New research was presented at AHA 2015, the American Heart Association’s annual Scientific Sessions, from November 7 to 11 in Orlando. The features below highlight some of the studies that emerged from the conference.
Gender & Salary in Cardiology
The Particulars: Research has shown that women are paid less than men across numerous professions. However, little is known about how salaries differ by gender among cardiologists, particularly after controlling for various job factors.
Data Breakdown: For a study, researchers assessed self-reported salaries of more than 2,500 cardiologists in 2013. Women had an average salary of $400,162, compared with an average salary of $510,996 for men. Women worked significantly fewer half-days, and fewer women worked full time. However, based on measured job and productivity characteristics, the researchers expected women to have an average salary that was more than $30,000 higher than what was actually observed. For most services evaluated in the study, procedure volumes were similar for men and women who performed at least five of those services in the previous year.
Take Home Pearl: Significant gender disparities appear to exist between male and female cardiologists.
Hypertension & Arousals of Sleep Disorders
The Particulars: Previous studies have suggested that limb movement disorders during sleep may influence cardiovascular morbidity as well as being associated with hypertension. However, few studies have investigated arousals of sleep disorders—limb movement or respiratory—and their relationship to ambulatory blood pressure monitoring (ABPM).
Data Breakdown: Study investigators reviewed data from patients who had undergone ABPM and polysomnography within 6 months of each other. Among participants, 64% had nocturnal hypertension, 32% had uncontrolled hypertension and 61% had a non-dipping pattern. Patients with nocturnal hypertension, uncontrolled hypertension, and non-dippers were more likely to have elevated arousal indices when compared with others. Limb movement index and nocturnal hypertension were both related with arousals during sleep.
Take Home Pearls: Patients with sleep disorders appear to have a high prevalence of nocturnal hypertension, non-dipping patterns, and uncontrolled hypertension. Nocturnal hypertension and limb movement appear to be associated with arousals of sleep disorders.
Characterizing Hypertensive Urgency
The Particulars: Data indicate that hypertensive urgency is commonly encountered in the outpatient setting. Little is known about the prevalence and short-term outcomes of this condition. Whether hospital management of this patient population is superior to outpatient blood pressure (BP) management has not been established.
Data Breakdown: Patients presenting to an office with systolic BP of 180 mm Hg or greater or diastolic BP of 110 mm Hg or higher were compared for a study based on whether they were sent home or referred to an emergency department (ED). No significant differences were observed in acute coronary syndrome or stroke/transient ischemic attack events (MACE) between the two groups at 7 days, 30 days, or 6 months. Patients referred to the ED were less likely to have uncontrolled hypertension at 1 month but not at 6 months; however, hypertension rates were above 80% for both groups. Patients referred to the ED also had higher admission rates at 7 and 30 days.
Take Home Pearls: The rate of MACE in asymptomatic patients with hypertensive urgency appears to be low. ED visits appear to increase hospitalizations but did not appear to lead to improved outcomes. Most patients with hypertensive urgencies appear to have uncontrolled hypertension at 6 months.
Assessing Lipid Management Strategies
The Particulars: Cholesterol guidelines published in 2013 by the American College of Cardiology (ACC) and American Heart Association (AHA) recommend statin treatment based on patients’ predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk and de-emphasize LDL-cholesterol targets. The adoption rate of these guidelines among clinicians remains unknown.
Data Breakdown: More than 500 cardiologists, primary care physicians, and endocrinologists were surveyed about their likelihood of prescribing statins in four hypothetical patient scenarios for a study. Among respondents, 73% reported primarily using the 2013 ACC/AHA guidelines to guide lipid management. However, only half reported “often” or “always” calculating 10-year ASCVD risk to aid lipid management decisions for primary prevention. Also, more than one-third reported that they would prescribe a statin to an older adult for whom the guidelines recommend statins based on 10-year ASCVD risk. Up to 40% of respondents said they would prescribe a statin to younger patients with a high LDL-cholesterol level for whom the guidelines would not recommend a statin.
Take Home Pearls: Most clinicians appear to report adoption of the 2013 ACC/AHA cholesterol guidelines. However, many report practices that are not adherent with these guidelines.
Atrial Fibrillation & Flutter in the Elderly
The Particulars: Few studies have explored the prevalence of sub-clinical atrial fibrillation (AF) and atrial flutter in elderly patients.
Data Breakdown: For a study, researchers investigated the prevalence of sub-clinical AF in patients aged 80 or older with stroke risk factors but without known AF or symptoms of arrhythmia. Participants underwent continuous, non-invasive ambulatory ECG monitoring for 30 days. Among the findings:
|Atrial flutter or AF||Percentage of patients|
|30 seconds or longer||19%|
|6 minutes or longer||15%|
|30 minutes or longer||12%|
|6 hours or longer||8%|
|24 hours or longer||2%|
Episodes of atrial tachycardia that lasted less than 30 seconds were observed in 47% of patients.
Take Home Pearls: Elderly patients with stroke risk factors appear to have a prevalence rate of 15% for atrial flutter or AF of 6 minutes or longer. Screening for AF may be warranted in this patient population.
Statins & Diabetes
The Particulars: Prior research has suggested that there may be an association between statin use and diabetes. However, these studies have not controlled for multiple covariates.
Data Breakdown: For a study, patients without diabetes who initiated statin treatment were matched with patients who did not receive a statin based on age, gender, and geographic location. The participants were then followed for 2 years. Statin exposure was associated with an increased incidence of diabetes, but the effect was only significant after patients reached 50 years of age. Among those who received statins, women and obese individuals had a higher incidence of diabetes than men and non-obese patients, respectively.
Take Home Pearl: Patients who take statins appear to have higher incidence of diabetes than patients who do not take statins, but more research is needed to better understand the mechanisms of this possible association.
Undiagnosed Diabetes & AMI
The Particulars: Studies have shown that diabetes is associated with poor cardiovascular disease (CVD) outcomes, particularly in the setting of acute myocardial infarction (AMI). However, few studies have investigated the frequency and CVD impact of a first diagnosis of diabetes or a missed diagnosis of incident diabetes among patients presenting with AMI.
Data Breakdown: Data on patients presenting with AMI between 2002 and 2013 were reviewed for a study. Patients with a history of diabetes or undiagnosed diabetes at the time of AMI had a higher risk of all-cause death, heart attack, stroke, and heart failure hospitalizations when compared with those with no history of diabetes. However, differences between diagnosed diabetes at the time of AMI and no diabetes were not significant.
Take Home Pearls: Patients with undiagnosed diabetes at the time of AMI appear to be an increased risk for poor CVD outcomes when compared with those without diabetes. These outcomes appear to be moderate if diabetes is diagnosed at the time of AMI.
BP Control in Patients With Diabetes
The Particulars: Guidelines released in 2013 recommend a target blood pressure (BP) level of less than 140/90 mm Hg for patients with diabetes. Whether controlling BP to this level effectively prevents atherosclerotic events among patients with diabetes of all ages remains unknown.
Data Breakdown: For a study, patients with diabetes were divided into four age groups and then assessed for blood pressure (BP) levels. Patients aged 65 and older and 65 to 75 with a BP of 140/90 mm Hg or higher had a significantly higher incidence of atherosclerotic events than those with lower BP levels. No such differences were observed for patients who were younger than 65 or for those aged 75 and older.
Take Home Pearl: Among patients with diabetes, achieving a BP level of less than 140/99 mm Hg appears to prevent atherosclerotic events among those aged 65 to 75.