The placement of automated external defibrillators (AEDs) in other than traditional medical venues continues. Last month, the Southeastern Pennsylvania Chapter of the American Red Cross reported that five law firms in Philadelphia have installed the heart-starting devices in their offices, and the head of the Pennsylvania State Police said that it has installed AEDs at its offices. Frank Donaghue, CEO of the Southeastern Pennsylvania Red Cross chapter, praised the law firms as accepting "the challenge of new safety standards," adding, "Next to every fire extinguisher and first aid kit, there should be an AED." The law firms are Cozen and O'Connor; Deckert, Price & Rhoades; Dilworth Paxson; Montgomery, McCracken, Walker & Rhoads; and Wolf, Block, Schorr & Solis-Cohen. Besides placement of AEDs at its main offices, Dilworth Paxson said it has placed AEDs at its locations across the state and in New Jersey, and Cozen and O'Connor has placed them in 12 offices in nine states and its London office. All locations also reported implementing Red Cross AED training programs and new emergency response standards.

The Red Cross chapter said that it has trained more than 1,400 people at 96 workplaces in the use of AEDs since the national organization's program was piloted in Philadelphia in September 1998. The American Red Cross said that the most sudden cardiac arrests occur on Monday, closely followed by Friday. "Sudden cardiac arrest can strike anyone, anyplace and often without warning," Donaghue said. "The current SCA survival rate in the U.S. is only 5%, largely because CPR and defibrillators are not used in time."

The installation of 70 AEDs at Pennsylvania State Police facilities – purchased from Survivalink (Minneapolis, Minnesota) – was announced last month by Deputy Commissioner Thomas Coury at a kick-off event at the State Police Academy in Hershey, Pennsylvania. Coury said, "We are encouraging members who have AED certification to sign them out for use on patrol or at public events," adding that designated troopers received AED training from the American Red Cross. These troopers in turn will use 20 AED training devices to train all troopers and liquor-enforcement officers. An estimated 500 troopers now have AED certification, including all members of the most recent classes to graduate from the State Police Academy, Coury said.

More attention needed to systolic BP

A national study issued in late July concludes that most physicians who treat hypertension believe that controlling diastolic blood pressure is more important than controlling systolic pressure. The researchers say that these results "are contradictory to the large percentage of patients (41% over the age of 65) diagnosed with elevated systolic blood pressure." Only 40% of the physicians polled agree that control of systolic pressure is more important than controlling diastolic pressure. The survey also showed that isolated systolic hypertension is more common among African-American patients, with nearly two-thirds of them presenting this condition. The survey was released during the National Faculty Summit of SHIELD (Systolic Hypertension In the Elderly), held in Chicago, Illinois.

"The SHIELD survey clearly challenges the continuing efforts to make elevated systolic blood pressure the central focus for the care of elderly hypertensive patients," said Stevo Julius, MD, professor of internal medicine at the University of Michigan Medical Center (Ann Arbor, Michigan). "The goal for SHIELD is to help physicians better treat elevated systolic blood pressure and reduce cardiovascular events related to uncontrolled systolic blood pressure."

The SHIELD survey revealed that doctors still do not focus enough on controlling systolic blood pressure, despite a recent recommendation to U.S. physicians by the Coordinating Committee of the National High Blood Pressure Education Program of the National Heart, Lung and Blood Institute (Bethesda, Maryland). In a statement, the committee declared that systolic BP should be the primary component for diagnosing, staging and treating high blood pressure for middle-aged and older Americans. The committee said, "Unequivocal clinical trial data indicate that lowering systolic BP markedly improves morbidity and mortality in older people. Thus, achievement of optima public health benefits requires a nationwide call to action to improve our current low rates of systolic BP control."

Second LIPID study validates 1st report

The Aug. 3, 2000, issue of the New England Journal of Medicine (NEJM) included the latest clinical paper from the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study, indicating that cholesterol-lowering treatment can assist in reducing the risk of stroke following a heart attack. Called the largest clinical study of its type undertaken in Australia and New Zealand, the new report validates the initial results of the trial, published by NEJM in 1998. In the latest paper, "Pravastatin Therapy and the Risk of Stroke," Australian and New Zealand researchers found that pravastatin reduced the risk of stroke by 19% in these heart patients. Eight strokes were avoided per 1,000 patients who took the drug over the six years of the study.

Stroke is Australia's second leading cause of fatalities, after coronary heart disease. It reportedly claimed 12,133 lives in that country in 1997 and is the leading cause of long-term disability in adults there. Professor Andrew Tonkin, director of health, medical and scientific affairs for Australia's Heart Foundation (Sydney, Australia), said the study's results helped solve some of the controversy regarding cholesterol levels and its relationship to stroke. "Pravastatin has a clear effect in reducing the risk of stroke in patients with a previous heart attack or unstable angina," Tonkin said. "Coupled with the knowledge that cholesterol lowering with pravastatin also reduced the risk of heart attack, bypass surgery or angioplasty in these patients, there is clear clinical evidence for this type of treatment."

The LIPID study was conducted by an independent group of researchers and coordinated by the National Health and Medical Research Council's Clinical Trials Center at the University of Sydney. It was conducted under the auspices of the National Heart Foundation of Australia and funded by a grant from Bristol-Myers Squibb (New York), maker of pravastatin. The study involved more than 9,000 patients throughout Australia and New Zealand.

Women still under-represented in trials

A report in the Aug. 17, 2000, issue of the New England Journal of Medicine (NEJM) indicates that women remain significantly under-represented in federal cardiovascular studies conducted by the National Heart, Lung and Blood Institute (NHLBI) over the past 30 years. With the exception of women-only studies, the representation of women in most cardiovascular clinical trials has not changed since the mid-1980s, despite federal efforts to increase their participation. Overall, women's participation was found to be 54%, but it was only 38% in studies including both men and women. Women were especially under-represented in trials of heart failure. While women account for 43% of the cases of heart failure, they made up only 26% of patients in NHLBI heart failure studies. The rates of enrollment of women in studies of hypertension and coronary artery disease did more closely match the number of women in the population with such health conditions. "The pattern of enrollment of women in studies of coronary artery disease and hypertension is encouraging, but improvement is needed in other areas," according to study authors Pamela Douglas, MD, of the University of Wisconsin School of Medicine (Madison, Wisconsin), and David Harris of Yale University (New Haven, Connecticut).

Despite National Institutes of Health policies requiring enrollment of women in proportion to their disease rates, the report concludes that there have been "no substantial increases in the proportion of women enrolled in mixed-sex trials over the past 30 years."

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