American Heart Association's Scientific Sessions
About 25,682 professionals attended the American Heart Association's Scientific Sessions, which took place Nov. 11-15 in Chicago. At the meeting, the American Heart Association, the American College of Cardiology and a national alliance of partners launched a major initiative to reduce door-to-balloon times for patients with ST-elevation myocardial infarction.
The "D2B Alliance" has already garnered support from the National Heart, Lung and Blood Institute, payors and more than 200 hospitals, said Harlan Krumholz, M.D., of Yale University and chair of the D2B Working Group. "The guidelines recommend that if you're going to take someone for emergency angioplasty, you should be able to do it in 90 minutes or less," said Krumholz. "Right now only about a third of the hospitals are even able to treat half of their patients in 90 minutes or less."
A study led by Elizabeth Bradley, Ph.D., and co-authored by Krumholz and others found that there are many simple strategies that can shave minutes off the door-to-balloon time. The findings were released early by the New England Journal of Medicine to coincide with the meeting (Abstract) For example, if emergency room doctors activate the catheterization lab staff, which occurs in less than 30 percent of hospitals, it can save 8.2 minutes.
"We're launching today a campaign to get all hospitals that are providing emergency angioplasty on board and participating with us to adopt these strategies," said Krumholz. The D2B program is providing hospitals with a toolkit to help implement changes.
"Thirty-five percent of patients in America have that artery open in 90 minutes or less; our goal is 75 percent," said Steven Nissen, M.D., president of the American College of Cardiology.
Among other important findings presented at the meeting is the OAT (Occluded Artery Trial) study (Abstract), said Raymond Gibbons, M.D., president of the AHA. The study, led by Judith Hochman, M.D., of New York University, suggests that late angioplasty (three to 28 days post-myocardial infarction) in stable patients with occluded arteries offers no benefit over medication alone.
"The OAT study shows that something that's being done on a widespread basis in the United States has no benefit, so why are we doing it?" asked Gibbons. "It's an expensive procedure, it has some risks and it turns out we're not talking about a marginal benefit here, we're talking about no benefit." The finding may "give some people reassurance that they don't always need to intervene," said Krumholz, who was not involved in the study.
And another important trial led by Allen Taylor, M.D., of Walter Reed Army Medical Center, suggests that organizing and pre-packaging medication can greatly increase elderly patients compliance with medicine regimens (Abstract). "We're always amazed by what we see when the real statistics come out, when you see how people fill the prescriptions and what medicine they take, it's only about half the meds," said Krumholz. "It's almost unbelievable."
AHA: Tolvaptan Can Relieve Hyponatremia
WEDNESDAY, Nov. 15 (HealthDay News) -- The vasopressin V2-receptor antagonist tolvaptan is effective in relieving hyponatremia, according to the results of a study published online Nov. 14 in the New England Journal of Medicine. The findings were reported at the American Heart Association's Scientific Sessions in Chicago.
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AHA: Atrial Natriuretic Peptide Curbs Damage After Heart Attack
WEDNESDAY, Nov. 15 (HealthDay News) -- Atrial natriuretic peptide (carperitide), an acute heart failure treatment available in Japan, can reduce infarct size and increase left ventricular ejection fraction when used to treat acute myocardial infarction patients, according to a study presented at the American Heart Association's Scientific Sessions in Chicago.
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AHA: Better Never Than Late Reperfusion After MI
TUESDAY, Nov. 14 (HealthDay News) -- Stable patients with totally occluded coronary arteries do not benefit from percutaneous coronary intervention when given three to 28 days after a myocardial infarction and may even be harmed by the practice, according to a study presented at the American Heart Association's Scientific Sessions in Chicago. The findings were also published online Nov. 14 in the New England Journal of Medicine.
