heart disease Tag
22 Aug Smoking Cessation Meds Underprescribed To Hospitalized Cardiac Patients
MedicalResearch.com Interview with: [caption id="attachment_36518" align="alignleft" width="142"]
Dr. Quinn Pack[/caption]
Dr. Quinn R Pack MD
Assistant Professor of Medicine at Tufts University School of Medicine
Baystate Northern Region Cardiology
Baystate Health
Springfield, MA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Smoking is the leading cause of preventable death and is very common among patients with heart disease. Several smoking cessation medications are available and recommended in clinical guidelines to help smokers quite. However, it was unknown how often these were used and what factors make the use of pharmacotherapy more common.
The main finding is that, across of broad range of hospitals, smoking cessation medications are infrequently used and the hospital where the patient was treated was the most important factor in determining if the patient was treated.
21 Aug Cardiovascular Events Rise With Increased Duration of Psoriasis
MedicalResearch.com Interview with: [caption id="attachment_36560" align="alignleft" width="133"]
Dr. Egeberg[/caption]
Alexander Egeberg, MD PhD
Gentofte Hospital
Department of Dermatology and Allergy
Kildegårdsvej 28
2900 Hellerup
Denmark
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The majority cardiovascular events in psoriasis occur in patients at low risk by traditional cardiovascular risk calculators. It has been speculated that long-term exposure to systemic inflammation may increase the risk of adverse cardiovascular outcomes. Therefore, clinically available historical features such as disease duration may identify those at higher risk for cardiovascular disease.
Using a translational epidemiological approach, combining 18F-fluorodeoxyglucose positron emission tomography computed tomography scanning with nationwide epidemiological data of more than four million individuals, we provide the first convincing evidence to suggest a detrimental effect of psoriasis duration on cardiovascular disease beyond traditional cardiovascular risk factors, even in patients deemed “low-risk” by conventional risk scores. We found a 1% increase in future major adverse cardiovascular event risk per additional year of disease duration. This finding has an effect size similar to smoking, a well-established cardiovascular risk factor.
16 Aug NEJM: On-Pump CABG Should Continue To Be Standard Surgical Treatment
MedicalResearch.com Interview with: [caption id="attachment_36451" align="alignleft" width="133"]
Dr. Shroyer[/caption]
A. Laurie Shroyer, Ph.D., M.S.H.A.
WOC Health Science Officer
Northport VAMC
Research and Development Office (151)
Northport, NY 11768
Professor and Vice Chair for Research, Department of Surgery
Stony Brook University, School of Medicine
Stony Brook, NY
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Since the 1990’s, two different approaches have been commonly used by cardiac surgeons to perform an adult coronary artery bypass graft (CABG) procedure, these approaches have been referred to as “on-pump” (with cardiopulmonary bypass) or “off-pump” (without cardiopulmonary bypass) procedures. The Department of Veterans Affairs (VA) Randomized On/Off Bypass Follow-up Study” (ROOBY-FS) compared the relative performance of off-pump versus on-pump approaches upon 5-year patients’ clinical outcomes including mortality and major adverse cardiovascular events.
10 Aug Children from Socially and Economically Disadvantaged Families Have Increased Cardiovascular Risks
MedicalResearch.com Interview with: Lead author, Dr Richard Liu, MCRI Ph.D. student and Senior author - Professor David Burgner PhD The Child Health CheckPoint Investigator Group Murdoch Children’s Research Institute The Royal Children’s Hospital Parkville, Victoria, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: The socioeconomic gradient in cardiovascular disease is well recognised in adults. The more disadvantaged someone is, the higher their risk of heart attack and stroke. The mechanisms by which this occurs are not well understood, but we know the pathological process underlying this, thickening of the arteries, or atherosclerosis, begins very early in life. Our current understanding of the early development of atherosclerosis has previously been limited mainly to autopsy studies. Non-invasive imaging is increasingly being used to examine the early development of atherosclerosis. We wanted to determine if there was an association between socioeconomic disadvantage and the thickness of the carotid artery wall in mid-childhood, which in adults is a proxy for atherosclerosis and indicates higher risk for heart attack and stroke in later life. We analysed both family and neighbourhood socioeconomic position data from 1477 Australian families, which included data on income, education and occupation of parents, as well as the relative socioeconomic status of the immediate neighbourhood.09 Aug Racial Gap in Survival After In-Hospital Cardiac Arrest Nearly Closed
Posted at 19:38h
in Author Interviews, Heart Disease, JAMA, Outcomes & Safety, Race/Ethnic Diversity
MedicalResearch.com Interview with:
Dr. Lee Joseph, MD, MS
Postdoctoral fellow at University of Iowa
Division of Cardiovascular Diseases
Department of Internal Medicine
University of Iowa Carver College of Medicine
Iowa City
MedicalResearch.com: What is the background for this study?
