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

Certification type linked to ICD implant complications .... Patients whose implantable cardioverter defibrillators (ICDs) are implanted by non-electrophysiologists are at increased risk of complications and are less likely to receive a specific type of ICD when clinically indicated. Jeptha Curtis, MD, of Yale University School of Medicine (New Haven, Connecticut) and colleagues analyzed data from the ICD Registry, a national registry of ICD implantations. Of 111,293 ICD implantations included in the analysis, the researchers found that the majority of implants were performed by electrophysiologists (70.9%), with about 29% performed by non-electrophysiologists (non-electrophysiologist cardiologists, 21.9%; thoracic surgeons, 1.7%; and other specialists, 5.5%). The rates of overall and major complications were 3.5% and 1.3%, respectively, among electrophysiologists, and 5.8% and 2.5%, respectively, among thoracic surgeons. The study appears in the April 22/29 issue of the Journal of the American Medical Association (JAMA. 2009;301[16]:1713-1714). (http://opa.yale.edu/news/article.aspx?id=6622)

Organic biosensor detects acute myocardial ischemia onset .... Engineering researchers at the University of Arkansas (Fayetteville) report that they have made and tested a biosensor that measures concentrations of potassium and hydrogen ions in the human heart, with high specificity. The research could lead to a superior method of monitoring indicators of acute myocardial ischemia, or AMI, one of the leading causes of cardiovascular failure. The researchers also developed a smoothing technique to assess the effect of external electric fields on the devices. To operate properly, implantable biosensor devices must be immune to these electric fields, or background noise. The findings were published in Applied Physics Letters. (http://dailyheadlines.uark.edu/14904.html)

Paying evidence-based financial incentives urged .... Two cardiologists – George Diamond, MD, a senior research scientist, emeritus and Sanjay Kaul, MD, of the Cedars-Sinai Heart Institute – writing in Circulation: Cardiovascular Quality and Outcomes, say that healthcare Reform should start with "evidence-based reimbursement", structuring physician payment incentives around existing empirical evidence of clinical benefit. The authors propose that physicians of the patients who undergo PCI be paid on a sliding scale, from $8,000 to $24,000, with the highest payments going to the physicians of patients with the most severe symptoms because the sickest patients receive the most benefit from the procedure. (Circulation: Cardiovascular Quality and Outcomes, 2009; 2: 134-140)

New technique detects previously unrecognized heart attacks .... Han Kim and colleagues at the Duke Cardiovascular Magnetic Resonance Center (Durham, North Carolina) report using a recently developed technique, known as delayed enhancement cardiovascular magnetic resonance (DE-CMR) to detect heart damage in patients whose Q-waves were absent and had no ECG abnormalities that are usually associated with myocardio infarction. Their study shows that the prevalence of this type of heart attack which doesn't display ECG abnormalities is more than three times higher than heart damage which does display ECG abnormalities. The study appears in PLoS Med [6(4): e1000057. doi:10.1371/journal.pmed.1000057] (http://dcmrc.mc.duke.edu/)

Integrated Regional Networks provide rapid treatment of heart attacks .... Specialized emergency networks dramatically reduces time-to-treatment for patients with ST-elevation myocardial infarction (STEMI), according to a new study. Researchers performed a pooled analysis of 10 pioneering STEMI heart attack networks, employing common approaches and involving 72 hospitals in Oregon, California, Minnesota, Michigan, North Carolina and Georgia. The study that 86% of patients with STEMI who called 911 and were treated within a coordinated regional network received skilled coronary intervention within 90 minutes, surpassing the D2B Alliance target (a >75% rate of D2B 90 min) of the American College of Cardiology (Washington). The study appears in the April issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

(Abstract: http://interventions.onlinejacc.org/cgi/content/abstract/2/4/339?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=integrated+regional+networks&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT)

Breastfeeding linked to less risk of heart attack, stroke .... The longer women breastfeed, the lower their risk of heart attacks, strokes and cardiovascular disease, report University of Pittsburgh researchers. According to the study, postmenopausal women who breastfed for at least one month had lower rates of diabetes, high blood pressure and high cholesterol. Women who had breastfed their babies for more than a year were 10% less likely to have had a heart attack, stroke, or developed heart disease than women who had never breastfed. They found that the benefits from breastfeeding were long-term – an average of 35 years had passed since women enrolled in the study had last breastfed an infant. The study appears in the May issue of Obstetrics & Gynecology.

Vibration frequency linked to vascular injuries .... Speaking at the Experimental Biology 2009 meeting in New Orleans, Dr. Kristine Krajnak, a team leader in the Engineering and Control Technologies Branch of the Health Effects Laboratory Division of the National Institute for Occupational Safety and Health (NIOSH; Morgantown, West Virginia), described results from the first study to directly link the different physical responses of tissue that occur with exposure to different vibration frequencies with biological mechanisms underlying the development of vascular dysfunction. The study, along with results of other NIOSH studies, supports the need to reduce job-related exposure to vibration. Ongoing research is evaluating the effectiveness of anti-vibration devices, such as anti-vibration gloves and tools. Her presentation is part of the scientific program of The American Physiological Society (Bethesda, Maryland).

Preview snapshots from the spring meeting of the European Society of Cardiology Council (Sofia Antipolis, France) on cardiovascular nursing and allied professions, today and tomorrow, in Dublin, Ireland. (www.escardio.org/about/press/press-releases/pr-09/Pages/cardiovascular-nursing-2009-second-announcement.aspx)

Telemonitoring enhances home care .... Jill Riley, of the Royal Brompton Hospital (London) will discuss how telemonitoring can be used to enhance the self care of heart failure patients. "Telemonitoring is particularly helpful in heart failure where the condition of patients may change and nurses can identify those who need the most help. However it also helps teach patients how to live with and self-manage their heart failure," says Riley, who interviewed patients, participating in a telemonitoring trial, about their attitudes.

Strategic challenges for primary angioplasty .... Professor Tom Quinn of the University of Surrey (Guildford, UK) will discuss the impact that primary percutaneous coronary intervention (PCI) is having on nurses and allied health professionals. He says that cath lab nurses will need to develop strategies to provide patients and families with appropriate levels of information about the procedure during the very acute phase, while not delaying treatment. Additionally, with shorter hospital stay because of the more rapid recovery seen with primary angioplasty, cardiac rehabilitation nurses will need to develop systems for ensuring that patients get appropriate access to support after the acute event.

'Take-home pearls' in heart disease prevention .... In a joint U.S. and European session on "Global Cardiovascular Disease Prevention: a call to action," Nancy Houston Miller, of the Stanford Cardiac Rehabilitation Program (Palo Alto, California), will discuss how cardiology nurses and allied health professionals can start to introduce behavioral skills training into their every day practice. The techniques she will describe include advice on how to display empathy, techniques of asking open ended questions, how to most effectively deliver a one- to three-minute message, developing skills for goal setting and monitoring, and how best to set up an office from the educational standpoint.

— Compiled by Don Long, MDD National Editor

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