Okay, now for some catchup
May. 17th, 2007 08:01 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
bunrabImplantable Defibrillators Offer Heart Patients a Better Quality of Life: StudyApril 12 -- Implantable cardioverter-defibrillators (ICDs) help heart disease patients live longer, lead more active lives and enjoy a quality of life comparable to that of average Americans.
That's the conclusion of a new study by researchers at the University of Pennsylvania School of Medicine.
It also concluded that patients with ICDs -- electronic monitoring devices that deliver a lifesaving shock to the heart in the event of cardiac arrest -- have a high level of satisfaction with the units, a finding that offsets longstanding perceptions that ICDs extend, but seriously impair, patients' lives.
Among the study's findings:
- Patients reported high levels of emotional, physical and functional well-being and said they were satisfied and able to adapt to living with the ICD.
- Driving, lifting heavy objects and sexual activity were the most common lifestyle concerns among ICD patients. This suggests that doctors should discuss these issues with patients.
The study is published in the April issue of the journal Pacing and Clinical Electrophysiology.
The researchers said their study is the first to look at quality of life and cost in "primary prevention" ICD patients -- those who have no prior history of abnormal heart rhythms but whose heart disease may increase their risk of sudden cardiac death.
"While the lifesaving benefits of ICDs have been well documented over the last decade, little was known about the experience of patients in the real world, post implantation," study author Dr. Peter Groeneveld, assistant professor of general internal medicine, said in a prepared statement.
"This study looked at a population that better represents current device recipients, which, in turn, means that physicians can now communicate a more accurate description of life with the device to patients," he said.
Nearly 50,000 surgeries to implant ICDs were done in the United States in 2005.
SOURCE: University of Pennsylvania School of Medicine, news release, April 5, 2007
Publish Date: April 12, 2007
Next,Patient Questionnaire Can Gauge Heart Failure RiskApril 10 -- A 23-item questionnaire may help doctors identify heart failure patients at greatest risk of death or hospitalization, according to a study in the journal Circulation.
The study of 1,358 patients found that every five-point drop in score on the Kansas City Cardiomyopathy Questionnaire (KCCQ) was associated with a 12 percent increased risk of cardiovascular death or hospitalization and an 11 percent increased risk in all-cause death.
The patients filled out the questionnaire four times: one month, three months, six months and a year after they developed heart failure.
Among the questions on the KCCQ:
- Over the past two weeks on average, how many times has shortness of breath limited your ability to do what you wanted?
- Compared with two weeks ago, have your symptoms of heart failure (shortness of breath, fatigue or ankle swelling) changed?
- Heart failure symptoms can worsen for a number of reasons. How sure are you that you know what to do, or whom to call, if your heart failure gets worse?
- Over the past two weeks, how much has your heart failure limited your enjoyment of life?
The KCCQ was developed by Dr. John Spertus, director of outcomes research at the Mid-America Heart Institute, professor of medicine at the University of Missouri-Kansas City and adjunct professor of medicine at Washington University in St. Louis. Spertus, who owns the copyright to the KCCQ, was senior author of the study.
"Physicians who treat the nearly five million heart failure patients in this country have been looking for a rule of thumb to help determine which patients might benefit from the most aggressive care, and this one looks promising," Spertus said in a prepared statement.
"The Kansas City Cardiomyopathy Questionnaire is low-cost, non-invasive, easy to administer and quantifies patients' perspectives on their heart failure. It takes five to eight minutes to complete, and the data can be put in an Excel spreadsheet, so physicians can graph changes over time," Spertus said.
The study was funded by Pfizer, Inc. The authors of the paper disclosed financial ties to industry, such as consultancies, honoraria or grant support from Pfizer, Amgen, Lilly and other pharmaceutical companies.
SOURCE: American Heart Association, news release, April 9, 2007
Publish Date: April 10, 2007
Followed byProtein Monitoring Improved Heart Failure TreatmentApril 19 -- A trial that used blood levels of a biomarker called brain natriuretic peptide (BNP) to guide treatment of heart failure more than halved the incidence of death or hospitalization for the condition over 15 months, French cardiologists report.