Response: In-hospital cardiac arrest (IHCA) is common and affects more than 200,000 patients every year. Although survival for in-hospital cardiac arrest has improved in recent years, marked racial differences in survival are present. A previous study showed that black patients with in-hospital cardiac arrest have 27% lower chance of surviving an in-hospital cardiac arrest due to a shockable rhythm compared to white patients. Moreover, lower survival in black patients was largely attributable to the fact that black patients were predominantly treated in lower quality hospitals compared to white patients. In other words, racial disparities in survival are closely intertwined with hospital quality, and this has been borne out in multiple other studies as well
In this study, we were interested in determining whether improvement in in-hospital cardiac arrest survival that has occurred in recent years benefited black and white patients equally or not? In other words, have racial differences in survival decreased as overall survival has improved. If so, what is the mechanism of that improvement? And finally, did hospitals that predominantly treat black patients make the greatest improvement in survival?
To address these questions, we used data from the Get With The Guidelines-Resuscitation, a large national quality improvement registry of in-hospital cardiac arrest that was established by the American Heart Association in the year 2000. Participating hospitals submit rich clinical data on patients who experience in-hospital cardiac arrest. Over the last 17 years, the registry has grown markedly and currently includes information on >200,000 patients from > 500 hospitals. The primary purpose is quality improvement. But it has also become an important resource to conduct research into the epidemiology and outcomes associated with in-hospital cardiac arrest.
Using data from the Get With the Guidelines-Resuscitation, we identified 112,139 patients at 289 hospitals between 2000-2014. Approximately 25% of the patients were of black race and the remainder were white patients. We constructed two-level hierarchical regression models to estimate yearly risk adjusted survival rates in black and white patients and examined how survival differences changed over time both on an absolute and a relative scale.
03 Aug Cardiovascular Fat in Women at Midlife Varies By Race and Body Shape
Posted at 23:39h
in Author Interviews, Heart Disease, Menopause, Race/Ethnic Diversity, University of Pittsburgh
MedicalResearch.com Interview with:
[caption id="attachment_36295" align="alignleft" width="160"]
Dr. El Khoudary[/caption]
Samar R. El Khoudary, PhD, MPH, BPharm, FAHA
Associate Professor, Epidemiology
PITT Public Health
Epidemiology Data Center
University of Pittsburgh
Pittsburgh, PA 15260
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Heart fat is associated with greater coronary heart disease risk. Postmenopausal women have greater heart fat volumes than premenopausal women, and the association between specific heart fat depots and calcification in the coronary arteries is more pronounced after menopause. Race, central adiposity, and visceral adiposity are important factors that could impact heart fat volumes.
We evaluated whether racial differences in heart fat volumes and in their associations with central (abdominal visceral fat) and general adiposity (as measured by body mass index [BMI]) exist in midlife women. Our study included 524 women from the Study of Women's Health Across the Nation (SWAN) (mean age: 51 years; 62% White and 38% Black) who had data on heart fat volumes, abdominal visceral fat and BMI.
After accounting for the potential health effects of lifestyle and socioeconomic factors we found that midlife Black women had less heart fat volumes than white women and not surprisingly, the more fat a women carries overall, the higher her risk for a fatty heart. However, white women with higher BMI had significantly more heart fat, as measured by a CT scan, than black women with the same BMI. For black women, the levels of heart fat were greater if they carried more fat in their midsection, as measured by a cross-sectional CT scan, compared with white women with the same volume of fat in their midsection. The results echo the findings we have reported previously in midlife men and published at the International Journal of Obesity (2015) 39, 488–494.
