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

Community health centers skip on cardiology specialists referrals .... A new study reports that community health centers refer patients with heart problems to cardiology specialists less often than hospital-based primary care practices do. In a retrospective analysis, coronary artery disease patients treated in community centers were 21% less likely to get an initial cardiology consult, while those with heart failure were 23% less likely to get a referral than those seen at hospital-based primary care practices. The association was particularly true among women. The study was unable to determine if the referral pattern differences represented underuse at community centers or overuse at hospital-based practices. (http://americanheart.mediaroom.com/index.php?s=43&item=721)

Regulatory timeline for BP drug extended .... United Therapeutics (Silver Spring, Maryland) has reported that the FDA will require additional time to complete its review of the application for Tyvaso (inhaled treprostinil), a blood pressure drug, from April 30 to July 30, 2009. The extension was triggered by the company's April 2009 submission to the FDA of the results of a human factors study, which was considered a major amendment to the application. In March, the FDA notified the company that it required human factors testing to validate the instructions for use of the Optineb nebulizer in order to complete the evaluation. (www.unither.com/UnitherHome.aspx)

Urine test potential predictor of coronary artery disease .... Proteome analysis, a screening requiring only a patient's urine specimen, shows promise as a noninvasive way to diagnose atherosclerosis and coronary artery disease, according to research presented at the American Heart Association's (Dallas) Arteriosclerosis, Thrombosis and Vascular Biology Annual Conference. Constantin von zur Muehlen, MD, and colleagues identified 17 protein fragments, known to be present on the surface of atherosclerotic plaques. "The accuracy of the urine proteome pattern to identify coronary artery disease was 84 percent," Muehlen said. Mosaiques Diagnostics & Therapeutics (Hannover, Germany), maker of the test, co-funded the study. (http://americanheart.mediaroom.com/index.php?s=43&item=724)

Smoking, high BP account for 1 in 5 deaths, each, among U.S. adults ... A broad assessment of has smoking and high blood pressure (BP) concludes that they are responsible for the greatest number of preventable deaths – each accounting for around 1 in 5 deaths in U.S. adults, according to a study appearing in PLoS Medicine (6[4]: e1000058. doi:10.1371/journal.pmed.1000058). Using national survey data, they obtained information on deaths from the US National Center for Health Statistics. Of the 2.5 million U.S. deaths in 2005, the researchers estimated that almost 470,000 associated with tobacco smoking, nearly 400,000 with high BP. Being overweight/obese accounted for nearly 1 in 10 deaths, whilst high salt intake was responsible for 1 in 25 deaths of U.S. adults – the most of any of the dietary factors analyzed. (www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000058)

Better stroke predictors for black patients .... Predictors of atrial fibrillation (AF) may offer a better way to prevent stroke in blacks, according to a study by researchers at Wake Forest University School of Medicine. They reviewed ECG data from the Atherosclerosis Risk in Communities (ARIC) study of more than 15,000 people in four states during the 1980s and 1990s. They found that, while ECG reports of AF were significantly less in black participants than in whites, black participants suffered more ischemic strokes. However, the analysis uncovered that ECGs on black participants revealed a higher rate of predictors of future AF – P-wave terminal force, P-wave duration, P-wave area and PR duration – than did the ECGs of white participants. The study appears in the current issue of Stroke.
(www1.wfubmc.edu/news/NewsArticle.htm?Articleid=2609)

Home-based rehabilitation trialed by Aussie cardiac patients .... In Australia, a group of patients who have been treated in hospital for cardiac health problems, such as a heart attack, are using mobile phone and web technology enabling them to practice healthy lifestyle programs at home and still receive the appropriate medical support. Phil Gurney, MD, CEO of the Australian E-Health Research Centre, said patients used mobile phones to measure physiological data, such as the number of steps taken, and make their online wellness diary entries. "Daily motivational and educational text messages are sent by phone and mentors set personalized goals at weekly phone or video conferences," Gurney said. The rehabilitation system is being trialed with patients from the Metro North Health Service District Primary and Community Health Services Program, in conjunction with the Prince Charles Hospital, Redcliffe Hospital and Caboolture Hospital. (www.csiro.au/news/Heart-Phone.html)

Higher drug co-payments discourage hypertension treatment .... Patients newly diagnosed with hypertension, diabetes or high cholesterol are significantly more likely to delay initiating recommended drug treatment if they face higher co-payments for medications, according to a new study from the RAND Corporation (Santa Monica, California). In a study of 272,474 retirees, among those newly diagnosed with high BP, for example, those starting drug treatment within a year of diagnosis dropped from 55% to 40% when their co-payment doubled. After five years, the difference was 82% to 66%, according to the study. Similar differences were seen among those diagnosed for the first time with diabetes and high cholesterol. (www.rand.org/news/press/2009/04/28/copayments_treatment.html)

CABG, PCI found equally effective .... In the current edition of Deutsches Arzteblatt International, an interdisciplinary team of authors consisting of cardiologists and cardiac surgeons has issued a statement saying that coronary artery bypass grafting and the less-invasive balloon angioplasty/stenting procedure are of equivalent value and can be placed in a complementary treatment plan. According to the authors, the main indication bypass surgery is when the proportion of ischemic myocardia is at least 10%. A bypass operation can greatly improve the symptoms in the intermediate and long term. Severe co-morbidity, such as renal failure or chronic obstructive pulmonary disease, supports the use of angioplasty/stenting rather than CABG. (www.aerzteblatt.de/int/article.asp?src=search&id=64226&p=PCI)

Computerized scan detects heart disease .... A computerized chest scan successfully singles out those people coming into emergency rooms with chest pains who have serious heart disease, a new study indicates, according to a report in the April 28 issue of the Journal of the American College of Cardiology. Of the 368 people in the study, computed tomography angiography (CTA) was 100% effective in identifying the 31 who actually had acute coronary syndrome, None of the people cleared by the scans had a coronary event in the following six months. The case for using CTA for triage in suspected heart disease is not completed, Hoffman said. "The next step is a randomized trial," he said. "We have to look at physician behavior, how physicians will adopt this technology." (http://content.onlinejacc.org/cgi/content/abstract/53/18/1642)

Factors for heart cell creation identified by Gladstone scientists .... Scientists at the Gladstone Institute of Cardiovascular Disease (San Francisco) report the identification, for the first time, of key genetic factors that drive the process of generating new heart cells. The researchers said that a surprising factor was a cardiac-specific protein called BAF60c, which helps determine whether transcription factors like GATA4 and TBX5 can even gain access to the DNA regions they were supposed to turn on or off. The discovery, reported in the current issue of the journal Nature, provides new directions on how stem cells may be used to repair damaged hearts, the authors said. "When we finally identified the key factor that could work with GATA4 and TBX5 to turn cells into beating heart cells, it was somewhat of a surprise to us," said Benoit Bruneau, PhD, lead researcher. (www.gladstone.ucsf.edu/gladstone/site/gicd/)

– Compiled by Don Long, MDD National Editor

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