MedicalResearch.com Interview with:
Yuting Zhang, Ph.D.
Associate Professor and Director
Pharmaceutical Economics Research Group
University of Pittsburgh Graduate School of Public Health
Department of Health Policy and Management.
Medical Research: What are the main findings of the study?
Dr. Zhang: Patients with atrial fibrillation who take the blood thinner dabigatran are at greater risk for major bleeding and gastrointestinal bleeding than those who take warfarin, indicating that greater caution is needed when prescribing dabigatran to certain high-risk patients. High-risk groups include those who are 75 and older; African Americans; those with chronic kidney disease; and those with seven or more co-existing medical problems.
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MedicalResearch.com Interview with:
Dr. Arnold Ng, MBBS, PhD
Department of Cardiology
Princess Alexandra Hospital
University of Queensland, Australia
Medical Research: What is the background for this study? What are the main findings?
Dr. Arnold: The WHO and American Diabetes Association currently recommends the use of HbA1c >=6.5% as a diagnostic criterion for diabetes. HbA1c is advantageous over fasting plasma glucose and glucose tolerance testing by avoiding the need for patient fasting and inconvenient patient preparation. In addition, patients who are acutely unwell (e.g. STEMI) may develop stress hyperglycemia, complicating the diagnosis of diabetes. It is currently unclear if HbA1c (indicative of overall glycemic control) or fasting plasma glucose predicts worse left ventricular function after acute STEMI.
The present study demonstrated that HbA1c identified approximately another 20% of previously undiagnosed patients as diabetic. Furthermore, the present study was first to demonstrate that HbA1c, not fasting plasma glucose, was independently associated with more impaired LV diastolic function and elevated filling pressures after STEMI.
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MedicalResearch.com Interview withDr. Sunny Jhamnani MD
Clinical Fellow in Cardiology at Yale School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Jhamnani: Lifestyle modifications are the crux of atherosclerotic disease management. However adherence to them is not adequate. Additionally, randomized controlled trials (RCTs) looking effects of diet and exercise on atherosclerotic disease progression have not been convincing.
We did a systematic review and a meta-analysis of all RCTs looking at the effects of diet and exercise on coronary and carotid atherosclerotic disease progression. We found that , lifestyle modifications were associated with a decrease in coronary atherosclerotic burden in percent stenosis by -0.34 (95% CI: -0.48 to -0.21) standardized mean difference (SMD), with no significant publication bias and heterogeneity (p:0.21, I2:28.25). Similarly, in the carotids, there was a decrease in the carotid intimal medial thickness in mm by -0.21 (95% CI: -0.36 to -0.05) SMD and by -0.13 (95% CI: -0.25 to -0.02) SMD, before and after accounting for publication bias and heterogeneity (p:0.13, I2:39.91 and p:0.54, I2:0), respectively.
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MedicalResearch.com Interview withFrank B. Hu, MD, PhD
Professor of Nutrition and Epidemiology
Harvard School of Public Health
Professor of Medicine Harvard Medical School
Boston, MA 02115
Medical Research: What is the background for this study? What are the main findings?Dr. Hu: There has been much confusion and sensational headlines about the role of different types of fat in coronary heart disease. A recent meta-analysis suggested that higher saturated fat intake was not associated with coronary heart disease (CHD), but people don't consume saturated fat in isolation from other components of diet. Typically people swap for one type of fat for another. Therefore it is important to look at replacement nutrient when we talk about health effects of saturated fat. Randomized clinical trials have shown that replacing saturated fat with polyunsaturated fat reduces total and LDL cholesterol. Thus it is important to examine whether such replacement confers long-term beneficial effects on heart disease prevention. We performed a systematic review and meta-analysis of prospective cohort studies to summarize the evidence regarding the link between dietary intake of linoleic acid (the predominant type of polyunsaturated fat) and heart disease risk in generally healthy people. We identified 13 published and unpublished cohort studies with a total of 310,602 individuals and 12,479 total coronary heart disease events including 5,882 CHD deaths. We found that dietary linoleic acid intake is inversely associated with coronary heart disease risk in a dose-response manner—meaning, higher intake of linoleic acid resulted in a lower risk of CHD. Comparing the highest to the lowest level of consumption, dietary linoleic acid was associated with a 15% lower risk of coronary heart disease events and a 21% lower risk of CHD deaths. These results were independent of common coronary heart disease risk factors such as smoking and other dietary factors such as fiber consumption.