28 Jul USPSTF: Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors
Posted at 00:38h
in Author Interviews, Education, Heart Disease, JAMA, Lifestyle & Health, Primary Care, UCLA
MedicalResearch.com Interview with:
[caption id="attachment_36189" align="alignleft" width="133"]
Dr. Mangione[/caption]
Carol M. Mangione, MD, MSPH, FACP
Barbara A. Levey, MD, and Gerald S. Levey, MD
Endowed chair in medicine
David Geffen School of Medicine
University of California, Los Angeles
Professor of public health at the UCLA Fielding School of Public Health
MedicalResearch.com: What is the background for this study?
Response: Americans can experience several health benefits from consuming healthy foods and engaging in physical activity. The Task Force recommends that primary care professionals work together with their patients when making the decision to offer or refer adults who are not obese and do not have hypertension, high cholesterol, high blood sugar, or diabetes to behavior counseling to promote healthful diet and physical activity. Our focus was on the impact of a healthful diet and physical activity on cardiovascular risk because this condition is the leading cause of premature morbidity and mortality. The Task Force evaluates what the science tells us surrounding the potential benefits and harms of a particular preventive service. In this case, the Task Force found high quality evidence focusing on the impact a healthful diet and physical activity can have on a patient’s risk of cardiovascular disease. Relying on this evidence, the Task Force was able to conclude that there is a positive but small benefit of behavioral counseling to prevent cardiovascular disease.
24 Jul Duration of Dual Anti-Platelet Therapy After Cardiac Stenting Needs To Be Personalized
MedicalResearch.com Interview with: Abhishek Sharma MD and Division of Cardiovascular Medicine State University New York Downstate Medical Center Dr.Sahil Agarwal M.B.B.S., M.D. Division of Cardiology St. Luke's University Health Network Bethlehem, Pennsylvania MedicalResearch.com: What is the background for this study? Response: Prior randomized control trials (RCTs) and meta-analysis of these trials which have attempted to compare differences in outcomes between strategies of short (S) (3-6 months) and longer (L) (12-30 months) durations of dual anti-platelet therapy (DAPT) after drug eluting stents (DES) implantation have reported conflicting results. In general, the events rates in these studies were small, affecting statistical power. To overcome this limitation, we conducted an updated meta-analysis to compare the efficacy and safety of strategies of S-DAPT versus L-DAPT strategy after DES implantation by restricting inclusion to randomized studies with follow-up durations of 24 months or longer. The current meta-analysis is the first to compare outcomes between S-DAPT and L-DAPT in a meta-analysis restricted to trials with patient follow-up of 24 months or longer. We found no significant difference in the rates of mortality or of stent thrombosis with S-DAPT or L-DAPT. S-DAPT was associated with significantly lower risk of major bleeding but slightly higher risk of future myocardial infarctions.19 Jul Lifestyle-Based Tool Estimates Premature Cardiovascular Events in Young Adults
MedicalResearch.com Interview with: [caption id="attachment_35980" align="alignleft" width="120"]
Dr. Gooding[/caption]
Holly Gooding, MD, MSc
Assistant Professor of Medicine and Pediatrics
Harvard Medical School
Division of Adolescent/Young Adult Medicine
Boston Children's Hospital
Division of General Internal Medicine
Brigham and Women's Hospital
Boston, MA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Dr Stephanie Chiuve and colleagues at the Harvard TH Chan School of Public Health developed the Healthy Heart Score to predict the risk of heart disease in older adults based on lifestyle factors measured in middle age. We have known for some time that the precursor to heart disease – known as atherosclerosis – actually starts in childhood and adolescence. We calculated the Healthy Heart Score for young adults ages 18-30 years old and found it works in this age group as well.
18 Jul Does Spironolactone Work In Acute Heart Failure?
MedicalResearch.com Interview with: [caption id="attachment_35977" align="alignleft" width="137"]
Dr. Butler[/caption]
Javed Butler, MD, PhD
Chief of the Cardiology Division
Dr. Vincent Yang, Simons Chair in Internal Medicine
Stony Brook University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Persistent congestion is associated with worse outcomes in acute heart failure (AHF). Mineralocorticoid receptor antagonists at high doses may relieve congestion, overcome diuretic resistance, and mitigate the effects of adverse neurohormonal activation in AHF. We therefore studies high dose spironolactone in patients with AHF. Unfortunately all of our primary and secondary endpoints were not different between spironolactone and placebo arms.
