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The Impact of Chronic Lung Disease in MI

The Impact of Chronic Lung Disease in MI

Chronic lung disease (CLD)—including COPD, chronic bronchitis, and emphysema—is common, presenting in approximately one in seven patients presenting with myocardial infarction (MI). Patients with CLD are more likely to die or be hospitalized from cardiovascular disease than from any other disease. Despite this knowledge, few studies have explored the influence of CLD on patient management and outcomes following MI. Gaining a better understanding of this relationship could lead to opportunities for improving quality of care and outcomes for CLD patients. Treatments & Mortality for Chronic Lung Disease In a study published in the American Heart Journal, my colleagues and I utilized the National Cardiovascular Data Registry to determine the association of CLD with treatments and adverse events after MI. Our results showed that CLD patients presenting with non-STEMI had a 20% increased risk for in-hospital death when compared with those who did not have CLD. No such link, however, was found among CLD patients with STEMI. In addition, CLD patients with non-STEMI were markedly less likely to receive invasive procedures, such as cardiac catheterization, PCI, or CABG surgery. They were also slightly less likely to receive evidence-based medical therapies, including thienopyridines, β-blockers, and statins. Conversely, differences in treatment of STEMI patients with CLD were not clinically significant, according to findings in our investigation. Taking a Closer Look at Bleeding Risks This is also the first study to our knowledge indicating that, independent of other factors, CLD patients had a 20% to 25% higher risk of bleeding when compared with those without CLD. Major bleeding is one of the most common in-hospital complications following acute coronary syndromes and is associated...

Improving Survival After Heart Failure

Heart failure (HF) is among the leading causes of hospitalization in the United States, afflicting more than 5.8 million men and women each year. The disease has been associated with substantial morbidity, mortality, and healthcare expenditures. The 5-year mortality rate for HF has been estimated at more than 50%, and roughly $40 billion is spent annually in costs related to HF. Previous studies have shown that there are gaps, variation, and disparities in the use of evidence-based, guideline-recommended therapies for HF. Regardless of the clinical setting, many eligible HF patients do not receive one or more of the therapies that have been proven to be effective in reducing all-cause mortality in clinical trials and analyses. Non-adherence to recommended HF therapies can significantly reduce quality of life and lifespan in sufferers with the disease. Examining Benefits of Proven HF Therapies A study published in the February 21, 2012 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Diseases evaluated the individual and incremental benefits of guideline-recommended therapies. “While certain therapies are recommended for HF patients in national guidelines from the American College of Cardiology and the American Heart Association, our study was the first to examine the specific incremental contribution of each of these therapies in improving survival when combined in a real-world clinical practice,” says Gregg C. Fonarow, MD, who was the lead author on the investigation. The study by Dr. Fonarow and colleagues utilized a nested case-control design that included HF patients who were enrolled in the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) cohort. The analysis involved 1,376...

Revised Guidelines for Evidence-Based PCI

Over the last decade, significant advances and innovations have rapidly evolved in the use of PCI for patients with coronary artery disease (CAD). The American College of Cardiology (ACC)/American Heart Association (AHA), together with the Society for Cardiovascular Angiography and Interventions (SCAI), released a revised clinical guideline for the management of CAD patients undergoing PCI. Published in the December 6, 2011 Journal of the American College of Cardiology, the update emphasizes careful selection of CAD treatment and includes the most extensive section to date on revascularization. The Heart Team Concept for PCI and CABG “The heart team includes an interventional cardiologist and a cardiac surgeon who review patient history and anatomy, discuss whether PCI and/or CABG are appropriate, and explain these options in detail with patients before a treatment option is chosen,” says Glenn N. Levine, MD, who chaired the ACC/AHA/SCAI guideline writing committee. The guidelines include a Class I recommendation for utilizing a heart team approach in patients with unprotected left main CAD and/or complex CAD in cases where the optimal revascularization strategy is not straightforward. New Section on CAD Revascularization For the first time ever, the CAD revascularization section was developed through a collaboration that involved experts from the ACC, AHA, and SCAI on both PCI and CABG. According to the guidelines, CABG is recommended for improving survival in patients with significant left main coronary artery stenosis, as well as those with significant stenoses in three major coronary arteries or in the proximal left anterior descending artery and one other major coronary artery. CABG or PCI is recommended for survivors of sudden cardiac death with presumed ischemia-mediated...
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