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MedicalResearch.com Interview with: Anne Bellemain-Appaix
Service de Cardiologie-La Fontonne Hospital, Antibes, France and
Gilles Montalescot Professor of Cardiology
Institut de CardiologiePitié-Salpêtrière Hospital
Université Paris 6, France
ACTION Study Group, Paris, France
Medical Research: What is the background for this study?Response: Pretreatment with P2Y12 inhibitors for Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS) patients, although advised in current guidelines, has been recently questioned in term of benefit/risk ratio (no ischemic benefit and increase in major bleeding). We wanted to answer this question by giving enough power to results in a complete meta-analysis of studies comparing P2Y12 inhibitors pretreatment (defined as its administration before the coronary angiogram) to no pretreatment in NSTE-ACS. (more…)
MedicalResearch.com Interview with:
W. H. Wilson Tang, MD FACC FAHA
Professor of Medicine,
Cleveland Clinic Lerner College of Medicine at CWRU
Director, Cardiomyopathy Program, Kaufman Center for Heart Failure
Research Director, Section of Heart Failure and Cardiac Transplantation Medicine
Heart and Vascular Institute, Cleveland Clinic Cleveland, OH 44195
Medical Research: What are the main findings of the study?Dr. Tang:A chemical byproduct of gut bacteria-dependent digestion, TMAO (trimethylamine N-oxide), was previously shown to contribute to heart disease development. In this study, blood levels of TMAO for the first time are linked to heart failure development and mortality risk.
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MedicalResearch.com Interview with:
George Thanassoulis, MD MSc FRCP(C)
Director, Preventive and Genomic Cardiology
FRQ-S Clinician-Scientist/Chercheur-Boursier Clinicien
Assistant Professor of Medicine, McGill University
McGill University Health Center Montreal, QC
Medical Research: What is the background for this study? What are the main findings?Dr. Thanassoulis: Although LDL-C (i.e. bad cholesterol) has been linked with aortic valve disease in several prior reports, randomized trials to lower cholesterol in aortic valve disease were not effective suggesting that cholesterol may not be important in valve disease.
To address this, we performed a Mendelian randomization study, that showed that a genetic predisposition to LDL-C, was associated with both calcium deposits on the aortic valve and aortic stenosis (I.e. Valve narrowing). These results can be viewed as the effect of a life-long increase in LDL-C on the incidence of aortic valve disease and suggest that increases in LDL-C cause aortic stenosis. (more…)
MedicalResearch.com Interview with:
Dr. Andrea M. Isidori, MD, PhD
Consultant - Assistant Professor of Endocrinology
Department of Experimental Medicine
Medical Pathophysiology
Sapienza University of Rome
Medical Research: What is the background for this study? What are the main findings?Dr. Isidori : Our meta-analytic research originated to clarify some controversies emerging from the available human studies. We wanted to analyze if chronic PDE5i administration was cardioprotective and safe, and, if so, where the benefits were mainly seen: cardiac muscle, peripheral vessels, or both. In the last sixteen years pre-clinical and clinical research into the extra-urological effects of PDE5i has expanded dramatically, revealing previously unsuspected indications for these drugs. Several animal studies have shown that PDE5i attenuates cardiac remodeling, with an anti-hypertrophic and anti-fibrotic effect, and protects the heart against different types of injury. Some small clinical trials have demonstrated that chronic PDE5 inhibition improves cardiac performance and geometry in various clinical conditions, including heart failure, myocardial infarction and diabetic cardiomyopathy.
