heart attack Tag

02 Oct Does Pre-Hospital Advanced Life Support Improve Survival in Out-of-Hospital Cardiac Arrest?

Posted at 15:16h in Author Interviews, Critical Care - Intensive Care - ICUs, Emergency Care, Heart Disease

MedicalResearch.com Interview with: Alexis Cournoyer MD Université de Montréal Hôpital du Sacré-Cœur de Montréal Institut de Cardiologie de Montréal, Montréal, Québec, Canada. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Out-of-hospital advanced cardiac life support (ACLS) is frequently provided to patients suffering from cardiac arrest. This was shown to improve rates of return of spontaneous circulation, but there was no good evidence that it improved any patient-oriented outcomes. Given the progress of post-resuscitation care, it was important to reassess if ACLS improved survival in out-of-hospital cardiac arrest. Also, with the advent of extracorporeal resuscitation, a promising technique that needs to be performed relatively early in the course of the resuscitation and which seems to improve patients' outcome, we wanted to evaluate if prolonged prehospital resuscitation with ACLS was effective in extracorporeal resuscitation candidates. In this study, we observed, as was noted in previous study, that prehospital advanced cardiac life support did not provide a benefit to patients regarding survival to discharge, but increased the rate of prehospital return of spontaneous circulation. It also prolonged the delay before hospital arrival of around 15 minutes. In the patients eligible for extracorporeal resuscitation, we observed the same findings.

25 Jul Trying Statins Again After Adverse Effect Linked To Lower Risk of Heart Attack

Posted at 15:28h in Annals Internal Medicine, AstraZeneca, Author Interviews, Brigham & Women's - Harvard, Heart Disease, Merck, Pharmacology

MedicalResearch.com Interview with: [caption id="attachment_36047" align="alignleft" width="120"]

Alexander Turchin, MD,MS Director of Quality in Diabetes Associate Professor, Harvard Medical School Brigham and Women's Hospital Boston, MA

Dr. Turchin[/caption] Alexander Turchin, MD,MS Director of Quality in Diabetes Associate Professor, Harvard Medical School Brigham and Women's Hospital Boston, MA MedicalResearch.com: What is the background for this study? Response: Cardiovascular disease is the # 1 cause of death in the U.S. and worldwide. Statins are some of the most effective medications available for prevention of cardiovascular events. However, many patients stop statins, frequently because of adverse reactions. In our study we aimed to assess the risk-benefit balance of trying a statin again after experiencing an adverse reaction.

14 Jun AEDs Delivered By Drones May Improve Cardiac Arrest Survival

Posted at 13:01h in Author Interviews, Heart Disease, Karolinski Institute, Technology

MedicalResearch.com Interview with: Andreas Claesson, RN, Paramedic PhD Centre for resuscitation science Karolinska institute Stockholm, Sweden. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Survival from out-of-hospital cardiac arrest is low, the technology is existing. When implementing this kind of system with a drone equipped with an AED, defibrillation may occur at an early stage and before EMS arrival mainly in rural areas.

01 May Elevated Kidney Biomarker Creatinine Predicts Worse Outcome in STEMI Heart Attack

Posted at 11:23h in Author Interviews, Cleveland Clinic, Heart Disease, Kidney Disease

MedicalResearch.com Interview with: [caption id="attachment_34251" align="alignleft" width="76"]

Dr. Khayata[/caption] Mohamed Khayata, MD Internal Medicine Resident PGY-3 Cleveland Clinic Akron General Akron, Ohio MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies showed that patients with ST-elevation myocardial infarction (STEMI) who had elevated creatinine and/or impaired creatinine clearance on presentation had higher short- and long-term mortality independent of other cardiovascular risk factors. We used the National Cardiovascular Database Registry to investigate the impact of creatinine levels at the time of presentation on the cardiovascular outcomes in patients who presented with STEMI. Our study showed that elevated creatinine levels correlated with higher incidence of atrial fibrillation, bleeding, heart failure, and cardiogenic shock during hospital stay after the percutaneous intervention.

