JACC
13 Nov Increased Aortic Stiffness May Explain Elevated Hypertension Risk in African Americans
Posted at 14:22h
in Author Interviews, Blood Pressure - Hypertension, Heart Disease, JACC, Race/Ethnic Diversity, UT Southwestern
MedicalResearch.com Interview with:
[caption id="attachment_29589" align="alignleft" width="140"]
Dr. Wanpen Vongpatanasin[/caption]
Wanpen Vongpatanasin, M.D.
Professor of Medicine
Norman & Audrey Kaplan Chair in Hypertension
Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research
Director, Hypertension Section,
Cardiology Division,
UT Southwestern Medical Center
Dallas, TX 75390-8586
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Aortic stiffness is known to be associated with cardiovascular disease, including heart attack, stroke, and heart failure, possibly related to increase afterload to the left ventricle. Previous studies have not directly assessed proximal aortic function among ethnic minorities in the United States. We evaluated the multiethnic, population-based Dallas Heart Study participants (N=2544, 54.2% women, 49.7% Black) who underwent cardiovascular magnetic resonance imaging (CMR) at 1.5 Tesla. Aortic stiffness and characteristic impedance (Zc) were determined from aortic arch PWV and lumen area measurements. Linear regression was used to evaluate ethnic differences in proximal aortic wall stiffness using aortic arch PWV and Zc as dependent variables with and without adjustment for traditional cardiovascular risk factors.
29 Oct ECG and Echocardiography for Identification of Arrhythmic Events in Early ARVC
MedicalResearch.com Interview with: Kristina H. Haugaa, MD, PhD, FESC Ida Skrinde Leren MD, PhD Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet Oslo, Norway MedicalResearch.com: What is the background for this study? Response: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inheritable cardiomyopathy, predisposing to life-threatening arrhythmias. Ventricular arrhythmias are frequent in ARVC patients and importantly, arrhythmias may occur also before evident structural changes are seen, making risk stratification challenging. Additional tools are needed to detect early disease and to optimize medication and timing of implantation of a cardioverter defibrillator (ICD). We aimed to explore early markers of ARVC disease and their association with previous ventricular arrhythmias.28 Oct Study Supports Feasibility of TAVI for High-Risk Aortic Regurgitation
MedicalResearch.com Interview with: Anna Franzone, MD and Prof.Thomas Pilgrim, MD Department of Cardiology Bern University Hospital INSELSPITAL Bern, Switzerland MedicalResearch.com: What is the background for this study? What are the main findings? Response: Surgical aortic valve replacement is the therapeutic standard for patients with pure native aortic regurgitation (AR). However, transcatheter aortic valve implantation (TAVI) is emerging as a novel treatment option for patients deemed inoperable or at high-risk for surgery because of advanced age and multiple comorbidities. We performed a systematic review and meta-analysis including 237 patients with pure native AR undergoing TAVI across 13 studies. The primary study endpoint, all-cause mortality at 30-day, ranged from 0% up to 30% with a summary estimate rate of 7% . The occurrence of complications such as the need for a second valve implantation was relatively low as well as the rates of other endpoints (cerebrovascular events, major bleeding and vascular complications).27 Oct Shorter Hospital Stays and Lower Costs for Rivaroxaban Compared With Warfarin for Venous Thrombosis Admissions
MedicalResearch.com Interview with:
Jay Margolis, PharmD
Sr. Research Scientist
Truven Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Vitamin K antagonists (VKAs), most commonly warfarin, had been the only orally available anticoagulants available for the last 60 or so years. While highly effective, use of these agents was often problematic due to their narrow therapeutic index, need for routine coagulation monitoring, and interactions with food and other drugs. Recently introduced new oral anticoagulants (NOACs), particularly rivaroxaban, had been shown in clinical trials to provide comparable efficacy to the VKAs without the need for routine coagulation monitoring. There have been few studies outside of clinical trials showing benefits that translate to real-world populations.
In our study using real-world data from a large sample of geographically and demographically diverse US hospitals, patients hospitalized for incident venous thromboembolisms (VTE) initiating oral anticoagulant treatment with rivaroxaban had significantly shorter hospital stays and lower hospitalization costs compared with warfarin-treated patients.