We showed that continuous administration of Viagra improves cardiac performance (increase of ejection fraction and cardiac index) and has an anti-remodeling effect (decrease of left ventricular mass and increase of end diastolic volume) without a major impact on vascular parameters (blood pressure and vascular resistance) suggesting that it does indeed have a direct effect on the heart. The novelty of this meta-analysis is the identification of subgroups of patients that may benefit more from PDE5i: patients with cardiac hypertrophy and heart failure. Our study is the first to show in a large patient cohort that chronic PDE5i administration improves cardiac output and decreases heart rate. This could result in longer survival, increased exercise tolerance and a better quality of life. Surprisingly, the magnitude of effects was similar to that seen with the drugs currently used to treat these clinical conditions, and was obtained in a relatively brief period (3 to 12 months). Most strikingly, we found that PDE5is are among the very few drugs that are able to improve diastolic relaxation, thus helping the correct refilling of the ventricle after each contraction, a nearly unique feature in drugs used in cardiology, and with incredible potential for future development in the prevention of heart failure. We also demonstrated their high tolerability and safety in a population that included elderly patients with various stages of cardiac disease and numerous comorbidities who were taking multiple pharmacological treatments. This setting resembles what we normally see in real life, supporting that daily administration is safe and involves no increase in the risk of adverse events compared to on-demand use.
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MedicalResearch.com Interview with: Dr. David MacIver
Department of Cardiology
Musgrove Park Hospital, Taunton
Medical Research:What is the background for this study? What are the main findings?Dr. MacIver: The study was prompted by 2 triathletes who presented to our hospital with similar symptoms suggesting they both had had fluid on the lungs whilst swimming. Both athletes were fit and active and had excellent heart function.
They were diagnosed with a condition is known as swimming-induced pulmonary oedema or edema (SIPO in the UK and SIPE in the USA). A condition that has been well-documented in Navy seals during training swims in open water. A similar condition has been described in divers sometimes with fatal consequences. Fluid on the lungs or pulmonary oedema more commonly occurs in patients as a complication of severe heart disease such as heart attacks and is called acute heart failure. Pulmonary oedema has also been documented healthy race-horses during competitions.
We had recently suggested that acute pulmonary edema in patients with heart disease could be explained by a transient mismatch in the right and left ventricular stroke volumes. We thought it would be interesting to see if a similar mechanism could explain swimming-induced pulmonary edema. We found that factors that might contribute included cold water and high blood pressure. We speculated that cross-training with land based activities (running, cycling) might be relevant.
In this study we proposed a possible mechanism for swimming-induced pulmonary edema - fluid from the blood is force into the lung air sacs by the strong right ventricle. In effect, the individual begins drowning in their own lung fluid.
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MedicalResearch.com Interview with:Professor Pranas Serpytis
Vilnius University Hospital Santariskiu Clinic
Vilnius, Lithuania
Medical Research: What are the main findings of the study?Professor Serpytis:The main findings of the study were that women are more likely to develop anxiety and depression after acute myocardial infarction. In our study depression was assessed by HADS scale: no depression (0-7 score), possible depression (8-10 score), definite depression (11+ score). The mean score of assessing depression were 6.87 (± 4.6) among men and 8.66 (± 3.7) among women (p <.05). Cardiovascular disease risk factors such as smoking increases patients anxiety levels, and low physical activity is associated with an increased risk to suffer from depression.
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MedicalResearch.com Interview with:Ilina and Medha Krishen
Michigan high school students and sisters Ilina and Medha Krishen, have developed screening tools using electronic stethoscopes to detect lung and heart disease. Their research was presented at the 2014 CHEST national meeting. Ilina and Medha have kindly agreed to discuss their work for the MedicalResearch.com audience.
Medical Research: Ilina, please tell us a little about you and the background for your study.Ilina: I am a senior at Port Huron Northern High School in Fort Gratiot, Michigan. I was exploring the effects of air pollutants on lungs using frequency analysis of lung recordings. My goal was to see if I could pick up early changes in healthy smokers and firefighters.
Dr. Sridhar Reddy, a local pulmonologist and occupational medicine expert mentored me. He lent me his electronic stethoscope. I am a violinist and a clarinet player, so initially had a lot of fun analyzing music frequencies. Later, I moved to lung sounds (a little more difficult!).