19 Mar ST-Segment Elevation and Cardiac MRI in MI With Non-Obstructive Coronary Arteries

Posted at 14:12h in Author Interviews, Heart Disease

MedicalResearch.com Interview with: [caption id="attachment_33084" align="alignleft" width="133"]

Harmony Reynolds, MD Cardiologist and the Saul J. Farber Associate Professor of Medicine NYU Langone Medical Center

Dr. Reynolds[/caption] Harmony Reynolds, MD Cardiologist Saul J. Farber Associate Professor of Medicine NYU Langone Medical Center MedicalResearch.com: What is the background for this study? Response: Some patients with heart attack have open, rather than severely narrowed, coronary arteries when they have a heart attack. This type of heart attack, known as myocardial infarction with non-obstructive coronary arteries or MINOCA, can be caused by a number of different problems. Cardiac MRI is useful because it can help physicians to find the underlying cause of MINOCA. MINOCA patients with ST elevation on the ECG are at higher risk of death than those without ST elevation but it is not known whether ST elevation correlates with any specific underlying cause of MINOCA.

01 Mar Ischemic Postconditioning During Primary PCI for Patients With STEMI Heart Attack

Posted at 23:48h in Author Interviews, Heart Disease, JAMA

MedicalResearch.com Interview with: [caption id="attachment_32483" align="alignleft" width="200"]

Thomas Engstrøm Senior Consultant dr. sci., MD, PhD The Heart Center | Rigshospitalet | University of Copenhagen | Denmark Professor in cardiology | University of Lund | Sweden Adjunct professor in cardiology | University of Aalborg | Denmark

Dr. Engstrøm[/caption] Thomas Engstrøm MD, PhD The Heart Center | Rigshospitalet | University of Copenhagen | Denmark Professor in cardiology | University of Lund | Sweden Adjunct professor in cardiology | University of Aalborg | Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: Timely reperfusion by primary angioplasty (primary PCI) in patients with ST-elevation myocardial infarction is mandatory. However reperfusion it self can harm the myocardium - so called reperfusion injury. During a number of years ischemic postconditioning (iPOST) by repetitive interruptions of blood flow after reperfusion has been a promising technique to address reperfusion damage. The trial investigated the effect of iPOST in 1200 patients treated with primary PCI and in addition either iPOST or conventional angioplasty.

16 Dec Young Smokers Have Drastic Increase in Heart Attack Risk

Posted at 22:24h in Author Interviews, BMJ, Heart Disease, Smoking

MedicalResearch.com Interview with: [caption id="attachment_30578" align="alignleft" width="133"]

Dr. Kevin Campbell MD FACC Wake Heart and Vascular Assistant Professor of Medicine, UNC School of Medicine Cardiology and Cardiac Electrophysiology in Raleigh, Smithfield and Wilson North Carolina.

Dr. Kevin Campbell[/caption] Dr. Kevin Campbell MD FACC Wake Heart and Vascular Assistant Professor of Medicine, UNC School of Medicine Cardiology and Cardiac Electrophysiology in Raleigh, Smithfield and Wilson North Carolina MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this study, data was analyzed from nearly 1800 patients who had ST elevation MI. Findings were published in Heart. They found that younger smokers (age under the age of 50) had an 8-fold increased risk of acute STEMI , when compared to ex- and never smokers. In addition, researchers found that current smokers of all ages were 3.26 times more likely to have STEMI than ex- and never-smokers—suggesting that if you stop smoking, you can reduce your risk for heart attack.

