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Evaluating & Managing Patients With Congenital Heart Disease

Survivors of congenital heart disease (CHD) are at greater risk for neurodevelopmental issues from both biological and environmental risk factors when compared with heart-healthy children. As survival rates in CHD have improved, the focus of clinical research has transitioned from striving for short-term survival to enhancing long-term morbidity. How common is neurodevelopmental impairment? View figure. A New Scientific Statement on CHD In the July 30, 2012 online issue of Circulation, my colleagues and I from the American Heart Association (AHA) released a scientific statement reviewing factors that increase risk for developmental disorders in those with CHD. The statement provides an algorithm for treating these developmental disabilities and stratifies risk; age-based management of CHD patients is also reviewed. The statement also discusses the impact of developmental disorders on quality of life for these individuals. A key recommendation is that children born with CHD should receive early evaluation for related neurodevelopmental disorders. High-risk patients should be referred for further developmental and medical evaluation. Developmental disorders can be identified and managed with continuous surveillance, appropriate screening, early evaluation, periodic reevaluation, and continuous, comprehensive treatment coordinated by a central care provider. Other recommendations include: Establishing a “medical home” to coordinate care between various specialists. Reassessing risk of developmental disorders each time the medical home is visited. Referring high-risk patients with CHD for early interventions before developmental disorders are formally diagnosed. Conducting periodic re-evaluations throughout infancy and childhood at 1 to 2 years, 3 to 5 years, and 11 to 12 years of age for developmental disorders in children with CHD deemed high risk. Considering potential benefits from higher-education or vocational counseling when high-risk...

Few STEMI Patients Take Preventive Therapies

Despite the apparently high prevalence of cardiovascular risk factors among patients hospitalized for STEMI without known coronary heart disease (CHD), preventive therapy appears to be low, according findings from to a cohort analysis. Only 24.1% of patients in the analysis were on aspirin, 16.1% were on a statin, and 7.8% were on both. The authors noted that 70% of their STEMI population did not have known CHD before their event, and slightly more than 40% of those events would be considered premature. Abstract: American Heart Journal, July 18, 2012...

Subclinical Hyperthyroidism-Associated Risks

Endogenous subclinical hyperthyroidism appears to be associated with increased risks of coronary heart disease (CHD) mortality and incident atrial fibrillation (AF). A large international investigation found that participants with subclinical hyperthyroidism had a 14.5% risk of total mortality and a 41.5% risk for AF. Risks for CHD mortality and AF were highest among those with thyrotopin levels lower than 0.10 mIU/L. Abstract: Archives of Internal Medicine, May 28,...

Conference Highlights: ACC.12

New research was recently presented at ACC.12, the annual scientific meeting of the American College of Cardiology, from March 24-27 in Chicago. The features below highlight just some of the studies that emerged from the meeting. Angioplasty Safe at Community Hospitals Should LDL Be Targeted Early in Life? Improving BP Control With Telemedicine A Checklist to Reduce HF Readmissions Visualization Encourages Statin Adherence & Lifestyle Changes Improving the Quality of ACS Care Angioplasty Safe at Community Hospitals The Particulars: Community hospitals without cardiac surgery units have traditionally performed angioplasties only in emergency situations. Patients needing elective angioplasty have typically been transferred to hospitals with on-site cardiac surgery units. A recent guideline from the American College of Cardiology and American Heart Association questioned the need for such transfers. Data Breakdown: In a study, nearly 19,000 patients were randomized to undergo elective angioplasty at a facility with on-site cardiac surgery or at one of 60 community hospitals that had undergone special preparations to perform angioplasty. No differences were observed in death rates between the two facility types. Furthermore, no significant differences were seen in rates of complications, such as bleeding, renal failure, and stroke. Take Home Pearl: With appropriate preparation, community hospitals without on-site cardiac surgery units appear to have the capability to safely and effectively perform elective angioplasty. Should LDL Be Targeted Early in Life? The Particulars: Patients with high LDL cholesterol often do not begin treatment to lower their LDL levels until after coronary heart disease (CHD) has been quietly developing for years. Coronary atherosclerosis begins early in life. It has been hypothesized that lowering LDL at a younger...
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