American Heart Association, Nov. 8-12, 2008
The American Heart Association Scientific Sessions 2008 took place Nov. 8 to 12 in New Orleans and attracted more than 27,500 attendees from around the world. The meeting featured sessions on clinical, basic and population science, and presented breaking research on the prevention, diagnosis and treatment of cardiovascular disease.
"The theme of this year's meeting was very clearly the prevention of cardiovascular disease," said program committee vice-chair Mariell Jessup, M.D., of the University of Pennsylvania, who will serve as committee chair for the next two years.
The Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trial -- which showed that statin therapy helped prevent cardiovascular events in otherwise healthy subjects with elevated levels of C-reactive protein -- was the meeting's highlight, according to Jessup: "It overshadowed everything else because it has the potential for changing who might get a statin and also might change guidelines concerning who should be measured for C-reactive protein."
Other important research included the Irbesartan in Heart Failure with Preserved Systolic Function (I-PRESERVE) study, which randomly assigned 4,128 patients to either irbesartan or usual care and found no significant group differences in the primary outcome: a composite of all-cause death, hospitalization for heart failure, heart attack, unstable angina, arrhythmia and stroke. "Although this was a negative study, it heightened the need for prevention of heart failure and understanding the basic mechanisms that cause heart failure and preserved ejection fraction," Jessup said.
"Typically, the public and physicians think of heart failure as a large, poorly contracting heart that can't pump adequate blood to the rest of the body with an ejection fraction of under 35 percent," lead author Barry M. Massie, M.D., of the University of California San Francisco, said in a statement. "But up to half of all heart failure patients have normal or preserved ejection fractions. Their hearts pump well and are not enlarged yet these patients still have the classic heart failure symptoms of fluid retention, shortness of breath and edema or swelling."
One of the most hotly debated studies presented at the meeting was the Heart Failure and a Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) trial, which was presented in two sections. One section addressed the primary outcome -- the effect of exercise on hospitalizations and mortality, and the other addressed its effect on quality of life.
"Although the primary end point was negative, the authors felt strongly that a pre-specified analysis modified by risk factors showed that exercise did decrease hospitalizations and deaths," Jessup said. "So people were arguing about that during the entire meeting. On balance, most physicians felt that it was a very positive trial. Heart failure doctors were very excited to find something that has the potential to decrease morbidity and mortality. Importantly, the second section of the study also showed that exercise significantly improved quality of life."
During the study, 2,331 patients were randomized to either 36 supervised exercise sessions or usual care. "These findings are particularly important because this is the best medicated population in a heart failure trial that I have ever seen presented or published," Ileana Pina, M.D., chair of the HF-ACTION steering committee and a professor of medicine at Case Western Reserve University in Cleveland, Ohio, said in a statement. "This is really evidence-based care. No one can say, 'Well, they weren't well-medicated so maybe the exercise was taking the place of medication.' The benefits from exercise are on top of medication and devices."
Another important study -- TIMing of Intervention in Acute Coronary Syndrome (TIMACS) -- compared the usefulness, safety and cost effectiveness of early performing angiography within 24 hours versus a delay of 36 hours or more after the onset of unstable angina or non-ST segment elevation heart attack in 3,031 patients who were treated at 100 medical centers in 17 countries.
Overall, the researchers found that early intervention did not significantly reduce the risk of the primary endpoint: death, recurrent heart attack or stroke within six months. But when they compared outcomes in the 961 high-risk patients who had a Grace Risk Score of higher than 140, they found that the primary endpoint occurred in only 14.1 percent of those who received early intervention compared to 21.6 percent of those who received later intervention.
"If you are at low risk or intermediate risk for death with acute coronary syndrome, it doesn't matter whether you have your angiogram early or late, but if you are at high risk the early intervention strategy is far better," lead author Shamir R. Mehta, M.D., of McMaster University in Hamilton, Canada, said in a statement.
"These results have great potential for changing the way hospitals organize their procedures," Jessup said. "It has a lot of implications for hospitals that are trying to decide whether to bring in the catheter lab on a Saturday night for a patient with acute coronary syndrome as opposed to bringing it in for an ST-elevation myocardial infarction."
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AHA: New Type of Stent Shows Promise
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AHA: Heart Failure Is Epidemic Among Elderly
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AHA: MP3 Headphones May Affect ICD Performance
MONDAY, Nov. 10 (HealthDay News) -- Placement of MP3-player headphones within one inch of pacemakers and implantable cardioverter defibrillators (ICDs) may cause electromagnetic inference, according to research presented at the American Heart Association's Scientific Sessions held Nov. 8 to 12 in New Orleans.