28 Oct Is Denial Helpful or Harmful in Coping With Heart Attack?

Posted at 18:44h in Author Interviews, Heart Disease, Psychological Science

MedicalResearch.com Interview with: Xiaoyan Fang and Sophia Hoschar Institute of Epidemiology II Mental Health Research Unit Helmholtz Zentrum München German Research Center for Environmental Health Neuherberg MedicalResearch.com: What is the background for this study? What are the main findings? Response: Time to treatment is a crucial determinant of survival in patients who have suffered an acute myocardial infarction. During an acute myocardial infarction, patients often use denial as a coping mechanism which may provide positive mood regulating effects but may also prolong prehospital delay time (PHD). Indeed, some small exploratory studies, mainly performed over 10 years ago, provided a preliminary evidence that denial contributes to decreased adherence to effective cardiac treatment by disavowing of the diagnosis and by minimizing the perceived symptom burden and symptom severity. Thus, the object of Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study is to find the effect of denial on patients’ prehospital delay. Our study contributes important new findings to the role of denial in the face of an AMI in an extended data set of STEMI patients.

First, the psychological coping mechanism of denial in the face of an AMI turned out to have more beneficial than adverse effects: denial contributed to less suffering from heart-related symptoms and negative potentially traumatizing affectivity without leading the patients to maladaptive behavior (e.g. waiting for the symptoms to resolve).
In addition, from an overall perspective, denial only minimally increased the delay time, whereas in the time window of 3-24hrs, denial led to a clinical significant longer delay. Apparently denial did not function in the most favorable time window presumably because of an extreme painful symptom pattern which overcame the effect of denial on prehospital delay. In this case, denial might be an intervention point for those who are without severe symptoms.

19 Oct Both Men and Women Can Face Financial Barriers After Heart Attack

Posted at 14:46h in AHA Journals, Author Interviews, Cost of Health Care, Gender Differences, Heart Disease, Social Issues

MedicalResearch.com Interview with: Adam L. Beckman Yale College, New Haven, CT (at the time this work was completed) Erica S Spatz MD MHS Assistant Professor, Section of Cardiovascular Medicine Center for Outcomes Research and Evaluation Yale-New Haven Hospital Yale University School of Medicine MedicalResearch.com: What is the background for this study? Beckman: Despite the expansion of insurance coverage, young adults face major challenges to obtaining affordable healthcare. We suspected women may experience greater challenges than men — they often have lower income and less complete medical coverage than men, and care for multiple generations of family, and that this may in part explain why young women have worse outcomes following a heart attack as compared with similarly-aged men.

06 Apr Marijuana Use and Short-Term Outcomes in Patients Hospitalized for Acute Myocardial

Posted at 10:45h in Author Interviews, Cannabis, Heart Disease

MedicalResearch.com Interview with: [caption id="attachment_22916" align="alignleft" width="163"] Dr. Lori Walker[/caption] Lori A. Walker, PhD University of Colorado Dept. of Medicine/Cardiology, Aurora, CO 80045 MedicalResearch.com: What is the background for this study? Dr. Walker: Marijuana use is increasing worldwide, in part due to local changes in legal status. Concomitantly, there has been an increase in case studies reporting...

16 Feb Heart Attack Patients With Shock Particularly Vulnerable First 60 Days After Discharge

Posted at 01:17h in Author Interviews, Heart Disease, Hospital Readmissions

MedicalResearch.com Interview with: [caption id="attachment_21637" align="alignleft" width="142"]

Dr. Rashmee Shah[/caption] Rashmee U. Shah, MD MS Cardiovascular Medicine University of Utah School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Shah: The purpose of this study was to evaluate long term outcomes of acute myocardial infarction (AMI) survivors who have cardiogenic shock. We used the ACTION Registry-GWTG (from the NCDR), which is the largest database of AMI, or heart attack, patients in the United States. Some heart attack patients develop cardiogenic shock which is a condition in which the heart muscle becomes so weak that it cannot effectively pump blood to the rest of the body. These patients are critically ill, but with advances in our treatment for heart attacks, many will survive to hospital discharge. We wanted to know, after all the intense treatment and sometimes long hospitalization, how do these patients fare when they leave the hospital? From a total of 112,668 heart attack patients who survived hospitalization, we identified 5,555 who had cardiogenic shock. Over half of all patients were either hospitalized or died within one year of discharge, and this poor outcome was more common among patients who had cardiogenic shock. In fact, the risk of death or hospitalization seems to be clustered in the early post-discharge time period, within 60 days, for patients with cardiogenic shock. After 60 days, shock and non-shock patients experience similar risk. In other words, we found that heart attack patients who had cardiogenic shock are particularly vulnerable during the first 60 days after hospital discharge.

