AHA Journals
16 Aug Implantable Cardioverter Defibrillators and Reduction in Mortality, Readmissions
MedicalResearch.com Interview with:
Ryan T. Borne MD
University of Colorado Anschutz Medical Campus
Division of Cardiology
Aurora, CO 80045
Medical Research: What are the main findings of the study?
Dr. Borne: Using the NCDR ICD Registry, we identified Medicare beneficiaries aged 65 years and older with low left ventricular ejection fraction (≤ 35%) who underwent primary prevention implantable cardioverter defibrillator implantation, including those receiving cardiac resynchronization therapy with defibrillator, between 2006 and 2010 who could be matched to Medicare claims. We found that while there were modest changes in the patient characteristics undergoing ICD implantation, there were significant improvements over time in mid-term outcomes including 6-month mortality, re-hospitalization, and device-related complications.
13 Aug After Heart Attack: High Dose Aspirin Still Commonly Prescribed
MedicalResearch.com Interview with: Hurst M. Hall, MD and Sandeep Das, MD, MPH Division of Cardiology University of Texas Southwestern Medical Center Dallas, TX Medical Research: What are the main findings of the study? Answer: Most patients treated for a heart attack in the United States during this study period were discharged home on 325 mg of aspirin a day. This was true even among subgroups expected to be at high bleeding risk. In addition, there was tremendous variability in the proportional use of this higher dose aspirin across hospitals, suggesting a prominent local influence on prescribing patterns.13 Aug Cardiovascular Risks Remain Higher For Women, African Americans
MedicalResearch.com Interview with:
Susan Cheng MD
Cardiovascular Division, Brigham and Women's Hospital
Boston, MA 02115
Medical Research: What are the main findings of the study?
Dr. Cheng: We've known for some time that smoking, high cholesterol, high blood pressure, diabetes, and obesity all contribute to a person’s risk of being at risk for heart disease. The goal of our study was to look back over the last two decades and see how we've been doing in reducing the impact of these major cardiovascular risk factors on the actual risk for developing heart and vascular disease. We found that, not surprisingly, we've been doing generally better over time at lowering the overall impact of some risk factors such as smoking and high cholesterol. On the other hand, the impact of hypertension and diabetes has been high and has remained high over time.
09 Aug Stroke: Lower Cognitive Function Linked to Increase Risk, Mortality
MedicalResearch.com Interview with:
Kumar Bharat Rajan, PhD
Assistant Professor
Department of Internal Medicine
Section of Population Sciences
Chicago IL 60612
Medical Research: What are the main findings of the paper?
Dr. Rajan: Lower levels of cognitive functioning was associated with incident stroke and the change in cognitive functioning was increased after incident stroke. Cognitive functioning was an independent marker of mortality even after accounting for incident stroke.
08 Aug Which BNP Better Predicts CV Events in Stable Coronary Heart Disease?
MedicalResearch.com Interview with: Rakesh K. Mishra, MD San Francisco Veterans Affairs Medical Center San Francisco, CA 94121. Medical Research: What are the main findings of the study? Dr. Mishra: Increased levels of both BNP and NT-proBNP are associated with elevated risk of adverse cardiovascular events in patients with stable coronary artery disease. However, when added to existing clinical models of risk, NT-proBNP is superior to BNP for risk reclassification.28 Jul Quitting Snuff/Chew/Dip After Heart Attack May Half Risk of Dying
MedicalResearch.com: Interview with:
Gabriel Arefalk
Department of Medical Sciences
Uppsala University Hospital
Uppsala, Sweden
Medical Research: What are the main findings of the study?
Answer: In this prospective cohort study, we investigated mortality risk in 2474 smokeless tobacco users who had been hospitalized for a myocardial infarction between the years of 2005-2009 in Sweden. We used a nationwide quality register and database called SWEDEHEART and found that those who stopped using snus (the Swedish type of snuff) after their MI had half the risk of dying during follow up relative to those who continued to use snus. This association, which was of the same magnitude as for smoking cessation, seemed to be independent of age, gender and smoking habits, as well as of many other relevant covariates.