I used a Thinklabs Electronic Stethoscope for recording lung sounds. The inventor, Mr. Clive Smith, helped me understand the stethoscope.
I used the MATLAB program for analyzing frequencies. Mr. Charles Munson, a graduate student at the University of Michigan, helped me write the software program for it.
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MedicalResearch.com Interview with: Dr. Matthew Budoff, M.D.
Los Angeles Biomedical Research Institute
Torrance California
Medical Research: What are the main findings of the study?Dr. Budoff: We evaluated whether patients undergoing coronary CT angiography (non-invasive angiography) had better outcomes than those treated without the test. We found survival was better with CT angiography. Finding atherosclerosis allows cardiologists and primary care doctors to treat the patient better, including more statin therapy, more anti-platelet therapy, more lifestyle modifications. Several small studies showed similar results, but this was by far the most significant and largest study of it’s kind.
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MedicalResearch.com Interview with:
Graham Peigh, BA
Thomas Jefferson University
Medical Research: What are the main findings of the study?
Response:The main findings of our study show that extracorporeal cardiopulmonary resuscitation (E-CPR) can provide recovery when a patient is unresponsive to conventional CPR. In our sample of 24 patients, 13 survived ECMO, and 7 were successfully discharged from the hospital. Major meta analytic studies have shown that in-hospital CPR yields a discharge rate of under 20%, and our study presents results which demonstrate that E-CPR provides a method by which those survival figures can be increased. Importantly, our study also showed that vital organ function among ECMO survivors was maintained. All13 patients had improved or unchanged kidney and liver function, and 12/13 had improved or unchanged metabolic function. After using standard hypothermia protocols, all seven hospital survivors had full neurological recovery. This study differs from the majority of other studies on E-CPR because our institution does not have a dedicated E-CPR/Code team available to perform E-CPR 24/7. We believe that our results are thus generalizable to other academic institutions, which, like ours, have the capability to perform E-CPR, but are only able to do so during on-hours when physicians, perfusionists, and ECMO materials are available.
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MedicalResearch.com Interview with: David L. Katz, MD, MPH, FACPM, FACP
Director, Yale University Prevention Research Center
Griffin Hospital
Medical Research: What are the main findings of the study?Dr. Katz: We did not see any adverse effects of short-term, daily egg ingestion in adults with established coronary artery disease.
Medical Research: What was most surprising about the results?Dr. Katz: Eggs are routinely banned from 'heart healthy diets.' in particular eggs are always absent from cardiac care units, with egg beaters substituting. However, these same units routinely serve products with refined starch and added sugar. The scientific basis for excluding eggs from diets to improve cardiac health has long been suspect. Here, we show that in the short term at least, there are no discernible harms of daily egg ingestion even in adults with heart disease.
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MedicalResearch.com Interview with: Adrian Baranchuk MD FACC FRCPC
Associate Professor of Medicine
Director, EP Training Program Queen's University
Kingston, Ontario, Canada
Medical Research: What are the main findings of the study?Dr. Baranchuk: In this study, we investigated whether obstructive sleep apnea increases the risk of atrial fibrillation after coronary artery bypass surgery. We found the risk to increase by approximately two-fold for patients with obstructive sleep apnea, suggesting that this disease is a strong predictor of atrial fibrillation after coronary artery bypass surgery.
We also found that the risk increases in patients with more severe obstructive sleep apnea.
This is an important association to explore since atrial fibrillation after coronary artery bypass surgery increases patient mortality, the risk of stroke, hospital stay, healthcare costs, and has substantial burden on patients and their families. It is also a common complication of the surgery, occurring in up to half of the patients. Knowing which factors increase its risk gives us a better understanding of how to manage it and mitigate its negative consequences.