23 Nov Women Have Persistent Cardiovascular Risk After MI or Stroke

Posted at 20:38h in Author Interviews, Gender Differences, Heart Disease, JAMA, Stroke

MedicalResearch.com Interview with: Bob Siegerink PhD Frits R. Rosendaal MD, PhD Department of Clinical Epidemiology Leiden University Medical Center Leiden, the Netherlands Medical Research: What is the background for this study? What are the main findings? Response: The rates of death due to arterial thrombosis have been declining in the past years, which means that there are more patients with a high burden of disease. Arterial thrombosis is a uncommon disease in the young, but the burden of the disease might have a profound impact on their lives. We analyzed data form the RATIO study, in which we followed women with a ischemic stroke and myocardial infarction for up to 20 years. During this time, overall mortality was 2-4 times higher compared to the general population. This increase in risk was mainly driven by deaths from acute vascular events and persisted over the whole course of the follow up.

15 Apr Divorce Raises Risk of Heart Attack, Especially For Women

Posted at 19:25h in Author Interviews, Duke, Heart Disease, JACC, Women's Heart Health

MedicalResearch.com Interview with: Matthew E. Dupre, PhD Associate Professor of Medicine Department of Community and Family Medicine Department of Sociology Duke Clinical Research Institute MedicalResearch: What is the background for this study? What are the main findings? Dr. Dupre: The negative health consequences of divorce have been known for some time. However, we showed that lifetime exposure to divorce can have a lasting impact on ones’ cardiovascular health, particularly in women. This is a good example of why people going through a divorce need a good divorce lawyer chicago in order to keep their stress levels down and help their cardiovascular health. Results from our study showed that risks for acute myocardial infarction (AMI) were significantly higher in women who had one divorce, two or more divorces, and among the remarried compared with continuously married women after adjusting for multiple risk factors. Risks for AMI were elevated only in men with a history of two or more divorces relative to continuously married men. We were especially surprised to find that women who remarried had risks for AMI that were nearly equivalent to that of divorced women. Men who remarried had no significant risk for acute myocardial infarction. The results of this study provide strong evidence that cumulative exposure to divorce increases the risk of acute myocardial infarction in older adults. Also somewhat unexpected was that the associations remained largely unchanged after accounting for a variety socioeconomic, psychosocial, behavioral, and physiological factors. However, we lacked information on several factors that we suspect may have contributed to the risks related to divorce – such as elevated stress, anxiety, and the loss of social support; as well as possible changes is medication adherence or other prophylactic behaviors. MedicalResearch: What should clinicians and patients take away from your report?

30 Mar Heart Attack Carries Worse Prognosis In Dialysis Patients

Posted at 18:45h in Author Interviews, Heart Disease, Kidney Disease

[caption id="attachment_13101" align="alignleft" width="125"]