29 Jun TAVR Linked To Improved Quality of Life Even After Two Years
MedicalResearch.com Interview with: [caption id="attachment_35663" align="alignleft" width="171"]
Dr. Baron[/caption]
Suzanne J. Baron, MD, MSc
Saint Luke’s Mid America Heart Institute
School of Medicine
University of Missouri, Kansas City
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Transcatheter Aortic Valve Replacement (TAVR) has emerged as a viable treatment option for patients with severe aortic stenosis in patients at high and intermediate surgical risk. Prior studies have demonstrated that both TAVR and surgical AVR (SAVR) results in substantial quality of life benefit in patients at high surgical risk.
Whether these results applied to an intermediate risk population was unknown and so we performed a prospective study alongside the PARTNER 2A trial to compare both short- and long-term health status outcomes in intermediate-risk patients with AS treated with either TAVR or SAVR. The analysis included 1833 patients (950 TAVR, 833 SAVR), who were evaluated at 1 month, 1 year and 2 years post procedure. By 1 month, quality of life had improved in both the TAVR and SAVR groups, although the gain was significantly greater in patients treated with TAVR via the transfemoral approach as opposed to patients treated with SAVR or with TAVR via the transthoracic approach (i.e. direct aortic access or transapical access). At 1 and 2 years, both TAVR (via either approach) and SAVR were associated with similarly large, clinically meaningful improvements from baseline in both disease-specific and generic health status scales at 2 years.
27 Jun Cardiovascular Disease Not a Top Concern For Women or Their Physicians
MedicalResearch.com Interview with: [caption id="attachment_35621" align="alignleft" width="200"]
Dr. Merz[/caption]
C. Noel Bairey Merz, MD, FACC
Director, Barbra Streisand Women's Heart Center
Director, Linda Joy Pollin Women's Heart Health Program
Director, Erika Glazer Family Foundation Women's Heart Disease Initiative
Director, Preventive Cardiac Center
Professor of Medicine
Cedars-Sinai Medical Center
MedicalResearch.com: What is the background for this study?
Response: Cardiovascular disease (CVD) is the number 1 killer of women in the U.S.A., yet few younger women personalize awareness. CVD campaigns focus little attention on physicians and their role assessing risk.
MedicalResearch.com: What are the main findings?
Response: Overall, 45% of women were unaware that CVD is the #1 killer of women, only 11% knew a woman who has died from it. Overall, 45% of women reported it is common to cancel or postpone a physician appointment until losing weight. Cardiovascular disease was a top concern for only 39% of PCPs, after weight and breast health. A minority of physicians (22% of PCPs and 42% of cardiologists) felt well prepared to assess women’s CVD risk, and infrequently use guidelines.
27 Jun Limited Benefit To Expedited Stress Testing of Chest Pain In ER Patients
MedicalResearch.com Interview with: Alexander Sandhu, MD MS Cardiology Fellow Stanford University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Millions of patients present to the emergency department with chest pain but most do not have lab or EKG findings that indicate the patient is having a heart attack. In patients without signs of a heart attack, stress testing is frequently used to determine the need for further workup and treatment. However, there is limited evidence regarding the benefit of stress testing in these patients. We evaluated how cardiac testing - stress testing and coronary angiography - in these low-risk patients was associated with clinical outcomes. We used a statistical approach that took advantage of the fact that testing is more available on weekdays than weekends. We found that testing was associated with more angiography and revascularization (coronary stenting or coronary artery bypass surgery) but was not associated with a reduction in future heart attacks.15 Jun Survival Benefit from Primary Prevention Implantable Cardioverter Defibrillators
MedicalResearch.com Interview with: [caption id="attachment_35347" align="alignleft" width="156"]
Dr. Friedman[/caption]
Daniel J. Friedman, MD
Duke University Hospital
Duke Clinical Research Institute
Durham, NC
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although primary prevention ICDs have saved countless lives among patients with heart failure and a reduced ejection fraction, the use of primary prevention ICDs in patients with more advanced heart failure [defined by New York Heart Association Class (NYHA)] is controversial.