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MedicalResearch.com Interview with:Phil Tully PhD
Early Career Research Fellow, Discipline of Medicine
University of Adelaide Australia and
Abteilung für Rehabilitationspsychologie und Psychotherapie
Institut für Psychologie, Universität Freiburg Freiburg Germany
Medical Research: What are the main findings of the study?Response: The systematic review indicated that anxiety disorders ascertained by clinical interview are highly prevalent in patients with verified coronary heart disease. Also, approximately 50% of anxiety disorders were comorbid with depression. There was however some uncertainty in prevalence estimates with high level heterogeneity observed between studies. It was also evident that studies measuring generalized anxiety disorder in outpatient samples reported an increased prognostic risk for major adverse cardiac events in the longer term, when adjusted for confounding factors, however there was limited data. There were no randomized controlled trials targeting anxiety disorders in this population.
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MedicalResearch.com Interview with Nils P. Johnson, M.D., M.S.
Assistant Professor - Cardiovascular Medicine
Department of Internal Medicine
University of Texas Health Science Center
Houston Texas
Medical Research: What are the main findings of the study?Dr. Johnson: Our study had 3 main findings.
First, the numeric fractional flow reserve (FFR) value related continuously to risk, such that clinical events increased as FFR decreased and revascularization showed larger net benefit for lower baseline FFR values.
Second, fractional flow reserve measured immediately after stenting also showed an inverse relationship with prognosis, likely due to its relationship with diffuse disease.
Third, an fractional flow reserve-assisted strategy led to revascularization roughly half as often as an anatomy-based strategy, but with 20% fewer adverse events and 10% better angina relief.
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MedicalResearch.com Interview with:Jaime Hart, ScD
Instructor in Medicine
Channing Division of Network Medicine
Medical Research: What are the main findings of the study?Response: The main findings are, that among 107,130 women in the Nurses' Health Study, even after adjusting for a number of traditional cardiovascular risk factors, those women living within 50 meters of a major roadway had a 38% increased risk of sudden cardiac death and 24% increased risk of fatal coronary heart disease, compared to women living 500 meters or more away.
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MedicalResearch.com Interview with: Dr Jelena Kornej
Department of Electrophysiology
Heart Center Leipzig Leipzig Germany;
Medical Research: What are the main findings of the study?Dr. Komej: Both atrial fibrillation (AF) and renal impairment are known to coexist and associated with increased morbidity and mortality. However, there is only limited data on changes of renal function after AF catheter ablation and predictors thereof. This is the largest study analyzing the effects of atrial fibrillation catheter ablation on renal function and changes thereof in a contemporary population during mid-term follow-up. We found that lower baseline eGFR was associated with higher CHADS2and CHA2DS2-VASc scores and that both scores were independently associated with eGFR changes after atrial fibrillation catheter ablation as were atrial fibrillation recurrences.
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MedicalResearch.com Interview with: Zainab Samad, M.D., M.H.S.
Assistant Professor of Medicine
Duke University Medical Center
Durham, North Carolina
Medical Research: What are the main findings of the study?Dr. Samad: This was a sub study of REMIT, an NHLBI funded study. Our research team headed by Dr. Wei Jiang conducted the REMIT study between 2006-2011 at the Duke Heart Center. We found that women and men differ significantly in their physiological and psychological responses to mental stress. We explored sex differences across various domains felt to have implications towards cardiovascular disease pathophysiology and prognosis. We found that women had greater negative emotion, less positive emotion, while men had greater blood pressure increases in response to mental stress. On the contrary, women showed greater platelet reactivity compared to men in response to mental stress. A greater frequency of women had cardiac ischemia in response to mental stress compared to men.
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MedicalResearch.com Interview with: Joseph A. Ladapo, MD, PhD
New York University School of Medicine
Department of Population Health
New York, NY 10016
Medical Research: What are the main findings of the study?Dr. Ladapo: We showed that the use of cardiac stress testing has risen briskly over the past two decades, with the use of imaging growing particularly rapidly. We also showed that national growth in cardiac stress test use can largely be explained by population and provider characteristics, but the use of imaging cannot. Importantly, nearly one third of cardiac stress tests with imaging tests were probably inappropriate, because they were performed in patients who rarely benefit from imaging. These tests--about 1 million each year--are associated with about half a billion dollars in healthcare costs annually and lead to about 500 people developing cancer in their lifetime because of radiation they received during that cardiac stress test.