Hemodialysis[/caption] MedicalResearch.com Interview with: Tanush Gupta, MD Department of Medicine, Division of Cardiology New York Medical College, NY Medical Research: What is the background for this study? What are the main findings? Dr. Gupta: There are approximately 600,000 prevalent cases of end stage renal disease (ESRD) in the United States. Cardiovascular disease is the leading cause of death in ESRD patients. Moreover, approximately 20% of these deaths due to cardiovascular disease are attributable to acute myocardial infarction (AMI). Multiple studies have shown that ESRD patients have poor short- and long-term survival after AMI relative to the general population. We analyzed the publicly available Nationwide Inpatient Sample (NIS) databases from 2003 to 2011 to examine the temporal trends in ST-elevation myocardial infarction (STEMI), use of mechanical revascularization for STEMI, and in-hospital outcomes in adult ESRD patients in the United States. We found that from 2003 to 2011, whereas the number of acute myocardial infarction hospitalizations in ESRD patients increased from 13,322 to 20,552, there was a decline in the number of STEMI hospitalizations from 3,169 to 2,558. The use of percutaneous coronary intervention (PCI) for STEMI increased from 18.6% to 37.8%, whereas there was no significant change in the use of coronary artery bypass grafting. During the study period, in-hospital mortality in ESRD patients with STEMI increased from 22.3% to 25.3%. We also observed an increase in average hospital charges and a decrease in mean length of stay during the study period.

15 Mar Tai Chi Based Cardiac Rehabilitation Improved Functional Capacity After Heart Attack

Posted at 19:11h in Author Interviews, Heart Disease

MedicalResearch.com Interview with: Ricardo Stein, MD, ScD Exercise Cardiology Research Group, Cardiology Division Federal University of Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil MedicalResearch: What is the background for this study? Dr. Stein: Patients with a recent myocardial infarction (MI) present a reduction in functional capacity expressed as a decrease in peak oxygen consumption (VO₂ peak). The impact of a Tai Chi Chuan (TCC) cardiac rehabilitation program for patients recovering from recent MI has yet to be assessed. Our goal was to evaluate functional capacity after a TCC-based cardiac rehabilitation program in patients with recent non complicated MI. MedicalResearch: What are the main findings? Dr. Stein: After the 12-week study period, participants in the Tai Chi Chuan group experienced a significant 14% increase in VO₂peak from baseline (21.6 ± 5.2 to 24.6 ± 5.2 mL.Kg^-1.min^-1), whereas control participants had a non-significant 5% decline in VO₂peak (20.4 ± 5.1 to 19.4 ± 4.4 mL.Kg^-1.min^-1). There was a significant difference between the two groups (P<0.0001). As a primary outcome, CPET results for the TCC and control groups at baseline and after the 12-week intervention period leading to a significant difference in peak VO₂ (5.2 mL.Kg^-1.min^-1; 95% CI, 2.8 to 7.7, in favor to TCC group). This difference remained significant after adjustment to baseline measurements, age, gender, diabetes, and smoking (4.1 mL.Kg^-1.min^-1; 95% CI, 2.6 to 5.6, in favor to TCC group). Summarizing: - We observed a significant increase in VO₂ peak in TCC group participants. - Our results provide important information data from a randomized clinical trial of Tai Chi Chuan in patients with a history of recent MI. - Tai Chi Chuan can be an attractive alternative to cardiac rehabilitation for patients who don't have access to conventional cardiac rehabilitation programs.

11 Mar ‘Leadership Saves Lives’ Program Aims To Reduce Heart Attack Mortality

Posted at 15:09h in Author Interviews, Heart Disease, Mayo Clinic, Outcomes & Safety

MedicalResearch.com Interview with: Leslie Curry PhD, MPH Senior Research Scientist in and Lecturer in Public Health (Health Policy) Co-Director, Robert Wood Johnson Clinical Scholars Program Yale School of Public Health Medical Research: What is the background for this study? What are the main findings? Dr. Curry: Quality of care for patients with acute myocardial infarction (AMI) has improved substantially in recent years due to important investments by clinicians and policymakers; however, survival rates across U.S. Hospitals still differ greatly. Evidence suggests links between hospital organizational culture and hospital performance in care of patients with AMI. Yet few studies have attempted to shift organizational culture in order to improve performance, fewer have focused on patient outcomes, and none have addressed mortality for patients with acute myocardial infarction. We sought to address this gap through a novel longitudinal intervention study, Leadership Saves Lives (LSL). We have a large team of people with backgrounds in nursing, medicine, health care administration and research working in 10 very diverse hospitals across the country in 10 states. All hospitals are members of the Mayo Clinic Care Network and are fully committed to saving lives of patients with heart attacks. Teams of 10-12 clinicians and administrators are devoting substantial energy, expertise and good will to this project.