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AHA: Novel Anticoagulant Drug, Antidote Promising in Phase 1
TUESDAY, Nov. 14 (HealthDay News) -- A novel anticoagulant system that relies on a shape-changing RNA aptamer and its fast-acting antidote has been tested for the first time in patients, according to a report presented at the American Heart Association's Scientific Sessions and simultaneously published in Circulation: Journal of the American Heart Association. The drug platform, known as REG1, could have applications for oncology, rheumatic disease or infections and seemed safe. However, one patient did experience transient encephalopathy that may or may not have been therapy-related, reported Richard Becker, M.D., of Duke University in Durham, N.C.
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AHA: Folic Acid Does Not Curb MI, Stroke in At-Risk Women
MONDAY, Nov. 13 (HealthDay News) -- Women who are at risk or have cardiovascular disease can reduce their homocysteine levels if they take folic acid or vitamin B supplements, but this does not result in a clinically significant reduction in the risk of myocardial infarction, stroke, revascularization or cardiovascular-related mortality, according to a report presented at the American Heart Association's Scientific Sessions in Chicago.
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AHA: Pioglitazone Best for Slowing Artery Wall Expansion
MONDAY, Nov. 13 (HealthDay News) -- Pioglitazone slows the progression of carotid artery wall thickness in patients with type 2 diabetes mellitus better than glimepiride, according to a report published online Nov. 13 in the Journal of the American Medical Association. The findings were presented at the American Heart Association's Scientific Sessions in Chicago.
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AHA: Pharmacy Program Helps Elderly Adhere to Medications
MONDAY, Nov. 13 (HealthDay News) -- A pharmacy care program that includes custom blister-packed medications helps elderly patients adhere to their chronic medications better than usual care, according to a report released online Nov. 13 by the Journal of the American Medical Association. The findings were presented at the American Heart Association's Scientific Sessions in Chicago.
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AHA: Door-to-Balloon Time Reduction Strategies Examined
MONDAY, Nov. 13 (HealthDay News) -- In managing heart attack patients with ST-segment elevation, several hospital strategies can reduce door-to-balloon time, but few hospitals use them to meet the gold standard of 90 minutes or less, according to a report released online Nov. 13 and published in the Nov. 30 issue of the New England Journal of Medicine.
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AHA: For Most Part, Wi-Fi Does Not Affect Defibrillators
MONDAY, Nov. 13 (HealthDay News) -- For the most part, wireless communication networks such as Wi-Fi and Ethernet do not interfere with implantable cardioverter defibrillators and pacemakers, according to study findings presented at the American Heart Association's Scientific Sessions in Chicago. However, they can interfere with emergency telemetry or pacemaker programmers, so hospitals should locate such networks away from areas of patient care.
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AHA: Subclinical Changes in Kids with Heart Risk Factors
MONDAY, Nov. 13 (HealthDay News) -- A systematic overview of studies suggests that children with cardiovascular risk factors have signs of subclinical atherosclerosis, including an increase in carotid artery intima-media thickness and flow-mediated dilation dysfunction, according to a report presented at the American Heart Association's Scientific Sessions in Chicago.
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AHA: Anger Episode Can Trigger Arrhythmia in ICD Patients
MONDAY, Nov. 13 (HealthDay News) -- Patients with implantable cardioverter defibrillators, or ICDs, may be at greater risk of ventricular arrhythmias after an episode of anger, particularly if they have a history of ICD discharge, implant within the previous six months or left ejection fraction of less than 30 percent, according to a report presented at the American Heart Association's Scientific Sessions in Chicago.
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AHA: One COX-2 Has Heart Risk Similar to Naproxen in Study
MONDAY, Nov. 13 (HealthDay News) -- A randomized trial suggests that one COX-2 inhibitor, etoricoxib, may be no more likely to cause thrombotic cardiovascular events than diclofenac when used to treat osteoarthritis or rheumatoid arthritis patients, according to an industry-funded report presented at the American Heart Association's Scientific Sessions in Chicago and published online Nov. 13 in The Lancet. In addition, etoricoxib may be less likely to cause upper gastrointestinal events, such as perforations, ulcers and bleeding.
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