06 Oct Lower Salt Intake Linked To Decreased Blood Pressure, Heart Disease and Mortality
Posted at 11:22h
in Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Heart Disease, JACC, Salt-Sodium
MedicalResearch.com Interview with:
[caption id="attachment_28435" align="alignleft" width="130"]
Dr. Nancy Cook[/caption]
Nancy Cook ScD
Professor of Medicine, Harvard Medical School
Professor in the Department of Epidemiology
Harvard T.H. Chan School Public Health
Brigham & Women’s Hospital Division of Preventive Medicine
Boston, MA 02215
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The association of sodium intake with later mortality has been controversial. While there is a well-accepted effect on blood pressure, the effects of sodium on later cardiovascular disease, and particularly mortality, have been subject to dispute. While the adverse effects of high sodium are now widely accepted, effects at lower levels of sodium intake are less clear. Some recent studies have found a J-shaped relationship, with increased disease rates among those consuming lower levels of sodium, contrary to the effects on blood pressure.
In contrast, we found a direct linear relationship of usual intake of sodium with later mortality over 20 years of follow-up. Those with the lowest sodium intake experienced the lowest mortality. Our measure of intake was based on the average over 1-3 years of several measures of 24hr urine sodium excretion, the gold standard of sodium measurement. This is much more precise than measurements based on a single 24hr sodium excretion or especially on a spot urine sample, which is used in many publications that found the J-shaped curve. Our data were assessed in a healthy cohort of men and women without hypertension or cardiovascular disease, so had less potential bias due to these factors. We thus believe that our results showing the lowest mortality among those consuming the lowest levels of sodium are more accurate.
03 Oct Detecting Underlying Cardiovascular Disease in Young Competitive Athletes
MedicalResearch.com Interview with: Dr. James McKinney MD MSc FRCP(C) Division of Cardiology University of British Columbia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Sudden cardiac death (SCD) is the leading medical cause of death in young athletes. Sporting activity may predispose athletes with underlying cardiovascular conditions to develop life threatening ventricular arrhythmias during physical exercise. Despite being a relatively rare event, the death of a young healthy person is a tragic event that is difficult to comprehend. The prevalence of an underlying cardiovascular disorder in young athletes that predisposes to SCD is approximately 0.3%. Sudden cardiac death is often the first clinical manifestation of an underlying cardiovascular condition; up to 80% of athletes are previously asymptomatic. Pre-participation screening is the systematic practice of medically evaluating athletes for the purpose of identifying (or raising suspicion of) abnormalities that could provoke sudden death. There is agreement amongst sporting and medical bodies that athletes should undergo some form of pre-participation screening. An Achilles’ heel of screening is the significant number of false-positive screens that require subsequent costly secondary testing to rule out disease. Prevention of sudden cardiac death among athletes is a common goal, however the optimal strategy for its achievement is uncertain.20 Sep 52 Genes Linked To Size of Heart Identified
MedicalResearch.com Interview with: Prof. dr. P. van der Harst Interventional Cardiologist Scientific Director Cardiac Catheterization Laboratory University Medical Center Groningen Groningen The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: The electrocardiogram harbors important clues for the development and progression of heart diseases. We studied the voltages of the QRS-complex, a measure of cardiac hypertrophy which is associated with heart failure and various cardiomyopathies. We carried out a genome-wide association study (GWAS) and identified 52 regions in the genome that were associated with one or more QRS characteristics. 32 of these were novel. In these 52 regions we found 67 candidate genes that are might play a role in the adequate function of the human heart and the development of heart disease.19 Sep Large fluctuations in blood pressure associated with higher risk of heart disease and kidney failure
Posted at 22:24h
in Author Interviews, Blood Pressure - Hypertension, Heart Disease, JACC, Kidney Disease
MedicalResearch.com Interview with:
[caption id="attachment_28124" align="alignleft" width="120"]
Dr. Elvira Gosmanova[/caption]
Elvira Gosmanova MD
Department of Nephrology
University of Tennessee Health Science Center
Memphis TN, 38163
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It has been long known that elevated blood pressure is a risk factor for numerous adverse health-related outcomes. However, the majority of individuals do not have blood pressure in a constant range.