Specifically, there are conflicting data from the pivotal primary prevention ICD trials regarding whether primary prevention ICDs reduce all-cause mortality among patients with a severely reduced ejection fraction (≤35%) and NYHA III heart failure.
We performed a patient level meta-analysis using data from 4 pivotal primary prevention ICD trials (MADIT-I, MADIT-II, SCD-HeFT, and DEFINITE) to assess whether primary prevention ICD efficacy varied by NYHA class (II vs. III). Overall, the ICD reduced all-cause mortality among the overall population of patients (NYHA II and III). We subsequently assessed ICD efficacy after stratification by NYHA class.
Among NYHA II patients, the ICD significantly reduced all-cause mortality by reducing sudden cardiac death. Although NYHA III patients randomized to an ICD experienced a significantly lower rate of sudden cardiac death, this did not translate into a reduction in all-cause mortality, due to competing causes of non-sudden death (which an ICD cannot treat). Based on relatively wide confidence intervals associated with the estimate for ICD effect in NYHA III patients, there appears to be substantial heterogeneity in outcomes among these patients. This suggests that many NYHA III patients can benefit from a primary prevention ICD, but further study is necessary to determine which NYHA III patients are poised to benefit.
14 Jun More Education Means Lowers Cardiovascular Risk, Regardless of Income
MedicalResearch.com Interview with: [caption id="attachment_35213" align="alignleft" width="133"]
Dr. Kubota[/caption]
Yasuhiko Kubota, MD, MPH
Visiting Scholar
Division of Epidemiology and Community Health
School of Public Health
University of Minnesota, Minneapolis, MN
MedicalResearch.com: What is the background for this study?
Response: Educational inequality is one of the most important socioeconomic factors contributing to cardiovascular disease. Since education is usually completed by young adulthood, educational inequality may affect risk of cardiovascular disease early in the life course. We thought it would be useful to calculate the lifetime risk of cardiovascular disease according to educational levels in order to increase public awareness of the importance of education.
Thus, our aim was to evaluate the association of educational attainment with cardiovascular disease risk by estimating the lifetime risks of cardiovascular disease using a US. biracial cohort. Furthermore, we also assessed how other important socioeconomic factors were related to the association of educational attainment with lifetime risk of cardiovascular disease.
09 Jun Income Disparities Persist In Cardiovascular Risk Factors in the US
MedicalResearch.com Interview with: [caption id="attachment_35105" align="alignleft" width="200"]
Dr. Odutayo[/caption]
Dr. Ayodele Odutayo
MD MSc DPhil(pending)
Centre For Statistics in Medicine,
University of Oxford
Resident Physician (PGY1), Post-Doctoral Fellow,
Applied Health Research Centre
St. Michael’s Hospital,
University of Toronto
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Previously published studies have reported increasing gaps in life expectancy among adults belonging to different socioeconomic strata and suggested that much of this gap was mediated through behavioural and metabolic risk factors.
In this study, we found that from 1999-2014, there was an increasing gap in the control of cardiovascular risk factors between high income adults compared to adults with incomes at or below the poverty line. The proportion of adults at high cardiovascular risk (predicted risk of a cardiovascular event ≥20%), the mean systolic blood pressure and the percentage of current smokers decreased for high income adults but did not change for adults with incomes at or below the poverty line. Notably, the income disparity in these cardiovascular risk factors was not wholly explained by access to health insurance or educational attainment. Trends in the percentage of adults with diabetes and the average total cholesterol level did not vary by income.
24 May Normalizing Testosterone With Replacement Therapy Reduced Atrial Fibrillation Risk
MedicalResearch.com Interview with: [caption id="attachment_34833" align="alignleft" width="149"]
Dr. Barua[/caption]
Rajat S. Barua, MD; PhD; FACC; FSCAI
Associate Professor of Medicine (Cardiology), University of Kansas School of Medicine
Director, Cardiovascular Research, Dept. of Cardiology, Kansas City VA Medical Center
Director, Interventional Cardiology & Cardiac Catheterization Laboratory
Kansas City VA Medical Center
MedicalResearch.com: What is the background for this study?