27 Feb NSAIDS After Heart Attack Increase Risk of Bleeding and Further Heart Attacks

Posted at 17:45h in Author Interviews, Heart Disease, JAMA, Pain Research

MedicalResearch.com Interview with: Anne-Marie Schjerning Olsen, MD, PhD Department of Cardiology Gentofte Hospital, University of Copenhagen Denmark MedicalResearch.com: What is the background for this study? Dr. Olsen: The question addressed in the study was: Do people who have had a myocardial infarction (heart attack) and are who taking drugs (known as antithrombotics) to reduce their risk...

10 Feb Two Frequent Genetic Variants Lower Risk for Heart Attack

Posted at 22:44h in AHA Journals, Author Interviews, Genetic Research, Heart Disease

MedicalResearch.com Interview with: Wolfgang Sadee, Dr.rer.nat. Felts Mercer Professor of Medicine and Chair, Pharmacology Director and Elizabeth S Barrie, PhD Center for Pharmacogenomics The Ohio State University Columbus OH MedicalResearch: What is the background for this study? What are the main findings? Dr. Sadee and Dr. Barrie: We have determined that two frequent genetic variants can interact in a way that lowers the carrier’s risk for a heart attack. These genetic variants are single nucleotide polymorphisms (SNPs) - single base changes in the DNA sequence - of the dopamine-beta hydroxylase gene (DBH), which converts dopamine to norepinephrine. Both act as hormones in the periphery and as neurotransmitters vital to the brain's activity central nervous system. Numerous studies had tested genetic variants in DBH for effects on brain functions. In contrast to expectations, however, our work demonstrates that our two genetic variants lower DBH activity primarily in the periphery, in tissues with sympathetic innervation mediated by norepinephrine, such as the heart, lung, and liver. As a result, we searched for genetic influence on risk of various diseases of the cardiovascular system and the lung, metabolic disorders, and more. Each of the two DBH variants alone was associated with a number of disease states; however, when considering both variants in combination, a strong protective effect on the risk for heart attacks was discovered in several clinical trials. Such combined effects arising from interactions between two genetic variants may be more common than currently realized, possibly providing a path towards effective biomarker panels for personalized medicine.

20 Jan High-Intensity Statin Therapy Underutilized After Heart Attack

Posted at 00:19h in Author Interviews, Heart Disease, JACC, Statins

MedicalResearch.com Interview with: Dr. Robert S. Rosenson, MD Professor, Cardiology Icahn School of Medicine at Mount Sinai Cardiovascular Institute New York, New York 10029 Medical Research: What is the background for this study? What are the main findings? Dr. Rosenson: High intensity statin therapy is evidence-based and guideline directed for patients with acute coronary syndromes. In a 5 percent random sample of Medicare patients, we investigated the utilization of high vs low-moderate dosage statin in older adjusts who were admitted with an acute myocardial infarction of severe myocardial ischemia requiring hospitalization for a revascularization procedure (PCI or CABG). We report that only 27 percent of hospitalized patients received high-intensity statin therapy based on their first outpatient fill for a statin medication. The most important determinant for the utilization of statin therapy is the dosage of the statin previously prescribed as an outpatient. When patients were started on a high-intensity statin, the continued use diminished in the ensuing year

14 Dec Heart Attack: Off-Hours Stent Surgery Has Same Outcomes

Posted at 12:54h in Author Interviews, Heart Disease, Mayo Clinic, Outcomes & Safety

MedicalResearch.com Interview with: Atsushi Sorita, MD, MPH Mayo Clinic, Division of Preventive Medicine Rochester, MN 55905. Medical Research: What is the background for this study? What are the main findings? Dr. Sorita: Prior studies have suggested that patients with heart attack who are admitted during off-hours (weekends, nights and holidays) have higher risk of death when compared with patients admitted during regular hours. In our study, we found that patients undergoing percutaneous coronary interventions for heart attack who were admitted during off-hours did not have higher mortality or readmission rates as compared with ones admitted during regular hours at a highly-integrated academic center in the United States.

