MedicalResearch.com Interview with: Laura Mauri, MD,MSc Professor, Harvard Medical School Brigham and Women Hospital MedicalResearch.com: What is the background for this study? Dr. Mauri: The Dual Antiplatelet Therapy (DAPT) Study, the largest randomized controlled trial to date comparing different durations of dual antiplatelet therapy (thienopyridine plus aspirin) after coronary stenting, found that patients who were free from major ischemic or bleeding events at 1 year after coronary stenting with either drug-eluting or bare metal stents, and who were compliant with their antiplatelet therapy, experienced significant reductions in stent thrombosis and myocardial infarction (MI) but increases in moderate or severe bleeding when treated with 30 months of thienopyridine plus aspirin, as compared with 12 months.  In this analysis of the DAPT Study, we wanted to determine whether the subset of patients who had a MI before the study or at the time of the index stenting procedure had different risks or benefits with long-term dual antiplatelet therapy compared to patients with no history of MI prior to or at the time of the index stenting procedure.  We also wanted to evaluate whether the use of a clinical decision tool to identify patients expected to derive benefit vs. harm from continuing thienopyridine beyond one year after coronary stenting (the DAPT Score), would aid in the individualized prescription of dual antiplatelet therapy duration among these populations. (more…)

MedicalResearch.com Interview with: Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, FCSHP, FACC Professor of Medicine (Cardiology) and Director, EPICORE Centre Faculty of Medicine and Dentistry University of Alberta EPICORE CENTRE Research Transition Facility University of Alberta Edmonton, AB MedicalResearch.com: What is the background for this study? What are the main findings? Response: As you know, most cardiovascular disease is caused by modifiable risk factors. However, the identification and control of these risk factors continues to elude us. Pharmacists in the community are the most accessible primary healthcare providers. That is being increasingly recognized and the scope of practice for pharmacists has been changing to meet these needs. In Alberta, Canada, pharmacists have one of the broadest scopes of practice - many can independently prescribe and order laboratory tests. We sought to test the effect of a pharmacist-based prescribing and care program in patients at high risk for cardiovascular events. We enrolled 723 patients at high risk for cardiovascular events (defined as those with diabetes, vascular disease (coronary, cerebrovascular, or peripheral arterial disease), chronic kidney disease, or high Framingham risk (>20%) primary prevention. All patients were recruited by their pharmacist and had to have at least one modifiable risk factor not well controlled. Patients were randomized to receive pharmacist intervention or usual care. Intervention patients received a Medication Therapy Management review, consisting of assessment of cardiovascular risk, patient education, and management of the patients' risk factors, according to the latest Canadian guidelines. Pharmacists conducted follow-up visits monthly. Usual care patients were the control (comparison) group and received usual pharmacist and physician care. Both groups were followed for 3 months. The primary outcome measure was the difference in estimated cardiovascular risk at 3 months, as calculated using validated risk engines such as Framingham, the International Risk Score, and the UKPDS risk. We found a 21% reduction in the risk for cardiovascular events in the pharmacist care group compared to control. There was also significant reductions in blood pressure, LDL cholesterol, glycated hemoglobin in those with diabetes, and 21% fewer smokers in the pharmacist care group compared to control. (more…)

MedicalResearch.com Interview with: Cathy Handy, MD MPH  Fellow, Department of Oncology Johns Hopkins Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Handy: We explored the relationship between coronary artery calcium and age related diseases.  Coronary artery calcium refers to calcium deposits in the blood vessels of the heart.  It can be seen with a non invasive imaging test and is thought to be a biologic measure of aging.  Previous research has shown coronary artery calcium to be highly correlated with cardiovascular disease and mortality. We found that it is also associated with an increased risk of cancer, pneumonia, chronic kidney disease, chronic obstructive pulmonary disease and hip fractures. (more…)

MedicalResearch.com Interview with: Frank J. Rybicki, MD, PhD Professor, Chair and Chief, Department of Radiology The University of Ottawa, Faculty of Medicine and The Ottawa Hospital Editor-in-Chief, 3D Printing in Medicine Medical Research: What is the background for this document? Dr. Rybicki: This document represents a conglomeration of the approach to appropriateness of three large medical professional groups. The American College of Radiology Appropriateness Criteria® are evidence based guidelines to assist referring physicians to order the most appropriate imaging test for a wide range of clinical scenarios. The Appropriateness Criteria are divided by organ section, and while they include emergent imaging studies, there is not a single publication to provide imaging guidance for patients who present to the emergency room with chest pain. The American College of Cardiology Appropriate Use Criteria provides evidence based data for a very large gamut of cardiovascular conditions. These guidelines include emergent cardiovascular imaging; however the Appropriate Use Criteria are divided by modality and like the ACR have not specially addressed this important, high risk patient population. The American College of Emergency Physicians, a key stakeholder group that represents referring physicians, has developed a large number of guidelines but also has not organized this group of imaging recommendations. Thus, the background of this document was a joint effort among all three societies to update, harmonize, and publish contemporary guidelines that can be readily incorporated into clinical practice but also provide standards for a large fraction of patients who come to the emergency room with chest pain who require imaging to evaluate for a life threatening diagnosis. Medical Research: What types of chest pain conditions are covered by these guidelines? Dr. Rybicki: Based on the background as noted above, the Writing Group for this important document included cardiologists, emergency physicians, and radiologists. Since the group was charged with describing common clinical scenarios seen in contemporary practice, there are four entry points for chest pain conditions. They are as follows:

1. Suspected Non-ST Segment Elevation Acute Coronary Syndrome
2. Suspected Pulmonary Embolism
3. Suspected Acute Syndrome of the Aorta
4. Patients for Whom a Leading Diagnosis is Problematic or not Possible 

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MedicalResearch.com Interview with: Tanush Gupta, MD Chief Resident & Instructor of Medicine and Prakash Harikrishnan, MD Fellow in Cardiology New York Medical College at Westchester Medical Center Valhalla, NY   Medical Research: What is the background for this study? Response: Complete heart block (CHB) is a relatively frequent complication in patients hospitalized with ST-elevation myocardial infarction (STEMI). Patients who develop complete heart block in the setting of STEMI have a 3- to 5-fold increase in in-hospital mortality compared to those without CHB. However, most of the existing reports on CHB complicating STEMI are from the pre-thrombolytic and thrombolytic era in the 1980s and 1990s, before the widespread use of percutaneous coronary intervention (PCI) and advent of modern adjunctive medical therapies. Hence, the purpose of this investigation was to examine the association of complete heart block with in-hospital outcomes in patients hospitalized with STEMI and to examine the temporal trends in the incidence and outcomes of CHB complicating STEMI using the National Inpatient Sample (NIS) databases from 2003 to 2012. (more…)

MedicalResearch.com Interview with: Lorenzo Azzalini, MD PhD MSc Marc Jolicoeur, MD MSc MHS Montreal Heart Institute, Université de Montréal Montreal Health Innovations Coordinating Center Montréal,...