Response: Atrial fibrillation is the most common cardiac arrhythmia worldwide, with significant morbidity, mortality and financial burden. Atrial fibrillation is known to increase with age and is higher in men than in women. Although the underlying mechanisms of this sex difference are still unclear, one preclinical and several small clinical studies have suggested that testosterone deficiency may play a role in the development of atrial fibrillation. To date, no studies have investigated the effect of testosterone-level normalization on incidence of new atrial fibrillation in men after testosterone replacement therapy.
In this study, we investigated the incidence of atrial fibrillation in hypogonadal men with documented low testosterone levels. We compared the incidence of atrial fibrillation among patients who did not receive any testosterone replacement therapy, those who received testosterone replacement therapy that resulted in normalization of total testosterone, and those who received testosterone replacement therapy but that did not result in normal total testosterone levels.
21 May Anticoagulation With Bivalirudin vs Heparin for STEMI treated with PCI: Pros and Cons of Each
MedicalResearch.com Interview with: [caption id="attachment_34759" align="alignleft" width="150"]
Dr. Jovin[/caption]
Dr. Ion S. Jovin, MD, ScD
Associate Professor of Medicine at Virginia Commonwealth University Pauley Heart Center
Director of the Cardiac Catheterization Laboratories and
Site Director of the VCU Interventional Cardiology Fellowship Program at
McGuire V.A. Medical Center
Visiting Assistant Professor in the Department of Surgery/Cardiothoracic Surgery
Yale University, New Haven, CT
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is still uncertainty regarding the best anticoagulant for patients with acute ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) and especially PCI done via radial (as opposed to femoral) access. Our study compared outcomes of patients with STEMI treated with PCI done via radial access in the NCDR database who received one of the two main anticoagulants: bivalirudin and heparin. There is a large degree of variation in the use of the two anticoagulants in PCI and in primary PCI both within the United States but also in the world.
We did not find a statistically significant difference between the outcomes of the two groups of patients, but we also found that a significant number of patients in both the heparin and in the bivalirudin group were also treated with additional medicines that inhibit platelet activation (glycoprotein IIb/IIIa inhibitors).
21 May Elevated Cardiovascular Mortality Concentrated in US Geographic Clusters
MedicalResearch.com Interview with: [caption id="attachment_34726" align="alignleft" width="161"]
Dr. Roth[/caption]
Dr. Gregory Roth MD MPH
Division of Cardiology, Department of Medicine
Institute for Health Metrics and Evaluation
University of Washington, Seattle
MedicalResearch.com: What is the background for this study?
Response: My colleagues and I at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, evaluated and analyzed mortality rates from cardiovascular diseases (CVD) on the county level from throughout the United States. We obtained the data from: The National Center for Health Statistics and population counts from the U.S. Census Bureau, the National Center for Health Statistics, and the Human Mortality Database. This data ranged from 1980 through 2014.
10 May All NSAIDS Raise Risk of Heart Attack, Even When Taken For Short Period of Time
MedicalResearch.com Interview with: Michèle Bally, BPharm, MSc, PhD Epidemiologist, Department of Pharmacy, CHUM Researcher, Health Innovation and Evaluation Hub, CRCHUM MedicalResearch.com: What is the background for this study? Response: The objective of this study was to better understand the risk of heart attack associated with using oral prescription non-steroidal anti-inflammatory drugs or NSAIDs (ibuprofen, diclofenac, celecoxib, and naproxen) the way people usually do to treat pain and inflammation in real life circumstances. A lot of people take medication, but they do not understand that some can be more harmful than beneficial, especially with consistent use. Unfortunately, something like a heart attack can happen anywhere. You could be at work and show signs of an attack. If this does happen, hopefully you have someone who is first aid trained to at least help you deal with these symptoms, until you get to the hospital. This is why having someone who knows that they are doing is beneficial in any environment. If it wasn't for companies like Coast2Coast in Ottawa, the chances of someone who was suffering from a heart attack may not have made it to the hospital if it wasn't for the assistance of someone who was first aid trained. In clinical trials, NSAIDs were typically taken on a continuous basis in high standardized doses, as assigned by the trial protocol. However, the dosages and the treatment durations studied in trials may not represent the reality of many patients who use NSAIDs in low or varying doses, use these drugs on and off, or switch between NSAID medications. We were particularly interested in determining the onset of the risk, that is how soon does the risk of heart attack start increasing? Also, we wanted to investigate the effect of dose and duration of treatment. To do this, we studied the use of a low or high dose level of NSAIDs over certain set periods of time, including taking these medications only for 1 to 7 days.05 May After PCI, Two Anticoagulants May Be As Effective As Three
MedicalResearch.com Interview with: [caption id="attachment_34397" align="alignleft" width="138"]
Dr. Agarwal[/caption]
Nayan Agarwal MD
Intervention Cardiology Fellow,
University of Florida,
Gainesville, FL
MedicalResearch.com: What is the background for this study?