In contrary, blood pressure measured in the same individual tends to fluctuate over time. Moreover, some individuals have more blood pressure fluctuation, as compared with others. The impact of fluctuation in blood pressure is still poorly understood. Smaller studies suggested that increased fluctuation in blood pressure may be associated with hazardous health outcomes. However, large scale studies were still lacking. Therefore, we conducted a study involving close to 3 million US veterans to investigate the association of increased visit-to-visit variability of systolic blood pressure (which was our measure of fluctuation of blood pressure over time) and all-cause mortality, and incident coronary heart disease, stroke, and end-stage renal disease.
We found that there was strong and graded increase in the risk of all the above outcomes with increasing visit-to-visit variability of systolic blood pressure.
04 Sep No Evidence of Worse STEMI Outcomes During Off-Hours
Posted at 00:37h
in Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Outcomes & Safety, Surgical Research
MedicalResearch.com Interview with:
Senthil Selvaraj, MD, MA and Deepak L. Bhatt, MD, MPH
Brigham and Women’s Hospital Heart & Vascular Center and
Harvard Medical School, Boston, MA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There has been significant controversy in the effect of off-hours presentation in ST-elevation myocardial infarction (STEMI). Off-hours presentation has been associated with longer treatment time, an independent predictor of worse outcomes in STEMI, though a number of other studies have shown no difference as well. Moreover, little data has been generated from clinical trials, which has the advantage of comprehensive and adjudicated outcomes.
In our analysis of nearly 2,000 STEMI patients from the CHAMPION PHOENIX study (a randomized, controlled trial of cangrelor in percutaneous coronary intervention), we found that off-hours presentation was not associated with worse efficacy or safety outcomes at 48 hours or 30 days. More specifically, outcomes not typically reported in registry data, such as ischemia-driven revascularization and stent thrombosis, were not significantly different between the groups. Interestingly, treatment times were actually faster in the “off-hours” group as well.
31 Aug Fewer Overall New Cardiovascular Drugs, But More Biologics Researched
Posted at 18:14h
in Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Pharmacology
MedicalResearch.com Interview with:
[caption id="attachment_27299" align="alignleft" width="125"]
Dr. Aaron Kesselheim[/caption]
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
MedicalResearch.com: 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.
30 Aug Current Allocation System for Heart Transplantation Might Disfavor Adults with Congenital Heart Disease.
Posted at 11:37h
in Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Transplantation
MedicalResearch.com Interview with:
[caption id="attachment_27286" align="alignleft" width="125"]
Dr. Laith Alshawabkeh[/caption]
Dr. Laith Alshawabkeh MD
Senior Fellow
Brigham & Women's and Boston Childrens Hospitals / Harvard Medical School
MedicalResearch.com: 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).
30 Aug Complex Stent Procedures May Require Longer Period of Antiplatelet Therapies
MedicalResearch.com Interview with: [caption id="attachment_27419" align="alignleft" width="160"]
Dr. Gennaro Giustino[/caption]
Gennaro Giustino MD
Resident Physician - Department of Medicine
The Icahn School of Medicine at Mount Sinai
MedicalResearch.com: 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.
19 Aug Right Ventricular Changes in Olympic Athletes Described
MedicalResearch.com Interview with: [caption id="attachment_27190" align="alignleft" width="170"]
Dr. Antonio Pelliccia[/caption]
Antonio Pelliccia, MD, FESC
Chief of Cardiology
Institute of Sport Medicine and Science
Rome
MedicalResearch.com: 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.
17 Aug Long-Lived Parents Linked To Longer Life For Middle Aged Adults
MedicalResearch.com Interview with: [caption id="attachment_27134" align="alignleft" width="200"]
Dr. Janice Atkins[/caption]
Dr Janice Atkins
Research Fellow
Epidemiology and Public Health
University of Exeter Medical School
RD&E Hospital Wonford
Barrack Road, Exeter
MedicalResearch.com: 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.
16 Aug One-in-Five Cardiac Arrests Occur Near Inaccessible Defibrillators
MedicalResearch.com Interview with: [caption id="attachment_26934" align="alignleft" width="160"]
Dr. Timothy Chan[/caption]
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
MedicalResearch.com: 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.