22 Jul Heart Attack: Young and Female Patients Have Worse Outcomes
MedicalResearch.com Interview with:
Aakriti Gupta, MD, MBBS
Center for Outcomes Research and Evaluation
Yale-New Haven Hospital,
New Haven, Connecticut
Medical Research: What were the main findings?
Dr. Gupta: Using a national database, we found that heart attack hospitalization rates for patients under the age of 55 have not declined in the past decade while their Medicare-age counterparts have seen a 20 percent drop.
We also found that among younger patients below 55 years of age, women fare worse because they have longer hospital stays, and are more likely to die in the hospital after a heart attack. Young women were also more likely to have higher prevalence of co-existing medical conditions including diabetes, high blood pressure and higher cholesterol levels. Overall, all patient groups in the study saw increases in these conditions including diabetes and high blood pressure in the past decade.
21 Jul When Should A Coronary CT Scan Be Repeated?
MedicalResearch.com Interview with:
Kanako K. Kumamaru, MD PhD
Assistant Professor, Departments of Radiology
Brigham and Women’s Hospital & Harvard Medical School
Boston, MA 02115
Medical Research: What are the main findings of the study?
Dr. Kumamaru: When a patient does not have diabetes and had no or ≤25% coronary stenosis in his/her previous coronary CT angiography (CCTA) performed within 3 years, the probability of newly developed coronary artery disease (CAD) is very low, suggesting no repeat CCTA necessary, even if the clinical scenario suggested CCTA to be appropriate. Especially, when coronary arteries were completely normal at the prior scan, no patient underwent subsequent revascularization during the study period.
21 Jul Cardiac Stents: Life-Long Prevention May Be Needed To Prevent Late Failure
MedicalResearch.com Interview with: Cheol Whan Lee and Seung-Jung Park Division of Cardiology, Asan Medical Center, University of Ulsan Seoul, Korea Medical Research: What are the main findings of the study? Answer: The time window of DES (drug-eluting stent) failure is widely variable from soon after DES implantation to several years after DES implantation. We observed patients with late DES failure are commonly presented with acute coronary syndrome. We hypothesized that temporal patterns of DES failure may be different, and analyzed all patients with first DES failure at our institution. We found that late drug-eluting stent failure is more likely to progress to acute myocardial infarction, aggressive angiographic patterns, and worse outcomes following retreatment.17 Jul Processesed Red Meat Linked To Higher Risk Of Heart Failure
MedicalResearch.com Interview with: Dr inz. Joanna Kaluza Department of Human Nutrition Warsaw University of Life Sciences - SGGW Warsaw POLAND Medical Research: What are the main findings of the study? Response: The most important finding of my study is the fact that processed red meat consumption, but not unprocessed red meat, increases a risk of Heart Failure incidence and Heart Failure mortality.15 Jul Family History Closely Linked To Carotid Artery Stenosis
MedicalResearch.com Interview with:
Iftikhar J. Kullo, MD
Division of Cardiovascular Diseases
Mayo Clinic Rochester, MN
Medical Research: What are the main findings of the study?
Dr. Kullo: The main findings of the study are:
1) Family history of stroke or heart attack is associated with presence of significant narrowing (greater than 70%) of the carotid arteries. These are the arteries that supply blood to the brain and narrowing or blockage of these arteries is associated with increased risk of stroke;
2) Having a sibling history of stroke or heart attack was more strongly associated with narrowing of the carotid artery than having a parent with such history;
3) The greater number of relatives with history of stroke or heart attack, the greater the odds of having narrowing in one of the carotid arteries.
14 Jul Fasting Prior To Lipid Measurement May Be Unnecessary
MedicalResearch.com Interview with:
Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI
Director of Research, Cardiac Catheterization Laboratory
Director, Cardiovascular Outcomes Group
Associate Professor of Medicine,
New York University School of Medcine
Principal Investigator ISCHEMIA-CKD trial
Medical Research: What are the main findings of the study?
