Keeping you up to date on recent headlines in cardiovascular healthcare:
Big disparities in Europe for treatment of arrhythmias .... The latest statistics regarding the use of pacemakers and implantable cardiac devices in the European Union and the European Society of Cardiology member countries outside of the EU indicate a disparate coverage of diseases and treatments. Some of the countries have no reimbursement, for instance, for implantable cardioverter defibrillators (ICDs) or pacemakers, and the penetration of catheter ablation of atrial fibrillation (AF) is very different. Among the findings: The number of ICD implanting centers range from less than 1 per million to 6.87 per million individuals; pacemaker therapy is performed in the range of 88/million to a around 1,200/ million inhabitants; ICD implant rates, including CRT-D devices, range from nearly 2.5/million to 354/million inhabitants; the use of biventricular pacemakers vs. biventricular ICDs shows a 8:1 ratio down to a 1:1.2 ratio; in the field of invasive electrophysiology and catheter ablation for supraventricular and ventricular arrhythmias the number of centers available ranges from less than 0.2 centers/million to more than 3 centers/million; the same also is true for catheter ablation of AF, linked to reimbursement policies but also to different approaches in the various EP societies. The data were presented on Sunday at Europace 2009, the meeting of the European Heart Rhythm Association (EHRA; Sofia Antipolis, France) in Berlin, ending tomorrow. These data, including the current status of healthcare systems across the continent, were included in the EHRA White Book2. (www.eurekalert.org/pub_releases/2009-06/esoc-di061709.php)
Different systems measuring treatment of hypertension studied .... A new study by researchers at Boston University Medical Center looked at 819 hypertensive patients using three different score methods to measure the intensity of hypertension care and whether these scores could predict the final systolic blood pressure (BP). They found that the standard-based measure, originally described by Okonofua, et al., in Hypertension 2006, was an excellent predictor of blood pressure control. In contrast, they say that the any-or-none medication increase and the norm-based measure did not predict blood pressure, and, therefore are not valid measures of treatment intensity. The study appears in the July issue of Circulation: Cardiovascular Quality and Outcomes.
Analysis of DES data shows safety/efficacy in on- and off-label use ....
The Cardiovascular Research Foundation (CRF; New York) has reported results of what it called the largest meta-analysis to date comparing mortality rates for drug-eluting stents (DES) vs. bare metal stents (BMS) and comparing the rates of myocardial infarction (MI) and target vessel revascularization (TVR). The analysis of 22 randomized trials, including more than 9,000 patients, showed no overall differences in death and MI, with a greater than 50% decrease in subsequent target vessel revascularization in both on-label and off-label use of DES. And in a 34-study observational meta-analysis (involving more than 180,000 "real-world" patients), DES showed a 22% and 13% reductions in death and MI, respectively, with a similar reduction in TVR (46%) as in the randomized trials. The study appears in the June 15 edition of Circulation. (www.crf.org/aboutus/news-and-events/34-news-and-events/151-horizons-ami-des-nejm-press-release)
Expert opinion: New treatments should be introduced gradually .... Despite the CRF report (see above item) concerning the safety/efficacy of DES, their introduction has been used as a case study for why new treatments should be introduced to the market gradually. In an editorial published in BMJ Clinical Evidence, Vijay Sharma, MD, discusses the recent debates concerning the long-term safety of DES devices, citing the reports highlighting an increased risk of clotting as late as one year after DES implant. He concludes that to avoid the pattern of early enthusiasm and later disfavor, "adverse effects should be actively sought, and treatments should be introduced gradually so that experience and evidence can be built up and the treatment can find its proper niche." (http://clinicalevidence.bmj.com/ceweb/resources/editors-letter-full.jsp?src=editorsletter_intro)
HeartWorks simulation: education for cardiothoracic anesthesiologists .... A virtual heart, called HeartWorks, billed as the world's first developed, is used to improve teaching of peri-operative transesophageal echocardiography (TEE) skills in the care of patients with heart disease. HeartWorks is a computer-generated model of the heart and echocardiography simulator, developed by three London-based cardiac anesthesiologists, now in production by Inventive Medical (London), a subsidiary of UCLH Charity (London). One of the developers called HeartWorks "a freely interactive model of the human heart which has an unprecedented degree of detail and photorealism. The model has been carefully animated to simulate normal human cardiac motion, with a variable heart rate that is synchronized to an EKG trace. It can be viewed from any angle both internally and externally, through a range of zoom, can be rotated freely around any axis, and sliced in any plane." (www.heartworks.me.uk/main.php?lang=us)
Lower income, less education key factors for risk of heart disease .... Doctors should not ignore the socioeconomic status of patients when evaluating their risk for heart disease, according to a study out of the University of Rochester Medical Center (Rochester, New York). The researchers say that Framingham Risk Scoring (FRS), the most frequently used model to assess risk, does not accurately predict whether a person of low income and/or less than a high school education will develop heart disease or die in the next 10 years, because measuring only overall cholesterol and bad cholesterol levels, BP, age and smoking status. When socioeconomic factors were added to FRS, the proportion of low-income and low-education patients at risk for death or disease during the next 10 years was nearly doubled. The study appears in the June 2009 American Heart Journal (www.urmc.rochester.edu/pr/news/story.cfm?id=2519)
Enzyme doesn't act alone in AF.... An overactive enzyme is behind a leaky calcium channel that plays a role in the development of atrial fibrillation (AF), but it doesn't act alone, say researchers at Baylor College of Medicine (Houston). The researchers show in mouse models that if the enzyme calmodulin kinase II is inhibited, calcium channels normalize and AF is prevented. To determine if the calcium leak alone was enough to set off AF, mice were bred with a specific genetic mutation in the calcium channel, making it prone to leaks, but they did not develop AF. A drug was used to block the activity of calmodulin kinase II, and the heart rates of the mice were raised; the mice with the calcium channel mutation had no signs of arrhythmia, supporting the conclusion that the enzyme plays a role in the disorder but does not act alone. The study appears online in the current edition of the Journal of Clinical Investigation. (www.bcm.edu/news/item.cfm?newsID=1461)
Omega-3 fatty acids may curb depression in heart patients .... New research out of the University of California San Francisco suggests a relationship between low levels of omega-3 fatty acids and an increased risk of depression in heart patients. The study looked at 987 adults with coronary heart disease. Among those with the lowest levels of omega-3 fatty acids, 23% suffered from depression. But among those with the highest levels of the fatty acid in their blood, only 13% were diagnosed with depressive symptoms. The findings support the previously reported association between low levels of omega-3 fatty acids and depression in non-hospitalized patients with stable coronary heart disease. The types of omega-3 measured in the study were docosahexaenoic acid and eicosapentaenoic acid. The study appears online in the Journal of Psychotherapy and Psychosomatics (Vol. 78, No. 2, 2009).
— Compiled by Don Long, MDD National Editor