12 Aug Intracoronary Antiplatelet Abciximab Bolus May Improve Outcomes of Primary PCI in STEMI patients with Diabetes
MedicalResearch.com Interview with: Raffaele Piccolo, MD Department of Cardiology Bern University Hospital University of Bern Bern, Switzerland MedicalResearch.com: 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.12 Aug New Onset Atrial Fibrillation Strongest Predictor of Stroke After TAVR
MedicalResearch.com Interview with: [caption id="attachment_21314" align="alignleft" width="120"]
Dr. Josep Rodés-Cabau[/caption]
Josep Rodés-Cabau, MD
Director, Catheterization and Interventional Laboratories
Quebec Heart and Lung Institute
Professor, Faculty of Medicine, Laval University
Quebec City, Quebec, Canada
MedicalResearch.com: What is the background for this study?
Response: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with severe aortic stenosis deemed at prohibitive or high surgical risk. Recently, a randomized trial demonstrated the non-inferiority of TAVR compared to surgical aortic valve replacement in intermediate risk patients for the outcome of death and disabling stroke at 2 years. Therefore, TAVR indications are likely to expand to younger and lower risk patients in the near future.
While the short-term (30-day) cerebrovascular event (CVE) rate post-TAVR has decreased over time, it remains the most dreadful complication of TAVR, and still occurs in 2% to 3% of patients. A few dedicated studies identified numerous predictors of CVE which mainly differ from one study to another. However, identifying the risk factors of CVE is of paramount relevance in clinical practice to implement preventive strategies, either instrumental (embolic protection devices) or pharmacological in high-risk patients. Thus, we performed a systematic review and meta-analysis using random-effect models to provide pooled estimates of sixteen (8 patient-related and 8 procedural-related) clinically-relevant predictors of CVE within 30 days post TAVR.
08 Aug Newly Diagnosed Brugada Syndrome Have a Different Prognosis
MedicalResearch.com Interview with: Ruben Casado-Arroyo, MD, PhD Heart Rhythm Management Center Cardiovascular Division, UZ Brussel–Vrije Universiteit Brussel, Cardiology Department, Arrhythmia Section Erasmus Hospital, Université Libre de Bruxelles Brussels, Belgium MedicalResearch.com: What is the background for this study? What are the main findings? Response: The objective of this study is to evaluate the evolution of the presentation of Brugada Syndrome (BrS) during the last 30 years. Only the first diagnosed patient of each family was included. The database was divided in two periods (early and latter group) in relation to the consensus conference of 2002. Aborted sudden death as the first manifestation of the disease occurred most frequently in the earlier period 12.1% versus 4.6% of the latter group. Inducibility (induction of ventricular fibrillation) during programmed electrical stimulation was achieved in 34.4% (earlier) and 19.2% (latter) of patients, respectively. A spontaneous type 1 electrocardiogram pattern that is a coved type ST elevation with at least 2 mm (0.2 mV) J-point elevation a gradually descending ST segment followed by a negative T-wave was presented at diagnosis 50.3% (earlier) versus 26.2% (latter patients). Early group patients had a higher probability of a recurrent arrhythmia (sudden cardiac death or ventricular arrhythmias) during follow-up (19%) than those of the latter group (5%). All these difference were significative. Overall, the predictors of recurrent arrhythmias were previous sudden cardiac death and inducibility. In the latter period, only previous sudden cardiac death was a predictor of arrhythmic events.27 Jul Coronary Artery Disease Testing Underutilized in Heart Failure Patients
MedicalResearch.com Interview with: [caption id="attachment_26379" align="alignleft" width="132"]
Dr. Ajay Kirtane[/caption]
Ajay J. Kirtane, MD, SM, FACC, FSCAI
Associate Professor of Medicine at Columbia University Medical Center
Chief Academic Officer, Center for Interventional Vascular Therapy
Director, NYP/Columbia Cardiac Catheterization Laboratories
New York, NY 10032
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Patients with inpatient heart failure are a higher-risk patient population who can benefit from the identification and treatment of coronary artery disease. We sought to identify how frequently these patients in fact underwent testing for coronary artery disease.
12 Jul Black Heart Failure Patients Have More Readmissions and Lower Mortality Than Whites
Posted at 11:39h
in Author Interviews, Heart Disease, Hospital Readmissions, JACC, NYU/NYMC, Race/Ethnic Diversity
MedicalResearch.com Interview with:
Matthew Durstenfeld MD
Department of Medicine
Saul Blecker, MD, MHS
Department of Population Health and Department of Medicine
New York University School of Medicine
NYU Langone Medical Center
New York, New York
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Racial and ethnic disparities continue to be a problem in cardiovascular disease outcomes. In heart failure, minority patients have more readmissions despite lower mortality after hospitalization for heart failure. Some authors have attributed these racial differences to differences in access to care, although this has never been proven.
