by Physicians Weekly | Nov 29, 2012
About 8 million people in the United States have peripheral artery disease (PAD), a condition that, if left untreated, increases heart attack and stroke risks, severely limits walking ability, and causes tissue death requiring limb amputation. The prevalence of PAD is nearly equal between men and women (Figure). Only about 10% of individuals with PAD experience classic, recognized exertional claudication, and many people experience no symptoms at all. As a result, few individuals with PAD receive prompt diagnosis or treatment. “The mortality rate and healthcare costs associated with PAD are comparable to those of heart disease and stroke,” says Alan T. Hirsch, MD. “Women, in particular, suffer an immense burden from PAD, but current data suggest that most women remain unaware of their risk. PAD continues to go largely unrecognized and untreated in women.” An Important Scientific Statement on PAD In the March 20, 2012 issue of Circulation, the American Heart Association (AHA), in collaboration with the Vascular Disease Foundation and the P.A.D. Coalition, released a scientific statement on women and PAD. It recommends that healthcare providers proactively increase awareness of and test women at risk for PAD. It also calls for more women-focused research into the disease. “There is a great need to identify women with PAD and those who are at risk for it, especially African-American women, so that we can help lower cardiovascular ischemic event rates,” says Dr. Hirsch, who was the chair of AHA writing group that developed the call-to-action statement. “This may also reduce the loss of independent functional capacity and ischemic amputation rates.” He notes that women in the United States already attend...
by Physicians Weekly | Jun 14, 2010
The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have updated their guidelines on the diagnosis and management of heart failure (HF). Published jointly in the April 14, 2009 issues of Circulation and the Journal of the American College of Cardiology, the new document revised guidelines previously released in 2005. They reflect the latest research findings on the management of HF, a condition that affects approximately 5.7 million Americans. “The purpose of the guideline update is to provide clinicians with recommendations for care using the best-available evidence,” says Mariell Jessup, MD, FACC, FAHA, who chaired the ACCF/AHA writing committee that updated the guidelines. “The new recommendations are based on randomized clinical trials and important registry data whenever possible.” Key Revisions Among several key updates, the new guidelines incorporate recommendations about the management of acute HF in the hospitalized patient. In addition, the document includes concrete recommendations on the use of a fixed-dose combination of hydralazine and isosorbide dinitrate. The recommendation concerning hydralazine and isosorbide dinitrate was strengthened based on findings from the A-HeFT (African-American Heart Failure Trial) trial. “The complete evidence resulting from A-HeFT was not available at the time of the publication of the last guidelines in 2005,” says Dr. Jessup. “We therefore felt it was important to strengthen the recommendation to Class I so that all self-identified African Americans who remained symptomatic despite optimal medical therapy would be offered the hydralazine/isosorbide dinitrate combination.” In order to keep recommendations in alignment with those from the ventricular arrhythmia guidelines published by the ACCF/AHA, the document also clarifies previous recommendations surrounding the use of implantable cardioverter...
by Physicians Weekly | May 17, 2010
Pulmonary arterial hypertension (PAH) is a complex, multidisciplinary disorder resulting from restricted flow through the pulmonary arterial circulation; this results in increased pulmonary vascular resistance and, ultimately, right heart failure. PAH has been thought of as a rare disease, but recent evidence suggests that the incidence may be higher than what has been previously reported. The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) issued their first expert consensus document on PAH. Published in both the April 28, 2009 issues of Circulation and the Journal of the American College of Cardiology, the guideline is intended to inform practitioners about the evolving areas of clinical practice and/or technologies widely available. The document also includes a table on prognostic factors for PAH in addition to diagnostic and treatment algorithms. The Details of PAH The prognosis of PAH is poor, with about a 15% mortality rate within 1 year on modern therapy. The ACCF/AHA guideline outlines predictors of a poor prognosis, including advanced functional class, poor exercise capacity, high right atrial pressure, significant right ventricular (RV) dysfunction, RV failure, low cardiac index, elevated brain natriuretic peptide, and the scleroderma spectrum of diseases. Idiopathic PAH (IPAH) appears to be the most common type of PAH; it’s more common in younger women who tend to present with nonspecific symptoms (eg, shortness of breath or fatigue). Familial PAH is often the result of a mutation in the BMPR2 gene, which is found in up to 25% of patients with IPAH. PAH is also associated with: Congenital heart disease. Connective tissue diseases. Drugs and toxins. HIV. Portal hypertension. Hemoglobinopathies. Patients with a...