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MedicalResearch.com Interview with: Naga Pothineni, MD
Division of Cardiology
University of Arkansas for Medical Science
MedicalResearch: What are the main findings of the study?Dr. Pothineni:Hepatitis C is a blood borne infection that is very common worldwide. Most pateints who contract hepatitis C develop a chronic form on infection that progresses to liver damage and eventually hepatocellular cancer. Coronary heart disease is a worldwide problem as well. There has been interest in chronic infections being a mechanism of progression of atherosclerosis and coronary heart disease. We wanted to study the association of coronary heart disease events in patients with hepatitis C. We conducted a retrospective study of around 24,000 patients of which around 10,000 were hepatitis C positive. Our study showed that patients who have hepatitis C have a higher incidence of coronary heart disease events (myocardial infarction) when compared to patients who are negative for hepatitis C. In our analysis, we found that hepatitis C positivity is an independent risk factor for coronary events after adjusting for traditional cardiovascular risk factors like age, hypertension, smoking and diabetes.
Another interesting finding in our study was that patients with hepatitis C have lower levels of cholesterol compared to patients without hepatitis C. Low cholesterol levels in these patients do not seem to be protective against future coronary heart disease events.
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MedicalResearch.com Interview with: Elizabeth Blanchard Hills, BSN MSJ
President, Informed Health Solutions
Medical Research: What is your role?Response: My name is Elizabeth Blanchard Hills, BSN, MSJ. My company, Informed Health Solutions, currently has the privilege of “transitioning” Dr. Smith’s work into clinical practice. We have been conducting an on-going pilot project with the University of Kansas Hospital since November 2013, and our results are corroborating the results of Dr. Smith’s randomized clinical trial. We have renamed SMAC-HF; it is now called CareConnext.
Medical Research: What are the main findings of the study? Response: That we could, in fact, significantly lower hospital readmissions among heart failure patients.
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MedicalReseach.com Interview with: Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI,
Director of Research, Cardiac Catheterization Laboratory,
Director, Cardiovascular Outcomes Group,
The Leon H. Charney Division of Cardiology,
Associate Professor of Medicine,
New York University School of Medicine New York, NY 10016.
Medical Research: What are the main findings of the study?Dr. Bangalore: Using data from the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial, we found that β-blocker use in patients with prior myocardial infarction but no heart failure was associated with a lower composite cardiovascular outcome, driven mainly by lower risk of recurrent myocardial infarction with no difference in mortality. However, in patients without prior myocardial infarction there was no benefit of β-blocker use with a suggestion of increase in stroke risk.
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MedicalResearch.com Interview with: Dr. Anil Nigam MD MSc FRCPC
Director, Research Program in Preventive Cardiology at ÉPIC Centre
Montreal Heart Institute
Associate Professor, Department of Medicine at Université de Montréal
Medical Research: What are the main findings of the study?Dr. Nigam: The main finding is that high-dose fish oil rich in marine omega-3 fatty acids did not reduce recurrence of atrial fibrillation in individuals with paroxysmal or persistent atrial fibrillation not receiving conventional anti-arrhythmic therapy.
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For MedicalResearch.comJyrki Virtanen, PhD
Adjunct Professor of Nutritional Epidemiology
University of Eastern Finland
Kuopio, Finland
Medical Research: What are the main findings of the study?Dr. Virtanen: The main finding was that saturated fat intake was not an independent risk factor for Coronary Heart Disease even in a population with relatively high average saturated fat intake, like in this population with middle-aged and older men from Eastern Finland. In other words, intake of carbohydrates in place of saturated fat was not associated with lower risk, not even when the quality of carbohydrates was taken into account. Only when polyunsaturated fat replaced saturated fat in the diet, was the risk of Coronary Heart Disease, especially Coronary Heart Disease mortality, lower. In fact, also replacing trans fat or carbohydrates with polyunsaturated fat was associated with lower risk. The associations were similar with both n-6 and n-3 polyunsaturated fatty acids.