Our study examined patients hospitalized within the municipal hospital system in New York City to see whether racial and ethnic disparities in readmissions and mortality were present among a diverse population with similar access to care. We found that black and Asian patients had lower one-year mortality than white patients; concurrently black and Hispanic patients had higher rates of readmission. These disparities persisted even after accounting for demographic and clinical differences among racial and ethnic groups.
23 Jun Patients With a Normal EKG after TAVI Rarely Require a New Pacemaker
MedicalResearch.com Interview with: Dr. Stefan Toggweiler, MD Heart Center, Luzerner Kantonsspital Lucerne, Switzerland MedicalResearch.com: What is the background for this study? Response: Transcatheter aortic valve replacement (TAVR) is increasingly used for the treatment of aortic stenosis in inoperable and high-risk patients. It is well known that TAVR is associated with acute and delayed occurrence of conduction disorders. Namely, delayed high-degree atrioventrcular block is a feared complication. Thus, patients are usually monitored by telemetry for a few days, but there is currently no consensus on the duration of telemetry. In this study, we evaluated how the postprocedural ECG determines the need for permanent pacemaker implantation in patients undergoing TAVR.22 Jun Many Atrial Fibrillation Patients At Risk of Stroke Receive Aspirin Instead of Appropriate Anticoagulation
MedicalResearch.com Interview with: [caption id="attachment_25417" align="alignleft" width="120"]
Dr. Jonathan Hsu[/caption]
Jonathan Hsu, MD, MAS, FACC, FAHA, FHRS
Assistant Professor
Cardiac Electrophysiology, Division of Cardiology
University of California, San Diego (UCSD)
MedicalResearch.com: What is the background for this study?
Response: Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and imparts significant stroke risk. In patients with AF determined to be at intermediate to high risk for thromboembolism, anticoagulation with warfarin (a vitamin K antagonist) or the newer non-vitamin K antagonist oral anticoagulants clearly reduces morbidity and mortality compared to aspirin. We sought to evaluate practice patterns of cardiovascular specialists in the United states to determine how often AF patients at risk for stroke are prescribed aspirin over oral anticoagulation, and predictors of this practice.
14 Jun Observational Study Confirms SPRINT Trials’ Link Between Lower BP Target and Fewer CV Events
MedicalResearch.com Interview with: Duk-Woo Park, MD, PhD [caption id="attachment_25174" align="alignleft" width="147"]
Dr. Duk Woo Park[/caption]
Division of Cardiology, Asan Medical Center
University of Ulsan College of Medicine and National Evidence-based Healthcare Collaborating Agency
Seoul, Republic of Korea
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Currently, less restrictive blood pressure (BP) target by the 2014 hypertension guidelines (JNC-8) and more intensive BP target of the SPRINT is now conflicting, which causes uncertainty and confusion among clinicians. In our study, the proportion of persons who would meet the SPRINT BP goals is substantially less than those who would meet the 2014 guideline blood pressure goals. There is a positive association between the risk of major cardiovascular events and increasing levels of BP control status under different 2014 guideline and SPRINT criteria. Our study reconfirmed the findings of the SPRINT trials in real-world population.
07 Jun Ventricular Arrhythmias Are Common in Patients With Advanced Cancers and ICDs
MedicalResearch.com Interview with: [caption id="attachment_24976" align="alignleft" width="200"] Dr. Andres Enriquez[/caption] Andrés Enriquez, MD Heart Rhythm Service Queen’s University and Kingston General Hospital Kingston, Ontario, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Enriquez: An increasingly frequent scenario for professionals who work with cardiac implantable devices is being called from the Oncology...
