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ACC 2015

ACC 2015

New research was presented at ACC.15, the annual scientific sessions of the American College of Cardiology, from March 14 to 16 in San Diego. The features below highlight some of the studies that emerged from the conference. CPAP Decreases Acute HF Rehospitalization Rates The Particulars: Prior research has identified sleep-disordered breathing in heart failure (HF) as a significant risk factor for patients with different forms of HF that can impact clinical outcomes. However, data are lacking on whether compliance with continuous positive airway pressure (CPAP) treatment influences readmission rates among patients with acute HF and sleep apnea. Data Breakdown: Patients who had been hospitalized for HF and determined to have sleep apnea within 4 weeks of discharge were examined for a study. Among those who were compliant with their CPAP treatment, average pulmonary artery systolic pressure levels decreased, whereas non-compliant patients experienced an increase in these levels. The average number of rehospitalizations decreased by 0.8 visits from baseline to 6 months follow-up in the compliant group but increased by 1.1 visits in the non-compliant group. Take Home Pearl: Compliance with CPAP therapy appears to reduce 6-month readmission rates among patients with acute decompensated HF who are found to have sleep apnea shortly after being discharged from the hospital. Sedentary Behavior & Coronary Artery Calcification The Particulars: Physical activity has been shown to have multiple cardiovascular benefits in numerous studies, but no definitive relationship has been shown between physical activity and coronary artery calcification (CAC). Little is known about the relationship between sedentary behavior and CAC, independent of physical activity. Data Breakdown: For a study, researchers analyzed data on more...
Treating Anemia in Heart Disease Patients

Treating Anemia in Heart Disease Patients

Studies indicate that anemia occurs in about one-third of patients with congestive heart failure and up to 20% of those with coronary heart disease (CHD). The condition has been linked to an increased risk for hospitalizations, decreases in exercise capacity, a poorer quality of life, and higher mortality. The risks and benefits of treating anemia in patients with heart disease are important to understand. Providing Guidance In the Annals of Internal Medicine, the American College of Physicians (ACP) published guidelines that presented the current evidence and provided clinical recommendations on the treatment of anemia and iron deficiency in adults with heart disease. The guideline was based on a review of the literature on anemia and iron deficiency published from 1947 to 2013. The first recommendation made in the guideline was to use a restrictive red blood cell transfusion strategy (trigger hemoglobin threshold of 7 to 8 g/dL, compared with a higher hemoglobin level) in hospitalized patients with CHD. “When compared with a restrictive transfusion strategy, there is low-quality evidence that showed no benefit of using a liberal transfusion strategy in which the trigger threshold for hemoglobin levels was greater than 10 g/dL,” says Amir Qaseem, MD, PhD, who was lead author of the ACP guideline. “This strategy will likely be a slight shift from the aggressive approaches clinicians have used in the past.” ACP also recommends against the use of erythropoiesis-stimulating agents (ESAs) in patients with mild-to-moderate anemia and congestive heart failure or CHD. “This is a strong recommendation that was made on moderate-quality evidence,” says Dr. Qaseem. “We found that the harms of treating patients with mild-to-moderate anemia...

Drug Wars in the Exam Room

As physicians, we have all been faced with patients inappropriately looking for prescriptions for controlled substances. Some are looking to abuse them and some to divert them for profit. It is often hard to distinguish when a patient truly needs these medications or when they are just “drug-seeking.” More experienced doctors have a better sense of which patients are which. Drug-seeking patients often play on our emotions because they know we generally care about patients and may have difficulty turning down a request for opioids from someone in supposed pain. For years, patients have used many ruses to access these medications. Many of them “doctor shop,” use several pharmacies, or frequent various emergency rooms, making it difficult to track their prescriptions. And it’s much harder for a doctor to turn down a request from a new patient in acute pain than from one the doctor knows well and doubts. Having so many controlled substances available and sold on the streets has led to an increase in prescription drug dependency. These patients have a hard time breaking these addictions and often can only stop with help from special rehab programs. It has led to a further resurgence of IV heroin addiction and opioid deaths in many areas. As the states have tightened controlled substance prescriptions, they have become less available for diversion and are now a gateway drug to heroin—which is cheaper than prescribed medications. I am seeing teens in my practice addicted to IV heroin, a habit that started by raiding parents’ or relatives’ medicine cabinets. It has never been more imperative for doctors to step up and do...
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