Author Interviews, Heart Disease, Women's Heart Health / 29.08.2019 Interview with: Amy Ferry Cardiology Research Nurse Centre for Cardiovascular Science The University of Edinburgh What is the background for this study? Response: The fourth universal definition of myocardial infarction now recommends the use of sex-specific diagnostic criteria. This approach has revealed a population of patients with myocardial infarction (predominantly women) who were previously unrecognised. The impact of these diagnostic criteria on the presentation and clinical features of men and women with suspected acute coronary syndrome is unknown.  (more…)
Author Interviews, CT Scanning, Heart Disease, NEJM / 25.08.2018 Interview with: Prof David Newby FRSE FMedSci Personal Chair - BHF John Wheatley Chair of Cardiology University of Edinburgh What is the background for this study? What are the main findings? Response: There are many tests that can try and determine whether a patient has heart disease. All are imperfect and do not directly see if the heart arteries are diseased. This study used a CT heart scan to see if there was any heart disease in patients who presented to the outpatient clinic with chest pains that could be due to coronary heart disease. The doctor use the scan result to decide whether they had heart disease and how to manage the patient. The study has found that if you use a CT heart scan then you are less likely to have a heart attack in the future. In the first year, you may require treatment with an angiogram and heart surgery (stent or heart bypass) but after the first year, you are less likely to need these treatments because the disease has already been treated promptly. (more…)
Author Interviews, Emergency Care, Heart Disease, JACC, Medical Imaging / 21.06.2018 Interview with: Jeffrey M. Levsky, M.D., Ph.D. Associate Professor, Department of Radiology Associate Professor, Department of Medicine (Cardiology) Albert Einstein College of Medicine Montefiore Medical Center What is the background for this study? What are the main findings? Response: Millions of Americans are evaluated each year for acute chest pain in the Emergency Department.  There are multiple modalities that can be used to triage these patients and there have only been a few studies comparing different imaging methods. We chose to study Stress Echocardiography and Coronary CT Angiography, two exams that have not been compared directly in this population.  We found that Stress Echocardiography was able to discharge a higher proportion of patients in a shorter amount of time as compared to Coronary CTA.  (more…)
Author Interviews, Cost of Health Care, Emergency Care, Heart Disease, JAMA / 16.11.2017 Interview with: David L. Brown, MD, FACC Professor of Medicine Cardiovascular Division Washington University School of Medicine St. Louis, MO 63110 What is the background for this study? What are the main findings? Response: Approximately 10 million patients present to emergency rooms in the US annually for evaluation of acute chest pain. The goal of that evaluation is to rule out the diagnosis of an acute heart attack. Imaging with coronary CT angiography and stress testing are not part of the diagnostic algorithm for acute heart attack.  Nevertheless many chest pain patients undergo some form of noninvasive cardiac testing in the ER. We found that CCTA or stress testing adding nothing to the care of chest pain patients beyond what is achieved by a history, physical examination, ECG and troponin test. (more…)
Author Interviews, Biomarkers, Heart Disease, JAMA / 14.11.2017 Interview with: Dr Andrew R. Chapman BHF Clinical Research Fellow University of Edinburgh Chancellors Building Edinburgh What is the background for this study? What are the main findings? Response: High-sensitivity cardiac troponin tests allow accurate measurement of cardiac troponin in the bloodstream. Currently, guidelines recommend we evaluate patients with suspected myocardial infarction using these tests, by looking for levels which are above the upper reference limit (99th centile). These troponin measurements are taken on arrival, and often repeated after admission to hospital up to six hours later. When levels are below this limit, the diagnosis of myocardial infarction is ruled out. However, using such a high limit in patients on arrival to hospital may not be safe, as lower risk stratification thresholds has been shown to reduce missed events,  and in these patients admission to hospital for repeat testing may not be necessary. However, there is no consensus as to the optimal threshold for use in practice. In a worldwide study of 23,000 patients from 9 countries, we have shown when high-sensitivity cardiac troponin I concentrations are below a risk stratification threshold of 5 ng/L at presentation, patients are at extremely low risk of myocardial infarction or cardiac death at 30 days, with fewer than 1 in 200 patients missed. Importantly, this threshold identifies almost 50% of all patients as low risk after a single blood test. As admission or observation of these patients is estimated to cost as much as $11 billion per year in the United States, this strategy has major potential to improve the efficiency of our practice. (more…)
