Clinical cardiology

Acute Coronary Syndrome

Poor and Medicaid recipients with MI have longest prehospital delays

Sep 24, 2008 13:45 EDT

New research shows that those with Medicaid insurance and those living in low-income neighborhoods are less likely than their better-off counterparts to get to the hospital quickly after an acute MI. This adds to prior studies that have shown that race, sex, age, and comorbid conditions can influence the time taken to get to the hospital following AMI. (Foraker RE et al. Arch Intern Med 2008; 168:1874-1879.)

Chapel Hill, NC - A new study has found that those with Medicaid insurance and those living in low-income neighborhoods are less likely to get to the hospital within two hours of an acute MI, compared with those from higher-income areas or with better insurance [1]. Randi E Foraker (University of North Carolina, Chapel Hill, NC) and colleagues report their findings in the September 22, 2008 issue of the Archives of Internal Medicine.

As outcomes following AMI are generally more favorable if prehospital delay time is minimized, "it is imperative that we find out what is lacking in these neighborhoods that prohibits people from seeking care," Foraker told heartwire. Read full article »

(Foraker RE et al. Arch Intern Med 2008; 168:1874-1879.)

Inside: Clinical cardiology

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Clinical cardiology

Antiplatelet Therapy: When the Evidence Meets the Experience

Oct 1, 2008 10:15 EDT

The optimal management of patients with ACS is an ever-evolving process; clinical experience and practice often outpace guidelines. Watch Drs Bohm, Camm, Fox, Mehta, and Connolly address the state-of-the-art management of ACS and the role of antiplatelets in ACS and beyond.

Clinical cardiology

Thienopyridines in PCI: The lowdown on loading doses

Jun 23, 2008 11:00 EDT

Current guidelines for thienopyridines in PCI note the lack of RCT data for higher loading doses. Read Dr Wang's lowdown on loading doses, including recent presentations from the 2008 SCAI-ACCi2 meeting. Then watch Drs Mehta and Mehran discuss where CURRENT-OASIS-7 will fit in.

Clinical cardiology

Improving the Quality of Care for Heart Failure

Sep 29, 2008 10:21 EDT

An estimated nearly five million Americans experience heart failure. Studies have shown improved quality of life and life expectancy with early diagnosis and treatment. Join Drs Peterson, Hernandez, Fonarow and Piña presenting new data on improving the quality of care for patients with heart failure.

Clinical cardiology

ICD Therapy: New Data on Quality of Life and Outcomes

Sep 10, 2008 11:00 EDT

New data on quality of life and long-term prognosis after ICD implantation for primary prevention was recently published in the New England Journal of Medicine. Join Drs Bhatt, Harrington, and Prystowsky as they review this new data and discuss the clinical context of these studies.

Arrhythmia/EP

Improving Cardiovascular Outcomes in AF

2 COMMENTS - Sep 3, 2008 14:00 EDT

For all the debates on rate vs rhythm control, contemporary analyses show little change in atrial fibrillation (AF) mortality rates in the past 20 years. Will recent developments, including novel pharmacologic agents and advances in catheter ablation, translate into meaningful clinical benefit for patients? Drs Camm, Falk, Knecht, and Hohnloser each give presentations on key issues relating to the contemporary management of patients with AF.

Arrhythmia/EP

Stroke in Pharmacologically-Managed AF

Sep 3, 2008 14:00 EDT

The rate vs rhythm AF trials suggest that rhythm-managed AF patients experience more strokes possibly due to cessation of warfarin in patients with unrecognized, asymptomatic AF. Stuart Connolly presents the ESC late-breaking ATHENA findings that challenge this viewpoint and Drs Fox, Dorian, and Steg discuss the implications and possible mechanisms.

Acute Coronary Syndrome

The Science and Medicine of Circulatory Dysfunction and Acute Pressure Syndromes

Aug 18, 2008 09:37 EDT

An investigator and clinical scholar, Dr. Christopher Granger, MD, the program chairman, and his distinguished colleagues illuminate the emerging threats and clinical challenges cardiologists face when managing patients who present with, or undergo, acute, severe, serious, precipitous, and/or life-threatening elevations in systemic blood pressure.

Arrhythmia/EP

Pioneering the future: Innovations and strategies in electrophysiology and clinical cardiology

May 27, 2008 11:30 EDT

Drs Lindsay, Brugada, Gold and Stein highlight the most recent clinical trial data demonstrating the efficacy and safety of ICDs and cardiac resynchronization therapy (CRT) devices and their potential impact on clinical practice.

Clinical cardiology

Managing atherothrombotic risk: Early impact and long-term benefit of antiplatelet therapy

Oct 9, 2007 11:45 EDT

This program delivers evidence-based education, debate on the issues, data from randomized trials, observational data, and objective opinions from leaders in cardiology on the subject of antiplatelet therapies and their appropriate use in atherothrombosis.

