Pulmonary vein antrum isolation (PVAI), a new treatment for atrial fibrillation (AF), has been found to produce regression in irregular heartbeats in most patients and improves heart failure patients' quality of life, according to a new study by the Cleveland Clinic (Cleveland), presented at this year's Scientific Sessions of the American Heart Association (AHA; Dallas). The clinic said that the lengthily named trial, Pulmonary Vein Antrum Isolation vs. AV Node Ablation with Bi-Ventricular Pacing for Treatment of Atrial Fibrillation in Patients with Congestive Heart Failure (PABA CHF), is the first randomized, controlled study to compare two current approaches to treating AF in patients with congestive heart failure.
PVAI is used to electrically isolate all four pulmonary veins from the left atrium. During the procedure, also known as pulmonary vein ablation (PVAI), catheters are inserted into the blood vessels of the atrium, and frequency energy is then used to block the pathway of irregular heartbeats.
During AV node ablation with biventricular pacing (AVNA/BiV), a catheter is used to deliver an electrical current to the part of the heart causing the AF to prevent the irregular heartbeats. The patient relies on the use of an implantable cardioverter defibrillator (ICD) to shock the heart into normal rhythm when AF arises.
"The study results suggest that PVAI is superior to AVNA/BiV in terms of both freedom from atrial fibrillation and improving patients' quality of life," said Andrea Natale, MD, section head of electrophysiology and pacing at Cleveland Clinic. "Given many patients are afflicted by both congestive heart failure and atrial fibrillation, PVAI is a real treatment option."
Recent studies have shown that patients who are pacemaker-dependent may benefit more from a biventricular device than a standard dual chamber device. "The question then becomes, is it better to cure the atrial fibrillation with pulmonary vein ablation or make patients pacer-dependent," Natale said. "More research needs to be done to answer this very important question."
Medicaid cardiac care faulted
The quality of cardiac care for Medicaid patients lags behind the care given to those with HMOs and private insurance according to a new study. The study by Dr. James Calvin, lead study author and director of cardiology at Rush University Medical Center, (Chicago), found Medicaid patients were less likely to receive short term medications and to undergo invasive cardiac procedures. They also had higher in-hospital mortality rates and were less likely to receive recommended discharge care. Differences were fewer and smaller for Medicare patients. The study was published in the Nov. 21 issue of the Annals of Internal Medicine.
In addition to Rush, study participants included Duke University Medical Center, New York University School of Medicine, Northwestern University School of Medicine, University of Cincinnati College of Medicine, and the University of North Carolina at Chapel Hill.
The researchers evaluated data from more than 37,000 patients younger than 65 and more than 59,000 patients 65 and older at 521 U.S. hospitals. All patients had acute coronary syndromes. These symptoms occur when there is insufficient blood supply to heart muscle. If the blockage lasts long enough, the muscle dies causing a heart attack.
The study measured the use of the recommended guidelines of the American College of Cardiology and the American Heart Association. Those guidelines include recommended medications within the first 24 hours, medications and dietary advice to control cholesterol levels, counseling to stop smoking, and cardiac rehabilitation programs.
When compared to patients with HMO or private insurance, Medicaid patients were less likely to receive aspirin, beta-blockers, clopidogrel, and lipid-lowering agents. Medicaid patients were also less likely to receive dietary counseling, smoking cessation counseling, and referral for cardiac rehabilitation. Gaps also existed for acute care. Delays were observed for Medicaid patients in the time to first electrocardiogram and in time to cardiac catheterization and revascularization when these procedures were performed.
Medicaid patients had higher in-hospital mortality rates (2.9% vs. 1.2%) and after adjustment, the risk for death was approximately 30% higher in Medicaid patients compared to those with HMOs and private insurances. Mortality rates were not significantly different for Medicare patients.
The patients evaluated in the study were from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early implementation of the ACC/AHA guidelines) quality improvement initiative. Data was collected from January 2001 through March 2005.