Dr. Bangalore: Our objective was to evaluate whether non-fasting LDL has similar prognostic significance as that of the conventionally measured fasting LDL values. We found that in an analysis of over 16,000 patients from the National Health and Nutrition Examination Survey that the non-fasting LDL values had similar prognostic significance as that of fasting LDL values for the prediction of long term (up to 14 years) death or cardiovascular death, thus questioning the traditional practice of insisting that patients fast prior to blood draw for a lipid panel. This was also true for other components of the lipid panel including the triglycerides and total cholesterol.
14 Jul Chronic Inflammation Associated With Increased Risk of Diabetes and Heart Disease
MedicalResearch.com Interview with: Dr Alex Dregan Lecturer in Translational Epidemiology and Public Health, Division of Primary Care and Public Health Research King's College London, London Medical Research: What are the main findings of the study? Dr. Dregan: Our study showed that chronic inflammation was associated with increased risk of developing cardiovascular disease, specifically type II diabetes and coronary heart disease. The risk of cardiovascular disease increased with the severity of inflammatory disorders. In addition, inflammation also increased the risk of multiple morbidity (two or more cardiovascular diseases).10 Jul Regular Use of Some NSAIDs May Increase Adverse Cardiovascular Events.
MedicalResearch.com Interview with:
Anthony Bavry, MD MPH
Interventional Cardiology, North Florida/South Georgia Veterans Health System
Associate Professor of Medicine, University of Florida
Gainesville, FL 32610
Medical Research: What are the main findings of the study?
Dr. Bavry:
1) Among post-menopausal women, the regular use of NSAIDs was associated with an increased risk of cardiovascular death, myocardial infarction, or stroke.
2) Cardiovascular risk was observed among users of celecoxib, naproxen, but not ibuprofen.
09 Jul Venous Thromboembolism Associated With Short and Long Term Increase In Mortality
MedicalResearch.com Interview with:
Kirstine Kobberøe Søgaard, MD
Department of Clinical Epidemiology,
Aarhus University Hospital, Denmark
Medical Research: What are the main findings of the study?
Response: Venous thromboembolism (VTE) is mainly considered an acute illness with a high mortality right after the event, whereas knowledge on the impact on long-term survival has been sparse. In our study, we used nationwide data on VTE since 1977, and included 128,223 patients with VTE and 640,760 individuals from the general population without a VTE diagnosis. We had complete follow-up data on individual patient level and were able to link information from other hospital admissions and thereby obtain each patient’s entire hospital history, as well as death statistics with specific cause of death. We confirmed the high mortality immediately after the thromboembolic event, but more interestingly, we found that mortality remained increased during the entire follow-up period of 30 years, with venous thromboembolism as an important cause of death among patients with deep venous thrombosis and/or pulmonary embolism.
07 Jul VA Study Defines Optimum Exercise Capacity Threshold By Age
MedicalResearch.com Interview with:
Peter Kokkinos PhD
Veterans Affairs Medical Center, Cardiology Division
Washington, DC 20422
Medical Research: What are the main findings of the study?
Dr. Kokkinos: The main finding of the study is that we defined an exercise capacity threshold for each age category (<50; 50-59; 60-69; and ≥70 years of age). The mortality risk increases progressively below this threshold and decreases above it. We then calculated the 5 and 10-year mortality risk for each age category.