Interventional/Surgery

Elective PCI possible without "safety net" of anticoagulation

1 COMMENT - Oct 6, 2008 17:00 EDT

Low-risk patients with uncomplicated lesions can have elective PCI safely performed using dual antiplatelet therapy without systemic anticoagulation, according to a new randomized study. An accompanying editorial begs to differ, however. (Stabile E et al. J Am Coll Cardiol 2008; 1293-1298.)

Prevention

India attempts to impose world's biggest smoking ban

Oct 3, 2008 11:30 EDT

The Indian government appears to have heeded the warnings of medical experts highlighting the immense problem of smoking in the country, with the introduction this week of a nationwide ban on smoking in public places.

Heart failure

Outcomes, quality of care largely unaffected by weekend admission for heart failure

Oct 2, 2008 18:15 EDT

The finding is contrary to what has been found for hospitalizations due to some other CV disorders. (Heart Failure Society of America 2008 Scientific Meeting.)

Clinical cardiology

Pfizer to drop development of drugs for hyperlipidemia, atherosclerosis, and heart failure

12 COMMENTS - Oct 2, 2008 17:00 EDT

UPDATED // Forbes reported the news online after obtaining an internal Pfizer memo.

Interventional/Surgery

Oct 1, 2008 17:45 EDT

Should the ACC/AHA guidelines for the management of STEMI patients extend the acceptable PCI-related delay to as long as 120 minutes? A group of Danish researchers thinks so, but Dr Elliott Antman, who cochaired the writing committee of those guidelines, disagrees. (Terkelsen CJ et al. Antman E. J Am Coll Cardiol 2008; 52:1211-1215, 1216-1221.)

Lipid/Metabolic

FDA finds no link between statin use and ALS

1 COMMENT - Oct 1, 2008 16:00 EDT

The meta-analysis, which included 41 clinical trials, revealed similar rates of ALS in the statin-treated and placebo-treated patients. The agency said further monitoring is still needed, however, because of the expansive use of the drugs and the dire consequences of this neurodegenerative disorder. (Colman E et al. Pharmacolepidemiol Drug Saf; published online September 29, 2008.)

Acute Coronary Syndrome

New study finds type of HRT is key with regard to MI risk

Oct 1, 2008 13:45 EDT

Important new information on HRT and the risk of MI has emerged from a Danish observational study, which finds that the type of HRT used could be key when it comes to the likelihood of a heart attack. (Lokkegaard E et al. Eur Heart J; published online before print September 30, 2008.)

Heart failure

Subspecialty certification on the way for specialists in advanced heart failure

Sep 30, 2008 16:30 EDT

The certification is expected to encompass the management of patients with implantable defibrillators and biventricular pacemakers, although not device insertions.

Interventional/Surgery

Miniaturized heart pumps: Difference between life and death in small children

Sep 30, 2008 15:45 EDT

Reporting on his own initial experience with a miniaturized ventricular assist device used as a bridge to transplant in small children, a leading pediatric heart surgeon is hoping that the pump—widely available in Europe—will soon be approved for use in the US. (Gandhi SK et al. Circulation 2008; 118:S89-S93.)

Clinical cardiology

Routinely screen for clinical depression in CHD, AHA formally recommends

Sep 30, 2008 09:45 EDT

Providers should take the opportunity in any setting in which they see CHD patients, according to a "science advisory" from the organization, which acknowledges a lack of direct evidence that such efforts will improve the patients' clinical outcomes. (Lichtman JH et al. Circulation 2008; published online before print September 29, 2008.)

Prevention

Eating dark chocolate reduces CRP

1 COMMENT - Sep 29, 2008 13:30 EDT

A new Italian study has shown, for the first time, that consuming moderate amounts of dark chocolate can significantly reduce CRP levels. (di Giuseppe R et al. J Nutr 2008; 138:1939-1945.)

Heart failure

Myosin-activating agent boosts systolic function, but please don't call it an "inotrope"

Sep 26, 2008 15:45 EDT

It's still in early-phase studies, but researchers hope the drug, which seems to prolong systole and enhance cardiac output without raising myocardial oxygen demand, will offer the benefits of conventional inotropic agents without their dark side. (Heart Failure Society of America 2008 Scientific Meeting.)

Brain/Kidney/Peripheral

"Consider" candesartan for diabetic retinopathy

Sep 26, 2008 10:45 EDT

Despite meeting none of the primary end points in the three DIRECT studies in diabetic retinopathy, the angiotensin receptor blocker candesartan could still be considered a treatment option in certain patients with this condition, say the trial authors and accompanying editorialists. (Chaturvedi N et al. Sjølie AK et al. Lancet; published online before print September 25, 2008.)

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