Trans fat intake was not associated with the Coronary Heart Disease risk, but that is most likely explained by the low intake of trans fat in Finland already in mid-1980s.
We also investigated the associations of the fatty acid intake with carotid artery atherosclerosis, and the results were generally similar to the findings with incident Coronary Heart Disease events.
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MedicalResearch.com Interview with: Joanna Chikwe MD
Associate Professor
Department of Cardiovascular Surgery
Mount Sinai Medical Center and
Natalia N. Egorova, PhD
Department of Health Evidence and Policy,
Icahn School of Medicine at Mount Sinai
New York, New York
Medical Research: What are the main findings of the study?Answer: This is one of the largest studies to date on the long-term outcomes of patients after aortic valve replacement. We found that bioprosthetic valves are as safe as mechanical valves in younger patients (age 50-69) - specifically, long-term death rates and stroke risk were very similar in patients who had either valve type. The main differences lay in the risk of other long-term complications: patients who had bioprosthetic valves were more likely to need repeat surgery in the long-term, whereas patients who had mechanical valves were more likely to experience a major bleeding event.
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MedicalResearch.com Interview with:Lior Yankelson, MD PhD
Tel Aviv Medical CenterMedicalResearch: What are the main findings of the study?Dr. Yankelson:The main findings of the study are that new onset atrial fibrillation after TAVI does not confer a significant risk for mortality , and confers somewhat increased risk for stroke. The latter issue is expected to become less significant with new technological advancements coming into the market, such as lower profile devices and emboli protection both mechanical and pharmaceutical. The more significant and alarming finding is that patients with atrial fibrillation have more than 4 fold risk for death at 1 year post TAVI compared to patients without afib. This is very significant and raises questions regarding the benefit for the procedure in these patients.
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MedicalResearch.com Interview with: Marwan Badri MBChB, MRCP
Cardiovascular disease fellow
Lankenau Medical Center
Wynnewood Pa
Medical Research : What is the background for this study?Dr. Badri: Recent years witnessed increased emphasis of the role of clinical guidelines in cardiovascular care. Physicians are encouraged to practice within the framework of major society guidelines to deliver better, more cost-effective patient care. It is therefore vital that the recommendations in these guidelines are applicable to most of the patient population. Since some clinical trials have been shown in the past to unfavorably exclude women, racial minorities and elderly patients, we conducted this study to see if the clinical trials used to form the American College of Cardiology/American Heart Association adequately represent these patient groups.
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MedicalResearch.com Interview with:Philip Gorelick, M.D., M.P.H, F.A.C.P.
Medical Director of the Hauenstein Neuroscience Center
Saint Mary’s Health Care, Grand Rapids, MI;
Professor, Translational Science and Molecular Medicine
Michigan State University College of Human Medicine;
Board member of the National Stroke Association
and
Judy Lenane, R.N., M.H.A.
Chief Clinical Officer of iRhythm Technologies, Inc.
Medical Research: What is atrial fibrillation and how common a problem is it among US adults?Dr. Gorelick: Nearly 3 million people in the US suffer from Atrial Fibrillation or “Afib,” an abnormal heart rhythm that causes the heart to beat rapidly and irregularly. While Afib can occur at any age, the incidence increases with age and the number of cases is expected to increase significantly in the coming years as the population ages. Approximately 5 percent of people 65 years and older and one in every 10 people over 80 years of age have Afib. It is more common in those with high blood pressure, heart disease or lung disease. (more…)
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MedicalResearch.com Interview with:
Yuting Zhang, Ph.D.
Associate Professor and Director
Pharmaceutical Economics Research Group
University of Pittsburgh Graduate School of Public Health
Department of Health Policy and Management.
Medical Research: What are the main findings of the study?
Dr. Zhang: Patients with atrial fibrillation who take the blood thinner dabigatran are at greater risk for major bleeding and gastrointestinal bleeding than those who take warfarin, indicating that greater caution is needed when prescribing dabigatran to certain high-risk patients. High-risk groups include those who are 75 and older; African Americans; those with chronic kidney disease; and those with seven or more co-existing medical problems.
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