New research presented at the 2011 annual Scientific Sessions of the American Heart Association from November 12-16 in Orlando addressed cardiovascular imaging, epidemiology, prevention, genetics, surgery, and more. The features below highlight just some of the studies that emerged from the conference.
» Vitamin C & Outcomes in Heart Failure Patients
» Elective PCI at Experienced Hospitals
» Customized Consent Forms Improve Patient Understanding
» Adherence to Sudden Cardiac Death Screening Guidelines for Athletes
» Lowering the Risk of Future Events in ACS
The Particulars: In clinical studies, rehospitalization rates for patients who have undergone colorectal surgical procedures are as high as 40%. Predicting rehospitalization rates in this patient group may help reduce the burden on the healthcare system.
Data Breakdown: In a study, heart failure patients with low vitamin C intake were 2.4 times more likely to have higher levels of inflammation and high sensitivity C-reactive protein (hsCRP) when compared with those who had high vitamin C intake from food. Patients with low vitamin C intake and hsCRP over 3 mg/L were twice as likely to die from cardiovascular disease during 1 year of follow-up.
Take Home Pearls:Higher levels of inflammation and higher risk of cardiac complications and death appear to be associated with low levels of vitamin C in heart failure patients.
Elective PCI at Experienced Hospitals [back to top]
The Particulars: Guidelines from the American College of Cardiology and the American Heart Association recommend that elective PCI be performed at hospitals with on-site cardiac surgery facilities. The need for emergency surgery during PCIs has dropped drastically in recent years due to a drop in complications.
Data Breakdown: Researchers assigned patients to have elective PCI at a hospital with cardiac surgery capabilities or a hospital without such capabilities. At 6 weeks, the death rate was under 1% for both patient groups. Neither group was more likely to require emergency heart bypass surgery.
Take Home Pearls: At hospitals without heart surgery capabilities, patients who undergo nonemergent angioplasty or stent implantation appear to fare as well as those who undergo the procedures at hospitals with heart surgery capabilities. Nine-month data from the study are expected to be available in early 2012.
Customized Consent Forms Improve Patient Understanding [back to top]The Particulars: Standard informed consent forms typically contain generic information without customized risks based on patients’ individual clinical characteristics. A customizable consent form could assist clinicians by allowing for more personalized medicine.
Data Breakdown: In a study, patients scheduled for PCI received either standard consent forms or forms generated through a web-based tool that allows physicians to enter patients’ specific health information and execute a complex prediction model. Those who received personalized consent forms, when compared with those who received standard forms, were more likely to read the form (72% vs 45%) and to understand the information (52% vs 31%). They were also more likely to feel that treatment descriptions and complications were clear and felt less nervous about the procedure.
Take Home Pearl: Patients scheduled for PCI appear to benefit when they receive easy-to-understand consent forms with pictures and personalized information. These web-based forms appear to enable physicians to include individualized risk factors and put patients at ease more so than with traditional forms.
Adherence to Sudden Cardiac Death Screening Guidelines for Athletes [back to top]
The Particulars: Research indicates that one in every 30,000 to 50,000 high school athletes die per year from out-of-hospital sudden cardiac arrest. The American Heart Association issued guidelines for sudden cardiac death screening of athletes in 1996 and re-affirmed them in 2007. The level of compliance with these guidelines is relatively unknown.
Data Breakdown: : A survey of 1,113 pediatricians and family physicians and 317 high school athletic directors found that fewer than 6% of physicians appear to fully follow guidelines for screening for sudden cardiac death in athletes. Less than half of the physicians and only 6% of athletic directors reported that they were aware of the guidelines.
Take Home Pearl: Few physicians appear to be aware of and follow national guidelines for sudden cardiac death screening during physicals for high school athletes. Improved education and policies may increase awareness and compliance with the guidelines.
Lowering the Risk of Future Events in ACS [back to top]
The Particulars: The rate of repeat heart attack, stroke, or death at 1 year following acute coronary syndrome (ACS) hospitalization is 10% or higher, according to previous research. These patients produce too much thrombin, the clot-forming enzyme targeted by the drug rivaroxaban.
Data Breakdown: An analysis was conducted to compare patients who did not receive rivaroxaban added to standard treatment with patients who did. Following hospitalization for ACS, patients treated with rivaroxaban plus standard treatment had a 16% reduced risk of cardiovascular death, stroke, or heart attack. Risks of death and stent thrombosis were reduced by more than 30% and 31%, respectively, among those in the rivaroxaban treatment arm. Patients who took rivaroxaban, however, experienced significantly more major bleeding. Rates of fatal bleeding were similar in the two patient groups.
Take Home Pearls: In patients hospitalized for ACS, rivaroxaban appears to reduce the risk of death, heart attack, and stroke. However, those receiving rivaroxaban appeared to be more likely to experience major, non-fatal bleeding than those who did not receive it.