04 Jul Validating Medicare Claims Data For Stroke
MedicalResearch.com Interview with Hiraku Kumamar, MD, MPH Department of Epidemiology Harvard School of Public Health, Boston, MA and Soko Setoguchi-Iwata, M.D. Duke Clinical Research Institute Durham, NC 27715 Medical Research: What are the main findings of the study? Answer: We evaluated the accuracy of discharge diagnosis of stroke in the Medicare claims database by linking it to a nationwide epidemiological study cohort with 30239 participants called REasons for Geographic And Racial Differences in Stroke (REGARDS). We found that among the 282 events captured using a strict claims definition of stroke, 91% were true events. We also found that 12% of the overall strokes had been identified only by Medicare claims, strongly supporting the use of these readily available data for event follow-up in cohort studies.03 Jul Newer Drug-Eluting Stents Narrow Gap Between Cardiac Bypass and Stent Surgery Outcomes
MedicalResearch.com Interview with:
Sripal Bangalore, MD, MHA
Director of Research, Cardiac Catheterization Laboratory,
Director, Cardiovascular Outcomes Group,
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: We found that while CABG was associated with mortality benefit when compared with bare metal stents or first generation drug eluting stent, the gap between CABG and PCI was smaller and non significant when PCI was with newer generation DES. The same was true for repeat revascularization with the magnitude of benefit with CABG descending considerable from comparison with balloon angioplasty to newer generation DES.
03 Jul PAD: Polyphenols in Dark Chocolate May Improve Peripheral Artery Disease
MedicalResearch.com Interview with: Lorenzo Loffredo, MD and Francesco Violi, MD Department of Internal Medicine and Medical Specialties Sapienza University of Rome, Rome, Italy; MedicalResearch: What are the main findings of the study? Answer: Dark chocolate is rich of polyphenols; these natural substances exert antioxidant properties and, through an increase of nitric oxide, dilate arteries. Our research group applied this effect to enhance blood flow in a very common disease, the peripheral arterial disease. This disease is characterized by reduced blood flow to the limbs. There are not any drugs that improve this blood flow, but dark chocolate could. Our study suggest that dark chocolate, and only dark chocolate, could reduce oxidative stress and improve blood flow and walking autonomy in patients with peripheral arterial disease. We observed no effect on blood flow, oxidative stress and on walking autonomy in PAD patients after milk chocolate assumption. This lack of effect was probably due to the low concentration of polyphenols in milk chocolate.30 Jun Cardiac CT Associated With Enhanced Preventative Medical Care
MedicalResearch.com Interview with:
Eddie Hulten, MD MPH FACC FSCCT and
Ron Blankstein, MD FACC
Cardiovascular Imaging Noninvasive Cardiovascular Imaging
Walter Reed National Military Medical Center Brigham and Women’s Hospital
Bethesda, MD Boston, MA
MedicalResearch: What are the main findings of the study?
Answer: Although any medical test should be used to change management, the extent to which CCTA (Cardiac computed tomography angiography) findings are associated with medication changes (aspirin and lipid lowering) is not previously extensively studied.
Thus, we conducted the largest and one of the longest follow up studies of preventive cardiovascular medications before and after coronary computed tomography angiography (CCTA). We demonstrated that CCTA findings are associated with significant changes in preventive medications after CCTA.
25 Jun Overall Hospitalizations for Stroke Decrease, but Racial Disparities Remain
MedicalResearch.com Interview with:
Wuwei (Wayne) Feng MD MS FANA
Assistant Professor, Department of Neuroscience
Department of Health Science & Research
Medical University of South Carolina Stroke Center
The Center of Rehabilitation Research in Neurological Conditions
MedicalResearch: What are the main findings of the study?
Dr. Feng: Stroke hospitalization rate is decreasing in the elderly, but increasing in the young/middle aged population, but this increase is mainly driven by the increase in blacks (not in whites) which incurred persistent racial disparity in stroke. It has tremendous economic impact as outlined in the paper. Of hospital charges totaling $2.8 billion over 10-year period, $453.2 million (16.4%) are associated with racial disparity (79.6% from patients <65 years).
By way of background:
84,179 stroke hospitalizations occurred in South Carolina from 2001 to 2010. Blacks accounted for 29,846 (35.5%) and whites accounted for 54,333 (64.5%) of the strokes. Among blacks, 50.4% were <65 years of age compared to 29.6% among whites. The overall stroke hospitalization rate decreased over the 10-year period. There was a significant reduction in stroke hospitalization rate in the older (≥65 years old) populations, for both blacks and whites.