Response: Long term anticoagulation is indicated in patients with mechanical heart valves, prior thromboembolic events, atrial fibrillation etc, to prevent recurrent thrombo-embolic episodes. About 20-30% of these patients also have concomitant ischemic heart disease requiring percutaneous coronary intervention (PCI).
Post PCI, patients require treatment with dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel, ticagrelor) to prevent stent thrombosis. Thus, these patients may end up needing triple antithrombotic therapy with oral anticoagulant (OAC) and DAPT, which increases the bleeding risk.
Both American College of Cardiology(ACC) and European Society of Cardiology (ESC), currently recommend triple therapy in these patients. Recently new evidence has emerged that such patients can be managed with dual therapy of a single antiplatelet (SAPT) and OAC. Hence, we decided to do a systematic review of these studies to evaluate safety and efficacy of dual therapy of SAPT and OAC against triple therapy of DAPT and OAC.
05 May Bystander CPR Not Only Improves Survival But Reduces Brain Damage
MedicalResearch.com Interview with: [caption id="attachment_34392" align="alignleft" width="200"]
Dr. Kragholm[/caption]
Kristian Kragholm, MD, PhD
Departments of Cardiology and Epidemiology/Biostatistics,
Aalborg University Hospital,
Aalborg, DK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It is well known that early help from bystanders including cardiopulmonary resuscitation (CPR) before arrival of the emergency medical services can increase chances of 30-day survival by three to four times compared to situations where no bystander resuscitation was initiated.
The main and novel finding of our study is that bystander interventions, in addition to increasing survival, also lowers the risk of damage to the brain and nursing home admission in 30-day survivors during the first year following out-of-hospital cardiac arrest.
02 May Myocardial Injury Not Uncommon After Non-Cardiac Surgery
MedicalResearch.com Interview with: [caption id="attachment_34286" align="alignleft" width="150"]
Dr. Devereaux[/caption]
Dr. PJ Devereaux MD, PhD, FRCP(C)
Director of the Division of Cardiolog
Scientific Leader of the Anesthesiology, Perioperative Medicine and
Surgical Research Group at the Population Health Research Institute
Professor and University Scholar in the Departments of Health Research Methods, Evidence, and Impact and Medicine
McMaster University
MedicalResearch.com: What is the background for this study?
Response: Although the majority of patients undergoing noncardiac surgery benefit from surgery and do well, even when a small proportion of these patients have a serious complication it represents a major population issue. A recent publication in JAMA Cardiology established that >5 million Americans age ≥45 years undergo major in-patient noncardiac surgery annually, and 1.3% of these patients die in the hospital. This means 65,000 of these patients die, and cardiovascular causes are a dominant cause.
25 Apr Use of HEART Score in ER Can Help Evaluate Low Risk Chest Pain
MedicalResearch.com Interview with: [caption id="attachment_34167" align="alignleft" width="180"]
Dr.Poldervaart[/caption]
Judith Poldervaart MD, PhD
Assistant professor
Julius Center for Health Sciences and Primary Care
University Medical Center
Utrecht
MedicalResearch.com: 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.
20 Apr Study Evaluates Effects of Calcification of Occluded Coronary Arteries During PCI
MedicalResearch.com Interview with: [caption id="attachment_34034" align="alignleft" width="100"]
Dr, Brilakis[/caption]
Emmanouil S. Brilakis, MD, PhD
Director, Center for Advanced Coronary Interventions
Minneapolis Heart Institute
Minneapolis, Minnesota 55407
Adjunct Professor of Medicine
University of Texas Southwestern Medical School at Dallas
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Calcification in the coronary arteries might hinder lesion crossing, equipment delivery and stent expansion and contribute to higher rates of in-stent restenosis, as well as stent thrombosis. In this project we sought to examine the impact of calcific deposits on the outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a contemporary, multicenter registry.
