Metabolic Syndrome, Catheter Ablation, & AF

Atrial fibrillation (AF) is increasingly being viewed by clinicians as a modern-day epidemic, affecting more than 2.2 million adults in the United States. AF is strongly age-dependent, affecting 4% of people older than 60 and 8% of those older than 80. Alarmingly, about one-quarter of people aged 40 and older are expected to develop AF during their lifetime. Another growing problem is the continued emergence of metabolic syndrome (MS), which is estimated to affect 21% to 24% of U.S. adults. Coexistence of MS and AF is common. Studies suggest that different components of MS, including hypertension, diabetes, dyslipidemia, and obesity, increase the likelihood of AF. Catheter ablation has been a major treatment advance for the condition, offering a new spectrum of options for drug-refractory AF patients. However, this procedure is yet to be a total success in maintaining long-term sinus rhythm, even in the best hands. Little is known about the role of MS on the long-term outcome of AF ablation, such as restoration of sinus rhythm and improvement in quality of life (QOL). Taking a Deeper Look at Atrial Fibrillation In the April 3, 2012 Journal of the American College of Cardiology, we had a study published that prospectively analyzed 1,496 patients with AF who were undergoing a first ablation. About 45% of our study group had long-standing persistent AF, while 29% had paroxysmal AF and 26% had persistent AF. Patients were classified as either having MS or not having MS. They were followed for AF recurrence and QOL at 12 months after their ablation procedure. At follow-up, 39% of patients with MS had experienced arrhythmia recurrence, compared...
Surrogate Use in Diabetes: Compromising Care?

Surrogate Use in Diabetes: Compromising Care?

A recent analysis published in BMJ finds that the widespread use of surrogate endpoints in diabetes care puts the patient’s concerns on the back burner. The authors argue that easier-to-measure surrogate outcomes are often used instead of outcomes important to patients, such as death, quality of life, or functional capacity when assessing treatments.  Diabetes care is largely driven by surrogates. Concentrations of glycated haemoglobin (HbA1c) are used as a surrogate marker for outcomes that are important to patients, such as blindness or amputation. Blood pressure, lipids, albumin excretion rates, and C-reactive protein are other surrogates physicians use to predict outcomes of cardiovascular disease and to guide clinical practice. However, according to the authors, “much of the evidence for clinical interventions is based on their effect on surrogate outcomes rather than those that matter to patients, such as quality of life or avoidance of vision loss or renal failure.” Surrogates for outcomes such as glucose, lipid, and blood pressure thresholds are also used to evaluate quality of healthcare and influence reimbursements. Focus may then fall on reducing the level of the surrogate, regardless of the impact on a patient’s outlook. The authors maintain that these markers “begin to take on an existence of their own as new disease entities.” Physician’s Weekly wants to know… Do you feel there is too much focus on surrogate use? Does surrogate use treat the individual as a biological being rather than a human?   |...