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
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.
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 age may produce strong reductions in CHD risk.
Data Breakdown: Researchers used genetic data to conduct a series of “natural” randomized controlled trials involving over 1 million study participants. They studied the effects of nine single-nucleotide polymorphisms (SNPs) that have been associated with lower levels of LDL. Each SNP was allocated randomly at conception, making inheritance of one of these SNPs much like being randomized to LDL-lowering treatment at birth. All nine SNPs assessed in the investigation were associated with a 50% to 60% CHD risk reduction for each 1 mmol/L lower lifetime exposure to LDL cholesterol.
Take Home Pearl: Lowering LDL early in life appears to result in a significant CHD risk reduction.
The Particulars: Hypertension is an important risk factor for cardiovascular disease. Use of an internet-based, patient–physician communication system that can help lower blood pressure (BP) may reduce future cardiovascular risk.
Data Breakdown: Hypertensive patients from two medical centers were randomized to receive usual care or telemedicine with usual care. Using a web-based portal, those in the telemedicine group reported BP readings more frequently and received more timely treatment decisions and medication adjustments from healthcare providers when compared with the usual care group. Non-diabetic patients in the telemedicine group had lower BPs than all other patients.
Take Home Pearl: When used in patients with hypertension, an internet-based telemedicine system appears to lead to more timely treatment decisions when compared with standard care.
The Particulars: Heart failure (HF) costs approximately $29 billion each year, and HF-related hospitalizations have been estimated to cost $2,084 per patient per day. Although 30-day readmissions are high for HF, hospitals may not be reimbursed for readmissions within 30 days under the Affordable Care Act. A cost-effective method for lowering HF-related readmissions is needed.
Data Breakdown: Investigators in a study tested a 27-item checklist containing interventions needed by HF patients. The checklist was utilized by clinicians at discharge. Among patients who were administered the checklist, 30-day readmission rates decreased from 20% to 2%. Readmissions remained lower when assessed again at 6 months post-discharge for those receiving the intervention.
Take Home Pearl: A 27-item, HF-specific checklist appears to significantly lower 30-day readmission rates when used during discharge of HF patients.
The Particulars: Adherence to statin therapy is key to providing optimal and cost-effective care for patients in need of cholesterol-lowering medication. Providing visual images of patients’ own arteries may motivate them to adhere to statin therapies.
Data Breakdown: A research team conducted a study in which they allowed patients on statin therapy to view their own cardiac CT scan results. Those with higher coronary artery calcium (CAC) scores were significantly more likely to adhere to treatment than those who did not view their results. In a second study, patients underwent two cardiac CT scans and were able to view the resulting images. As CAC scores increased, so too did the percentage of weight loss between the two scans.
Take Home Pearl: Patients who are permitted to view CT scans displaying calcium lining in their arteries appear to be motivated to adhere to statin therapy and make important lifestyle changes.
The Particulars: At some facilities, the uptake of evidence-based practices for acute coronary syndrome (ACS) may be lacking. Implementing a quality improvement (QI) program may increase use of evidence-based therapies and reduce major cardiovascular events in patients with ACS.
Data Breakdown: Brazilian researchers studied the use of a QI program that included 1) educational materials explaining recommendations for clinical care, 2) a trained case manager responsible for ensuring that all the recommended interventions were used appropriately, 3) reminder systems, and 4) practical training. At hospitals where the program was implemented, 67.9% of eligible patients received all recommended acute interventions, compared with 49.5% of those at hospitals that did not participate in the program.
Take Home Pearl: A program designed to improve the quality of ACS care appears to increase adherence with evidence-based practices.
Readings & Resources (click to view)
For more information on these studies and others that were presented at ACC.12, go to http://www.acc2012.org/.