15 May More Dialysis Patients with Heart Failure Receiving Evidence-Based Care
MedicalResearch.com Interview with: [caption id="attachment_24324" align="alignleft" width="140"]
Dr. Ambay Pandey[/caption]
Ambarish Pandey, MD
Cardiology Fellow, PGY5
University of Texas Southwestern Medical Center
Dallas, Texas
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Pandey: Previous studies have reported an underutilization of guideline based heart failure therapies among patients with heart failure (HF) and end-stage renal diseases. However, it is not known if the proportional use of these evidence-based medical therapies and associated clinical outcomes among these patients has changed over time. In this study, we observed a significant increase in adherence to heart failure process of care measures over time among dialysis patients with no significant change in clinical outcomes over time.
09 May Is Atherosclerotic Risk of Cardiovascular Disease Overestimated?
MedicalResearch.com Interview with: Alan S. Go, MD, chief of Cardiovascular and Metabolic Conditions Research at the Kaiser Permanente Northern California Division of Research Jamal S. Rana, MD, PhD, cardiologist at Kaiser Permanente Oakland Medical Center and adjunct investigator with the Division of Research MedicalResearch.com: What is the background for this study? Response: In 2013, the American College of Cardiology and American Heart Association published the Pooled Cohort risk equation for estimating the likelihood of atherosclerotic cardiovascular disease events. However, the equation was developed from several groups of enrolled volunteers primarily conducted in the 1990s with limited ethnic diversity and age range, so its accuracy may vary in current community-based populations. To determine whether the risk equation might be improved by being recalibrated in “real world” clinical care, we examined a large, multi-ethnic, community-based population of Kaiser Permanente members in Northern California whose cholesterol levels and other clinical measures could theoretically trigger a discussion about whether to consider starting cholesterol-lowering therapy based on estimated risk using the ACC/AHA Pooled Cohort tool. The study followed a population of 307,591 men and women aged 40 to 75 years old, including non-Hispanic whites, non-Hispanic blacks, Asian, Pacific Islanders and Hispanics, from 2008 through 2013 and had complete five-year follow-up. The study population did not include patients with diabetes, prior atherosclerotic cardiovascular disease or prior use of lipid-lowering therapy such as statins, as the application of this risk tool is meant for primary prevention of heart disease and stroke.05 May Over Half of Post Cardiac Bypass Patients Not Taking Recommended Statins and Aspirin
MedicalResearch.com Interview with: [caption id="attachment_24093" align="alignleft" width="125"]
Dr. Kevin Curl[/caption]
Dr. Kevin Curl, MD
Sidney Kimmel Medical College
Jefferson University
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Curl: If left untreated, half of coronary bypass vein grafts will become occluded within 10 years of surgery. We reviewed the health records of over 350 patients who had a previous coronary artery bypass graft (CABG) a minimum of three years prior. Our goal was to identify the long-term trends with medication adherence in this high risk population, namely aspirin and statin medications. The American College of Cardiology and the American Heart Association recommend both statins and aspirin medications unless they are unsafe for the individual patient. The mean age of the study population was 69 years, most patients had previously undergone "triple bypass" with 3 grafts, and the mean time from surgery was 11 years. We found that only 52 percent of patients were taking both aspirin and a statin medication. In addition, patients not taking a statin had higher (22 percent) low-density lipid or “bad” cholesterol.
15 Apr Gender Differences in Stress Test and CT Angiography in Patients with Suspected CAD
Posted at 01:57h
in Author Interviews, Gender Differences, Heart Disease, JACC, Women's Heart Health
MedicalResearch.com Interview with:
Dr. Neha J. Pagidipati
Duke Clinical Research Institute
Duke University School of Medicine
Durham, North Carolina
Medical Research: What is the background for this study? What are the main findings?
Dr. Pagidipati: Women and men experience coronary artery disease differently, and a great deal of literature has shown that these differences extend to the diagnostic performance of various noninvasive testing modalities. However, little is known about the sex-specific prognostic value of computed tomographic angiography (CTA) and functional stress testing.
We used data from the recent PROMISE trial to address this question. The PROMISE trial enrolled 10,003 patients (53% women) with stable symptoms suggestive of coronary artery disease to a diagnostic strategy of CTA vs stress testing, and found no differences in outcomes overall or by sex. We found that in women, a CTA is less likely to be positive, but when it is positive, it appears to have greater predictive value for a future cardiovascular event (all cause death, myocardial infarction, or unstable angina hospitalization) than stress testing. In men, a stress test is less likely to be positive, and though stress testing trended towards being more predictive of future events, there was no statistically significant difference in the prognostic value of either test type.