Keeping you up to date on recent headlines in cardiovascular healthcare.

Report confirms secondhand smoke causes heart attacks ... The American Lung Association (ALA; Washington) issued a statement from its president/CEO, Charles Connor, in response to a new report released by the Institute of Medicine (IOM; Washington), confirming secondhand smoke exposure to be a significant cause of acute coronary events, including heart attacks. The report also concluded that relatively brief exposure to secondhand smoke could cause acute coronary events, the ALA said. The organization said it is dedicated to protecting all workers from secondhand smoke" through its Smokefree Air Challenge, a nationwide campaign to eliminate exposure to secondhand smoke in all work and public places. Half of all states in addition to the District of Columbia have met the Lung Association's Smokefree Air Challenge by implementing laws to protect "almost all workers" from secondhand smoke exposure, according to the ALA. "With this powerful new evidence today from one of the most prestigious scientific bodies in the U.S., it is time for the remaining 25 states that have yet to enact smoke free air laws, to join the American Lung Association in our fight to save lives by improving lung health and preventing lung disease," the organization said. The National Academies of Sciences (Washington) also issued a statement about the IOM report. "It's clear that smoking bans work," said Lynn Goldman, professor of environmental health sciences at Johns Hopkins Bloomberg School of Public Health (Baltimore) and chair of the committee of experts that wrote the report. "Bans reduce the risks of heart attack in nonsmokers as well as smokers. Further research could explain in greater detail how great the effect is for each of these groups and how secondhand smoke produces its toxic effects. However, there is no question that smoking bans have a positive health effect."

Researchers use math to diagnose AHF in ER patients ... Researchers at St. Michael's Hospital (Toronto) say they have developed the first mathematical model in cardiology and emergency medicine to more quickly and reliably diagnose acute heart failure (AHF) in emergency room patients. Research findings published in the Journal of the American College of Cardiology, have been shown to help physicians diagnose AHF with greater accuracy. According to researchers, the model uses natriuretic-peptide levels (a peptide hormone released from heart muscle to help regulate body fluids and blood pressure) and the clinician's judgment to help diagnose patients whose history, physical or chest X-ray may not clearly indicate AHF. Currently, accurate clinical diagnosis of AHF in the emergency department is less than 80%, according to the researchers. The study developed the prediction model from the emergency department experience of 534 patients with undifferentiated shortness of breath enrolled in the Canadian Improved Management of Patients with Congestive Heart Failure (IMPROVE-CHF) trial.


Study finds race is not being reported in most trials ... A new study recently published online by the American Heart Journal shows that more than half of all randomized clinical trials (RCTs), for cardiovascular disease are not reporting vital information about the study populations race or ethnicity. NYU School of Medicine (New York) researchers found that out of the 156 cardiovascular disease RCTs analyzed, only 35% of trials reported any information on race or ethnicity between 1970 and 2006. From 2000 to 2006, 46% of trials included that information. "Over time, information on enrollment by race and ethnic group has improved but nevertheless, information on this important demographic of patient enrollment is far from ideal," said Jeffrey Berger, MD, director of Cardiovascular Thrombosis and assistant professor of Medicine and Surgery at The Leon H. Charney Division of Cardiology at NYU School of Medicine. "It is imperative that all studies provide basic information including race and ethnicity. Furthermore, we must have good representation of different ethnic and minority groups in RCTs to apply data appropriately." According to the study authors, diversity in RCTs must be increased because representation of minority ethnic groups remains too low. Study findings showed that only 15% of trials had sufficient diversity to even attempt efficient analysis of results by race. Researchers also cited that RCTs in the U.S. were more likely to report race than international trials with no U.S. participants. However, enrollment information on race in the U.S. was still less than one third of total trials. RCTs funded by industry, federal agency or a foundation all reported race with similar frequency. "Our study should have important implications for future design and publication of randomized clinical trials," Berger said. "Race and ethnic demographics should be strongly encouraged in future study publications, along with the optimal approach of mandating the reporting of race and ethnic group in all RCTs including cardiovascular disease trials. This way we can successfully move forward, enhancing the translation of study results with better targeted therapies for the diverse patient populations we treat."

Used pacemakers implanted in 12 patients in Philippines... Patients who received refurbished pacemakers donated from Detroit area funeral homes survived without complications from the devices, according to a case series reported by the University of Michigan Cardiovascular Center (Ann Arbor). According to the report, the pacemakers were implanted in 12 patients at the University of Philippines- Philippine General Hospital who could not afford advanced cardiac care and were confined to their beds as they waited for a permanent pacemaker. All donated pacemakers functioned normally at six months, and there were no device complications such as infections, according to the researchers. The study appeared online ahead of print in the Oct. 13 issue of the Journal of the American College of Cardiology. "In light of the widening healthcare disparity seen between the industrialized world and developing nations, we feel that pacemaker reuse is an ethical obligation to address the medical needs of those who could not afford therapy otherwise," said co-author Timir Baman, MD, cardiology fellow at the U-M Cardiovascular Center. Based on surveys showing a majority of heart patients were interested in donating their pacemakers after death, U-M has launched Project My Heart Your Heart, a joint collaboration between the U-M Cardiovascular Center, Michigan funeral homes, and World Medical Relief (Detroit), a non-profit organization that specializes in the delivery of used medical equipment. "Ongoing research is needed to evaluate the feasibility of regional and potentially nationwide pacemaker donation programs," added co-author Kim Eagle, MD, director of the U-M Cardiovascular Center.

Study suggests blood pressure device is cost effective ... A study conducted by the University of Rochester Medical Center (URMC; Rochester, Minnesota) demonstrates that, for certain patient populations, an implantable device designed to lower blood pressure may be a cost effective treatment. The Rheos, from CVRx (Minneapolis), is in Phase III clinical trials at sites throughout the U.S. for patients with drug resistant hypertension. The study – which appears this month in the Journal of Clinical Hypertension – used data from two large population-based studies and compared the incidence of adverse health events such as stroke and heart attack for groups of individuals with and without the blood pressure lowering benefit of the device. Researchers then projected the healthcare costs associated with those events over a patient's lifetime. According to the URMC, the results show that if Rheos continues to perform at a level consistent with the initial findings in ongoing clinical trials, then the device is a cost effective way to control hypertension. The Rheos system consists of a battery-powered implantable generator, which is inserted under the skin near the collarbone, and two carotid sinus leads, which run from the generator to the left and right carotid sinus in the neck. The device is designed to activate the carotid baroreceptors – a key regulator of the body's cardiovascular system, which prompts signals that are interpreted by the brain as a rise in blood pressure. The brain then works to counteract this perceived rise in blood pressure by sending signals to other parts of the body that relax the blood vessels and inhibit the production of stress-related hormones, the URMC noted. These changes enable the heart to increase blood output, while maintaining or reducing its workload, thereby reducing blood pressure when it is elevated and alleviating the symptoms of heart failure.

— Compiled by Amanda Pedersen, MDD

amanda.pedersen@ahcmedia.com