New research was presented at AHA 2019, the annual Scientific Sessions of the American Heart Association, from November 16-18 in Philadelphia. The features below highlight some of the studies that emerged from the conference.
Automated EHR Screening for Familial Hypercholesterolemia
Although prior studies indicate that familial hypercholesterolemia (FH) increases risk for premature cardiovascular disease (CVD), FH is usually diagnosed after a CVD event occurs. For a study, researchers sought to determine if an electronic health record (EHR) system could identify patients with FH before CVD events occur. The team retrospectively reviewed the Cleveland Clinic’s EHR system to identify patients with premature CVD through laboratory results and ICD-10 codes. Data on physical exam findings, pertinent family history, and genetic variant testing were also gathered. Of patients identified with definite FH, 23.8% were diagnosed through ICD codes. Only 8.0% of probable FH patients were diagnosed by ICD codes. Of the total identified cases, just 7.3% were referred to medical genetics, 17.9% to preventative cardiology, and 58.0% were referred to any cardiology specialist. The study authors developed an algorithm to utilize EHR data to identify potential FH cases and aid in referring patients to CVD risk reduction and cascade testing.
Man vs. Machine: Tech in Kids
Evidence suggests that telemedicine is becoming a time- and cost-effective way to provide patients with the care they would otherwise have difficulty receiving. While experience indicates that pediatric cardiology care could increasingly benefit from the use of telemedicine,, data are lacking on the success of DTC telemedicine in this area. To assess the benefits of DTC for pediatric cardiology patients, study investigators conducted a small retrospective study of cardiology DTC visits conducted at Children’s National Health System (CNHS) over 3 years. DTC patient visits were matched to data from previous in-person visits. The study team evaluated differences in charges, insurance contributions, patient payments, percent reimbursement, and zero reimbursement. The miles between patient’s homes and address of the previous visit was also measured. After DTC visits, 38% of patients made in-person follow-up cardiology appointments for reasons unrelated to DTC limitations. No patients presented urgent cardiology-related care needs at CNHS during a median 87-day follow up. Insurance reimbursement and out-of-pocket pay for DTC visits were less than in-person visits. And no adverse outcomes were reported.
COACT at 1 Year: Later Angiography in Non-STEMI Cardiac Arrest
Research has previously been reported on 90-day outcomes of the Coronary Angiography after Cardiac ArresT (COACT) trial. The original study analyzed the outcomes of patients who survived out-of-hospital cardiac arrest without signs of ST-elevation myocardial infarction (STEMI). The trial randomized COACT secondary to ventricular tachycardia/ventricular fibrillation (VT/VF) patients with return of spontaneous circulation within 20 minutes and no evidence of STEMI to immediate or delayed coronary angiography. The initial 90-day results indicated no significant difference between the immediate and delayed group. Continued research has assessed 1-year outcomes. These data indicate that the secondary outcomes for 1 year after a COACT event had no significant differences to the 90-day trial except for a delay in achieving target body temperature during induced hypothermia in the delayed angiography group. Secondary outcomes included MI, revascularization, hospitalization due to heart failure, or implantable cardiac defibrillation shocks with the two angiography strategies. The consistent findings suggest that delaying angiography is beneficial to COACT patients, both for the short- and long-term outcomes.
Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis
With a lack of data, researchers sought to determine the optimal timing and indications for surgical intervention in asymptomatic patients with severe aortic stenosis (defined as an aortic-valve area of ≤0.75 cm2 with either an aortic jet velocity of ≥4.5 m/second or a mean transaortic gradient of ≥50 mm Hg). Participants were assigned to early aortic-valve replacement surgery or conservative care according to current guideline recommendations. Within the early surgery group, 95% underwent surgery within 2 months, with no operative mortality. A primary end-point event (a composite of death during or within 30 days after surgery [operative mortality] or death from cardiovascular causes during the entire follow-up period) occurred in 1% of patients in the early surgery group versus 15% in the conservative care group (hazard ratio, 0.09). The conservative care group had a cumulative incidence of sudden death of 4% at 4 years and 14% at 8 years. The event of operative mortality or death from cardiovascular causes was significantly lower in the early surgery group compared with the conservative care group.
Marijuana Use Linked to Stroke in Young People
The number of states legalizing the use of marijuana is increasing, with little research on associated medical effects. To determine if there is a link between marijuana use and stroke risk in young adults, researchers analyzed data from the Behavioral Risk Factor Surveillance System for young adults aged 18-44. Participation was voluntary, and interviews were conducted by phone call. Interview questions covered marijuana use and stroke history. Compared with non-marijuana users, participants who self-reported recent (last 30 days) marijuana use had an 82% higher risk of stroke (odds ratio [OR], 1.82). The odds ratio was even higher for those who reported marijuana use more than 10 days per month (OR, 2.45). For participants who reported combustible cigarette and e-cigarette use, the risk was even higher (OR, 3.12 and 2.63, respectively). The study authors noted that recent studies indicate that heavy and chronic marijuana use can lead to other medical conditions that increase the risk of stroke, such as multifocal intracerebral vasospasm, multifocal intracranial stenosis, cardiac embolization, systemic hypotension, altered vasomotor function, other cerebrovascular dysfunctions, and procoagulant effects on platelets.