Causes of diastolic heart failure probed
A new study shows that blood flow to the legs is relatively normal in people with diastolic heart failure, suggesting other potential causes of their inability to do everyday activities, according to researchers at Wake Forest University Baptist Medical Center.
"Reduced tolerance for physical activity is the primary symptom of diastolic heart failure, and it greatly affects quality of life," said Dalane Kitzman, MD, professor of cardiology and senior researcher on the study. "This condition will increase as our population ages, so it's important to pinpoint the reasons for their symptoms and to develop effective treatments."
The study results are reported on-line in American Journal of Physiology — Heart Circulation Physiology and will be published in an upcoming print issue.
Cardiac IVD to exceed $45B billion by 2010
The Cardiac Markers report from Kalorama Information (New York) predicts that the world market for cardiac IVDs will grow to more than $4.5 billion by 2010, on the heels of advances in testing such as recently discovered genetic factors. Kalorama said that tests such as inflammation and homocysteine markers — relatively rare only a few years ago — are now part of the standard cardiac marker segment.
Overall growth in IVD cardiac marker tests will derive from new markers, such as ultra-sensitive CRP, plasminogen activator inhibitors, s100 protein, p-selectin, soluble fibrin, glycogen phosphorylase-BB, and thrombus precursor protein, among others, according to the report.
The impact of these emerging markers and tests will be most notably seen in Western markets, with the U.S. currently accounting for 45% of the market, Europe 27%, and Japan 13%. Cost, availability and technological resources still make such tests relatively prohibitive in the rest of the world, the report said.
The study examines tests and technologies currently available and those expected to take their place in the near future.
Kalorama is a division of MarketResearch.com which supplies independent market research for the life sciences.
Transplant centers warned by CMS
The Centers for Medicare and Medicaid Services (CMS) in late November sent letters notifying two heart transplant centers that the agency will withhold Medicare funding from their programs for not meeting the minimum federal standard of performing 12 transplants per year, the Los Angeles Times reported.
In June, the Times reported that an investigation found 20% of the 236 federally funded heart, liver and lung transplant programs do not meet minimum CMS standards for the number of procedures performed and survival rates. Nine lung transplant programs and 36 heart transplant programs did not meet CMS standards, and those programs accounted for 71 more deaths within one year than expected under normal conditions, based on a government analysis of survival rates.
CMS has the authority to revoke the certification of transplant programs that fail to meet agency standards. In August, CMS began to issue warning letters to about 35 transplant programs that have failed to meet agency standards and requested that the centers make improvements before action was taken.
CMS notified the heart transplant programs at Wake Forest University Baptist Medical Center, which performed two transplants in 2005, and Montefiore Medical Center (New York), which performed no transplants, that they will no longer receive Medicare funding.
A third program at St. Louis University Hospital, which also performed no transplants last year, voluntarily relinquished its Medicare funding after receiving a warning.
CMS Chief Medical Officer Barry Straube said, "It might be possible that people were not taking this seriously enough and thinking that we would not take this action."
The centers have 30 days to challenge the withdrawals.
Study: SBP rises sooner in boys
A Canadian study suggests that the reason men tend to have higher systolic blood pressure (SBP) than women could be because as boys get older their SBP tends to be higher than girls of equivalent age. The results of the five-year study, titled "Emergence of Sex Differences in Prevalence of High Systolic Blood Pressure: Analysis of a Longitudinal Adolescent Cohort," appeared in the December issue of Circulation, a journal of the AHA.
The researchers tracked a group of 1,200 adolescents from 1999 to 2005 and took measurements at grades 7, 9 and 11. They found the incidence of high SBP at grade 7 to be split about 50-50 between boys and girls. However, as the group reached grade 11 the high SBP group comprised 67% boys.
The study also suggests that for both male and female adolescents, reducing sedentary behavior and increasing physical activity may lower SBP, even if they are overweight.