We analyzed the outcomes of 1,476 consecutive CTO PCIs performed in 1,453 patients between 2012 and 2016 at 11 US centers. Data collection was performed in a dedicated online database (PROGRESS CTO: Prospective Global Registry for the Study of Chronic Total Occlusion Intervention, Clinicaltrials.gov Identifier: NCT02061436).
20 Apr More Work Needed To Ensure Compliance With High Intensity Statins After Heart Attack
MedicalResearch.com Interview with: [caption id="attachment_33991" align="alignleft" width="130"]
Dr. Rosenson[/caption]
Robert Rosenson, MD
Professor of Medicine and Cardiology
Icahn School of Medicine at Mount Sinai
New York
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: High intensity statin therapy is underutilized in patients with acute coronary syndromes. In 2011, 27% of patients were discharged on a high intensity statin (Rosenson RS, et al. J Am Coll Cardiol).
In this report, we investigate the factors associated with high adherence to high intensity statin. High adherence to high intensity statins was more common among patients who took high intensity statin prior to their hospitalization, had fewer comorbidities, received a low-income subsidy, attended cardiac rehabilitation and more visits with a cardiologist.
19 Apr Cardiac Magnetic Resonance Can Exclude Clinically Relevant Coronary Artery Disease
MedicalResearch.com Interview with: [caption id="attachment_34037" align="alignleft" width="132"]
Pr. Schwitter[/caption]
Pr. Juerg Schwitter MD
Médecin Chef Cardiologie
Directeur du Centre de la RM Cardiaque du CHUV
Centre Hospitalier Universitaire Vaudois - CHUV
Suisse
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Coronary artery disease (CAD) is still one of the leading causes of death in the industrialized world and as such, it is also an important cost driver in the health care systems of most countries. For the European Union, the estimated costs for CAD management were 60 billion Euros in 2009, of which approximately 20 billion Euros were attributed to direct health care costs (1). In 2015, the total costs of CAD management in the United States were estimated to be 47 billion dollars (2).
Substantial progress has been achieved regarding the treatment of CAD including drug treatment but also revascularizations procedures. There exists a large body of evidence demonstrating myocardial ischemia as one of the most important factors determining the patient’s prognosis and reduction of ischemia has been shown to improve outcome.
On the other hand, techniques to detect CAD, i.e. relevant myocardial ischemia, were insufficient in the past. Evaluation of myocardial perfusion by first-pass perfusion cardiac magnetic resonance (CMR) is now closing this gap (3) and CMR is recommended by most international guidelines for the work-up of known or suspected CAD (4,5).
Still, a major issue was not clarified until now, i.e. “how much ischemia is required to trigger revascularization procedures”. Thus, this large study was undertaken to assess at which level of ischemia burden, patients can be safely deferred from revascularization and can be managed by risk factor treatment only. Of note, this crucial question was addressed in both, patients with suspected CAD but also in patients with known (and sometimes already advanced) CAD, thereby answering this question in the setting of daily clinical practice.
18 Apr Beta-Blockers Reduce Heart Attack Size By Limiting Inflammation
MedicalResearch.com Interview with: [caption id="attachment_33993" align="alignleft" width="163"]
Dr. Ibáñez[/caption]
Borja Ibáñez MD
Spanish National Centre for Cardiovascular Research
Madrid
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Acute myocardial infarction (heart attack) is a severe condition responsible for thousands of deaths every year and with important long-term consequences for survivors. Best treatment for acute myocardial infarction is a rapid coronary reperfusion.
Upon reperfusion, all inflammatory cells and mediators accumulated in the circulation during the infarction process, enter into the myocardium and causes an extra damage to the heart. Activated neutrophils play a critical role in this damage occurring upon reperfusion. The final size of infarction is the main determinant for mortality and long-term morbidity. The possibility of limiting the extent of infarcted tissue is of paramount importance.
Betablockers have been used in patients for more than 4 decades, mainly to treat arrhythmias and high blood pressure. Recently the same group of investigators demonstrated that the very early administration (i.e. during ambulance transfer to the hospital) of the betablocker “metoprolol” was able to reduce the size of infarction in patients. The mechanism by which metoprolol was protective in patients suffering a myocardial infarction was unknown.