Annals Internal Medicine, Author Interviews, Emergency Care, Heart Disease / 25.04.2017 Interview with: Judith Poldervaart MD, PhD Assistant professor Julius Center for Health Sciences and Primary Care University Medical Center Utrecht What is the background for this study? What are the main findings? Response: Since its development in 2008, interest in the HEART score is increasing and several research groups around the world have been publishing on the HEART score. After validation of any risk score for cardiac events, there is a concern about the safety when used in daily practice. We were able to show the HEART score is just as safe as the usual care currently used at EDs, which has not been shown yet in previous research. That we did not find a decrease in costs, is probably due to the hesitance of physicians to discharge low-risk patients from the ED without further testing. But extrapolation of the findings of a cost-effectiveness analysis (including nonadherence) suggests that HEART care could lead to annual savings of €40 million in the Netherlands. Hopefully, in time (and more publications of the HEART score now appearing almost weekly from all over the world) this effect on use of health care resources will become more apparent. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JAMA / 17.02.2017 Interview with: James E. Udelson, MD Chief, Division of Cardiology Director, Nuclear Cardiology Laboratory Professor, Tufts University School of Medicine What is the background for this study? What are the main findings? Response: There are millions of stress tests done every year in the United States and many of them are normal,” said James Udelson, MD, Chief of the Division of Cardiology at Tufts Medical Center and the senior investigator on the study. “We thought that if we could predict the outcome of these tests by using information we already had from the patient before the test, we could potentially save the health care system money and save our patients time and worry.”   We were able to get a strong prediction of the possibility of having entirely normal testing and no clinical events such as a heart attack, by developing a risk prediction tool using ten clinical variables that are commonly available to a physician during an evaluation” (more…)
Author Interviews, Heart Disease / 10.01.2017 Interview with: Dr. Mohammed Qintar, MD Cardiovascular Fellow St Luke’s Health System Kansas City What is the background for this study? What are the main findings? Response: One in four patients experience recurrent chest pain after acute myocardial infarction, but not all patients present with cardiac chest pain secondary to coronary ischemia. The frequency of non-cardiac chest pain re-hospitalitzation after acute myocardial infarction and its impact on patients’ health status has not been described after acute myocardial infarction (AMI). Both providers evaluating these patients and patients who have recently suffered an AMI are understandably concerned about any recurrent chest pain symptoms, and often present for urgent evaluation of these symptoms. In the first year after acute myocardial infarction, we found that a third of patients hospitalized for evaluation of chest pain actually presented with non-cardiac chest pain. Compared with patients not hospitalized with chest pain, non-cardiac chest pain hospitalization was associated with worse angina-related quality of life and general mental and physical health status. The quality of life for patients hospitalized with non-cardiac chest pain was similar to patients hospitalized with cardiac chest pain, suggesting a significant impact on their quality of life even though their pain did not reflect underlying coronary ischemia. (more…)
Author Interviews, BMJ, Emergency Care, Heart Disease / 03.05.2014

Dr. Richard Body Emergency Department Manchester Royal Infirmary Manchester Interview with:  Dr. Richard Body Emergency Department Manchester Royal Infirmary Manchester UK What are the main findings of the study? Dr. Body: This paper actually reports the findings of two consecutive, separate studies.  We aimed to derive and then externally validate a clinical decision rule to risk stratify patients with suspected acute coronary syndromes in the Emergency Department (ED).  This rule could then be used to reduce unnecessary hospital admissions while also making judicious use of specialist high dependency resources. In the first study we derived a clinical decision rule that incorporates 8 variables: high sensitivity troponin T, heart-type fatty acid binding protein; ECG ischaemia; worsening angina; hypotension (systolic blood pressure <100mmHg on arrival); sweating observed in the ED; pain associated with vomiting; and pain radiating to the right arm or shoulder.  When we validated the rule at a different centre, we found that its use could have avoided hospital admission for over a quarter of patients while effectively risk stratifying others.  Of the 10% of patients who were identified as 'high risk', approximately 95% had a major adverse cardiac event within 30 days.  The findings suggest that the Manchester Acute Coronary Syndromes (MACS) decision rule could be used to 'rule in' and 'rule out' acute coronary syndromes immediately, using information gathered at the time of initial presentation to the ED.  Before clinical implementation, we recommend that effect of using the MACS rule in practice should first be evaluated in a trial setting.  This will enable us to determine: (a) whether physicians and patients are likely to comply with (and be satisfied with) the MACS rule; (b) the safety of the MACS rule when used in practice; and (c) whether use of the MACS rule leads to cost savings for the health service. (more…)
Author Interviews, Heart Disease, Pediatrics / 11.09.2013

David R. Fulton, M.D. Associate Cardiologist-in-Chief for Administration Tommy Kaplan Chair in Cardiovascular Studies Chief, Cardiology Outpatient Services Department of Cardiology Children's Hospital Boston Boston, MA 02115David R. Fulton, M.D. Associate Cardiologist-in-Chief for Administration Tommy Kaplan Chair in Cardiovascular Studies Chief, Cardiology Outpatient Services Department of Cardiology Children's Hospital Boston Boston, MA 02115   What are the main findings of this study? Dr. Fulton: The main findings of this study demonstrated that using a quality improvement methodology (SCAMPs), a diverse population of children and adolescents with chest pain could be managed  with relative uniformity and cost effectiveness in a multi-center collaborative.  Only 2 patients of the 1016 children who formed the basis for this review were shown to have a cardiac etiology.   The clinicians were able to screen and reach a diagnostic conclusion in a  large segment of this population using history, physical examination and ECG. (more…)