09 Dec Distance To Hospital Prevents Timely PCI and Lytic Therapy For Many Patients

Posted at 14:10h in Author Interviews, Heart Disease, JAMA, Johns Hopkins, Outcomes & Safety

MedicalResearch.com Interview with: Dr. Amit Navin Vora MD, MPH Third Year Cardiovascular Fellow John Hopkins University Medical Research: What is the background for this study? What are the main findings? Response: Current guidelines recommend timely reperfusion in patients presenting with ST-elevation myocardial infarction, with primary PCI being the preferred method if delivered in an expedient fashion. Otherwise, guidelines recommend that eligible patients should be treated with fibrinolysis prior to transfer to a PCI capable hospital. In our study, we used Google Maps to estimate drive times between the initial presenting hospital and the PCI-capable hospital looked at the association between estimated drive time and reperfusion strategy (primary PCI or fibrinolysis) selection. We found that less than half of eligible patients with an estimated drive time of more than 30 minutes received primary PCI in time, and only half of patients with more than an hour’s drive received lytics before transfer. This suggests that neither primary PCI nor pre-transfer fibrinolytic therapy is being used optimally. Among eligible patients with a drive time of 30-120 minutes, we found no significant mortality difference but higher bleeding risk among patients receiving lytics prior to transfer; this increased bleeding risk was focused in patients that required rescue PCI.

03 Nov HbA1c Predicts LV Dysfunction in STEMI Heart Attack

Posted at 23:32h in Author Interviews, Diabetes, General Medicine, Heart Disease

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.

01 Sep Heart Attack: Antiplatelet Use in Ambulance May Decrease Stent Thrombosis

Posted at 12:05h in Author Interviews, Heart Disease, NEJM

MedicalResearch.com Interview with: Gilles Montalescot M.D., Ph.D. Professor of Cardiology University of Paris VI; Director, Cardiac Care Unit Institute of Cardiology, Pitié-Salpêtrière University Hospital Paris, France Medical Research: What are the main findings of the study? Dr. Montalescot : Among the 1862 patients with ongoing STEMI who were enrolled in the ATLANTIC study, we found no difference between those randomized to pre-hospital (in-ambulance) ticagrelor 180 mg and those randomized to in-hospital (in-catheterization laboratory) ticagrelor 180 mg in terms of either pre-PCI ST-segment elevation resolution (≥70%) or pre-PCI TIMI 3 flow in the culprit artery, which were the co-primary endpoints. There was also no difference between the groups in terms of major adverse cardiovascular events at 30 days, with the exception that rates of definite stent thrombosis were lower in the pre-hospital ticagrelor group than in the in-hospital group, both in the first 24 hours (0% versus 0.8%, p= 0.008) and at 30 days (0.2% versus 1.2%, p = 0.02). The safety of pre-hospital ticagrelor did not appear to be an issue, since the incidence of non-CABG-related major bleeding was low and similar in both treatment groups, whichever bleeding definition was used (PLATO, TIMI, STEEPLE, GUSTO, ISTH or BARC).

