrum of HDL levels. (more…)
Author Interviews, Cleveland Clinic, Genetic Research, Heart Disease, PLoS / 14.08.2016 Interview with: Qing Kenneth Wang PhD, MBA Huazhong University of Science and Technology Wuhan, P. R. China and Department of Molecular Cardiology The Cleveland Clinic Cleveland, Ohio What is the background for this study? What are the main findings? Response: Coronary Artery Disease (CAD) and its complication myocardial infarction (MI or so called heart attacks) are the most common causes of deaths in the US and other parts of the world. Based on the American Heart Association statistics, 620,000 Americans have a new MI each year in the United States alone, 295 000 have a recurrent MI, and nearly 400,000 of them will die from it suddenly. Moreover, an estimated 150,000 silent first MI occur each year. CAD and MI are caused by an occlusion or blockage of a coronary artery, which disrupts blood flow to the heart region, leading to damage or death of cardiac cells, impairment of cardiac function and sudden death. Current treatment of CAD and MI relies on reperfusion therapy with reopening of the occluded coronary artery with percutaneous coronary intervention (PCA) and coronary artery bypass surgery (CABG). However, 12% of patients are not candidates for PCA or CABG due to an unfavorable occlusive pattern, diffuse coronary atherosclerosis, small distant vessels and co-morbidities. An alternative revascularization strategy has to be developed to benefit these patients. (more…)
Author Interviews, Clots - Coagulation, Diabetes, Heart Disease, JACC / 12.08.2016 Interview with: Raffaele Piccolo, MD Department of Cardiology Bern University Hospital University of Bern Bern, Switzerland What is the background for this study? Response: Over the past two decades, the prevalence of diabetes mellitus has doubled in Western countries and future projections are even worse by showing a 55% increase by 2035 when approximately 592 million of people are expected to live with diabetes all over the world. Acute myocardial infarction still represents the most common diabetes-related complication and its occurrence is associated with a higher risk of mortality. Timely recanalization of the occluded coronary vessel with primary percutaneous coronary intervention (PCI) represents the therapy of choice for acute ST-segment elevation myocardial infarction (STEMI). Our study investigated whether the direct application of an intracoronary bolus of abciximab, which is an antiplatelet drug blocking the glycoprotein IIb/III a receptor, at the time of primary PCI improves the outcomes at 1-year follow-up compared with the standard intravenous route. The study was in individual patient-level pooled analysis of 3 randomized trials including 2,470 patients, of whom 473 (19%) had diabetes. (more…)