Whereas, in the younger populations (<65 years old), the overall rate of stroke hospitalizations actually increased significantly; however this increase was only associated with black patients. For example, the hospitalization rate per 100,000 for young blacks was 121 in 2001, 139 in 2005 and 142 in 2010 (a 17.3% increase from 2001).
This racial disparity was more severe in the younger group with the highest disparity seen in the 45-54 year age groups for both ischemic strokes (having a clot) and intra-cerebral hemorrhagic strokes.
20 Jun Heavy Episodic Alcohol Use Raises Risk of Heart Attack
MedicalResearch.com: Interview with:
Dr. Darryl P. Leong MBBS(Hons) MPH PhD FRACP FESC
Hamilton General Hospital
237 Barton Street East Canada
MedicalResearch: What are the main findings of the study?
Dr. Leong: The main findings of this study are that while low-moderate levels of alcohol use are associated with a reduced risk of myocardial infarction, this protective association was not seen in peoples of all ethnicities.
Secondly, heavy alcohol use (≥6 drinks) within a 24 hour period was associated with a significant increase in the immediate risk of myocardial infarction.
22 May Dramatic Increase In Hospitalizations For Atrial Fibrillation As Population Ages
MedicalResearch.com Interview with: Nileshkumar J. Patel MD Staten Island University Hospital Staten Island, NY, 10304 and Abhishek J. Deshmukh MD University of Arkansas Little Rock, AR MedicalResearch: What are the main findings of the study? Answer: We analyzed data from almost 4 million hospitalizations for atrial fibrillation (AF) from more than 1,200 hospitals across 45 states in last decade, and found that - Hospitalization rates for atrial fibrillation have increased exponentially among US adults during the past 10 years, particularly in those 65 years or older. - The most frequent coexisting conditions were hypertension (59.99%), diabetes (21.47%) and chronic pulmonary disease (20.01%). - In terms of geographic distribution of admissions, the hospitals in the South constitute (38.5%) the highest percentage of atrial fibrillation hospitalizations, followed by Midwest (24.9%), Northeast (22.2%) and West (14.4%). - Overall in-hospital mortality was 1%. The mortality rate was highest in >80 years age group (1.93%) and patients with concomitant heart failure (8.2%). - The percentage of patients discharged to nursing facility increased from 8.1% in 2000 to 11.5% in 2010 and need for home health care increased from 6.7% to 13.1%. Approximately one fourth of the patients (25.83%) were discharged to long-term care institution if atrial fibrillation hospitalization was complicated by acute ischemic stroke. - Mean cost of AF hospitalization increased significantly from $6,410 in 2001 to $8,439 in 2010 (24.04% increase, p <0.001) even after adjusting for inflation. This represents an absolute increment in annual national cost from approximate 2.15 billion dollars in 2001 to 3.46 billion dollars in 2010. The mean cost of care was highest if AF hospitalization was associated with heart failure ($33,161) and valvular disorders ($28,030).21 May Online Educational Game Improved Clinicians’ Hypertension Knowledge and Patient Outcomes
MedicalResearch.com Interview with:
Dr. Price Kerfoot MD, EdM
Rabkin Fellow in Medical Education
Associate Professor of Surgery, Harvard Medical School
MedicalResearch: What are the main findings of the study?
Dr. Kerfoot:
(1) An online spaced education game improved clinicians' knowledge of hypertension intensification and generated a modest but significant improvement in time to blood pressure target among their patients with hypertension.
(2) As a method to increase clinicians' long-term knowledge, the spaced education game was significantly more effective than providing the identical content via a traditional method (online posting with e-mail reminders).
15 May Migraines Associated With Increased Risk of Silent Stroke
MedicalResearch Interview with: Dr. Teshamae Monteith MD Assistant professor of Neurology Chief of the Headache Division University of Miami Miller School of Medicine. MedicalResearch: What are the main findings of the study? Dr. Monteith:- A doubling of silent brain infarctions in those with migraine even after adjusting for other stroke risk factors;
- No increase in the volume of white-matter hyperintensities (small blood vessel abnormalities) that have been associated with migraine in other studies;
- Migraines with aura — changes in vision or other senses preceding the headache — wasn’t common in participants and wasn’t necessary for the association with silent cerebral infarctions.