26 Aug Patients Often Misinformed About Benefits of PCI for Heart Attack Prevention

Posted at 00:39h in Author Interviews, Heart Disease, JAMA

MedicalResearch Interview with: Michael B. Rothberg, MD, MPH Department of Internal Medicine Medicine Institute, Vice Chair for Research Cleveland Clinic, Cleveland, Ohio Medical Research: What are the main findings of the study? Dr. Rothberg: In this randomized study we found that when people are presented with no information about the benefits of elective PCI, most assumed that it would prevent a heart attack. Unfortunately, this is incorrect, so people may choose to have the procedure based on false information. We also found that simply telling them that PCI would not prevent a heart attack successfully dispelled this belief for most, but not all, participants. Explaining why PCI does not prevent heart attacks in this circumstance was the most effective way to change people's beliefs. We also found that most people were willing to take medications, but when they were told that PCI does not prevent heart attacks, they were more likely to agree to medication.

18 Aug Silent Heart Attack Common In Asymptomatic Resistant Hypertension

Posted at 20:19h in Author Interviews, Blood Pressure - Hypertension

MedicalResearch.com Interview with: Dr. Rodrigo Modolo Department of Pharmacology Faculty of Medical Sciences University of Campinas–UNICAMP Campinas, SP, Brazil; Medical Research: What are the main findings of the study? Dr. Modolo: The main findings of this study are the encounter of a high prevalence of silent myocardial ischemia (assessed by myocardial perfusion scintigraphy) in resistant hypertension and the identification of predictors of this alteration in this population.

13 Aug After Heart Attack: High Dose Aspirin Still Commonly Prescribed

Posted at 20:01h in AHA Journals, Author Interviews, Heart Disease, UT Southwestern

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.

10 Aug Heart Attack Outcomes Vary By Ethnicity, Gender and Age

Posted at 05:18h in Author Interviews, Heart Disease, JAMA, Race/Ethnic Diversity

MedicalResearch.com Interview with: Sahil Khera, MD and Dhaval Kolte, MD, PhD Department of Medicine, Division of Cardiology New York Medical College, NY Medical Research: What are the main findings of the study? Answer: We used the publicly available Nationwide Inpatient Sample (NIS) databases for our study. We analyzed data on 6.5 million patients with heart attack (all types) from 2002 to 2011 in United States. Out of these 3.98 million were admitted with a diagnosis of non-ST elevation myocardial infarction (NSTEMI). Our objective was to describe how the care for patients with NSTEMI has changed over the past 10 years and whether this has resulted in better patient outcomes. We looked at the proportion of patients with NSTEMI who underwent cardiac catheterization each year. We also studied how many patients died in the hospital, how long was the hospital stay, and what was the total cost of hospitalization for this condition. Lastly, we determined if the changes in treatment and outcomes over the years were similar for different age- groups, men and women, and for different racial/ethnic groups. In this analysis, we looked at cardiac catheterization trends after NSTEMI for both within 24 hours and within 48 hours. This is the first study of its kind to analyze two different time frames of early catheterization simultaneously. Although there was an increase in the proportion of patients with NSTEMI with increase in utilization of early cardiac catheterization and decrease in in-hospital death and length of stay, age-, sex-, and race/ethnicity-specific differences in the management and outcomes of NSTEMI were observed, and further studies are needed to develop strategies to ensure more equitable care for patients with this type of heart attack.

28 Jul Quitting Snuff/Chew/Dip After Heart Attack May Half Risk of Dying

Posted at 11:19h in AHA Journals, Author Interviews, Heart Disease, Tobacco Research

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

Posted at 13:12h in AHA Journals, Author Interviews, Gender Differences, Heart Disease, JACC, Yale

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.

03 Jul Is Testosterone Protective Against Heart Attack in Older Men?

Posted at 01:14h in Author Interviews, Heart Disease, Pharmacology, Testosterone

MedicalResearch.com Interview with: Jacques Baillargeon, PhD Director, Epidemiology Division Associate Professor Department of Preventive Medicine and Community Health University of Texas Medical Branch MedicalResearch: What are the main findings of the study? Dr. Baillargeon: The main findings of the study were that older men who were treated with testosterone did not appear to have an increased risk of Myocardial Infarction. For men with high MI risk, testosterone use appeared to be modestly protective against MI.