- High blood pressure, another important stroke risk factor, was more common in those with migraine. But the association between migraine and silent brain infarction was also found in participants with normal blood pressure.
14 May Stroke Risk Reduced by Increased Fruit and Vegetable Consumption
MedicalResearch Interview with: Dr. Yan Qu Qingdao Municipal hospital Fruits and Vegetables Consumption and Risk of Stroke A Meta-Analysis of Prospective Cohort Studies MedicalResearch: What are the main findings of the study? Reply: First, both fruits and vegetables were found inversely associated with risk of stroke, and the relationships might be linear. Second, the inverse association of fruits and vegetables consumption with risk of stroke is consistent across subgroup analysis by outcome (stroke incidence and stroke mortality), location where the study was conducted (USA, Europe and Asia), sex (male and female), and stroke subtypes (ischemic and hemorrhagic). Third, citrus fruits, leafy vegetables and apples/pears were found inversely associated with risk of stroke. Fourth, very similar results were found in the subgroup analysis by status [yes: 0.78 (0.71-0.86) or no: 0.79 (0.74-0.85)] of adjusting for 6 or more of the 7 covariates (smoking, alcohol, blood pressure/hypertension, serum cholesterol, physical activity, body mass index, ≥3 dietary variables). These findings generally indicated that the association of fruits and vegetables consumption with the reduced risk of stroke may not be the result of confounding by the known factors.13 May Neighborhood Socioeconomic Status Impact On Medicare Rating for Heart Failure
Posted at 21:48h
in AHA Journals, Author Interviews, Health Care Systems, Hospital Readmissions, Medicare
MedicalResearch.com Interview with:
Alex Blum, MD MPH FAAP
Chief Medical Officer
Evergreen Health, Baltimore MD 21211
MedicalResearch.com: What are the main findings of the study?
Dr. Blum: Accounting for the social risk of patients using a measure of neighborhood socioeconomic status (SES), did not alter the hospital rankings for congestive heart failure (CHF) readmission rates.
08 May Maintaining Physical Activity Important For Healthy Aging
MedicalResearch.com Interview with:
Luisa Soares-Miranda, PhD
Research Center in Physical Activity, Health and Leisure
Faculty of Sport, University of Porto
Rua Dr. Plácido Costa,
Porto PORTUGAL
MedicalResearch: What are the main findings of the study?
Dr. Soares-Miranda: Modest physical activity, such as the distance and pace of walking, is important for the heart’s electrical well being of older adults. In our study, older adults that increased their walking pace or distance had a better heart rate variability when compared with those that decreased their walking pace or distance. Our results suggest not only that regular physical activity later in life is beneficial, but also that certain beneficial changes that occur may be reduced when physical activity is reduced. This supports the need to maintain modest physical activity throughout the aging process. Even small increases can lead to a better health, while reducing physical activity has the opposite effect. So, any physical activity is better than none, and more is better.
02 May Bystander CPR: Dispatcher Assistance Improves Outcomes
MedicalResearch.com Interview with:
Yoshikazu Goto, MD, PhD
Kanazawa University Hospital, Section of Emergency Medicine
Takaramachi 13-1, Kanazawa 920-8640, Japan
MedicalResearch.com: What are the main findings of the study?
Dr. Goto: The main findings were as follows. Dispatcher-assisted bystander
cardiopulmonary resuscitation for children with out-of-hospital cardiac
arrest, increased bystander CPR provision rate, and was associated with
improved favorable neurological outcomes compared to no bystander CPR.
Conventional bystander CPR (chest compression plus rescue breathing) was
associated with greater likelihood of neurologically intact survival,
compared to chest-compression-only CPR irrespective of cardiac arrest
etiology.