Just 24 percent of the 110 trial participants whose drug treatment was adjusted according to BNP levels reached those critical end points of death or hospitalization. That compared to 52 percent of those who did not get BNP monitoring.
There were seven deaths from heart failure in the BNP-monitored group, compared to 11 in the non-monitored patients. The overall incidence of hospitalization was about the same in both groups, but just 22 hospital stays due to heart failure complications in the monitored group compared to 48 among patients whose BNP levels were not monitored.
The major difference in medical treatment was use of higher doses of beta-blocker and ACE inhibitor drugs in the BNP-monitored group, the researchers said.
BNP is a protein produced by the muscle cells of the heart ventricles as a response to excess stretching of those cells. Tests of BNP blood levels are used to help diagnosis heart failure, a condition in which the heart progressively loses its ability to pump blood, and to assess the prognosis for people with heart failure. Most drugs used to treat heart failure lower BNP levels.
The study participants, whose average age was 65, had essentially similar symptoms at the start of the trial, although those in the BNP-monitored group had a slightly lower average ejection fraction, which measures the heart's blood-pumping ability.
The findings are published in the April 24 issue of the Journal of the American College of Cardiology.
"This is an important study, because it provides additional information about the role that BNP measurement can play in helping physicians adjust treatment for heart failure," said Dr. Gregg C. Fonarow, co-director of the University of California, Los Angeles, Preventive Cardiology Program. "Many medications can be used to treat heart failure, and guiding those medications can be an art. This trial shows that, beyond standard care, BNP monitoring allows better adjustment of medications," Fonarow said.
Dr. Marvin A. Konstam, chief of cardiology at Tufts-New England Medical Center in Boston, agreed. "This is helpful information. It begins to build a case that monitoring BNP can facilitate medication adjustment for better outcome."
But it was a relatively small study, both Konstam and Fonarow said, and the final word is yet to come. "Additional trials involving more centers will be needed to confirm these findings," Fonarow said. "This is helpful additional information, but we need those additional trials before we can routinely recommend BNP monitoring."
At least two such trials are now under way, Konstam said, with results expected before long.
Konstam had one word of caution about the French results. The trial was not "blinded," meaning the doctors knew which patients were being monitored for BNP levels, and that knowledge might have affected their mode of treatment, he said. "It is a significant possibility and one that has to be clarified," he said.
SOURCES: Gregg C. Fonarow, M.D., co-director, University of California, Los Angeles, Preventive Cardiology Program; Marvin A. Konstam, M.D., chief, cardiology, Tufts-New England Medical Center, Boston; April 24, 2007, Journal of the American College of Cardiology
Publish Date: April 19, 2007
And,New Drug Fails to Improve Odds for Heart Failure PatientsMay 2 -- A new drug is no more effective at improving the survival rates of people with decompensated heart failure than a widely used medication is, a new international study has found.
Decompensated heart failure is one form of the general condition in which the heart progressively loses the ability to pump blood. It is characterized by a set of symptoms including shortness of breath and intolerance to exercise.
There were hopes that the new drug, levosimendan, would improve survival, because it uses a unique mechanism that makes heart muscle cells more sensitive to the calcium that causes them to contract. However, the study of 1,347 persons with acute decompensated heart failure, done at 75 centers in nine countries between March 2003 and December 2004, found essentially the same death rate for participants who got levosimendan as those who received an established medication, dobutamine, said a report in the May 2 issue of the Journal of the American Medical Association.
The trial leaves cardiologists without a totally satisfactory treatment for decompensated heart failure, said Dr. Robert Hobbs, a Cleveland cardiologist specializing in treatment of the condition. Some 5 million Americans have one form or another of heart failure, and about 1 million of them are hospitalized for it each year.
"The original therapy, which is still basic, is diuretics," Hobbs explained. "They make the body lose water, so people feel better. In the 1980s, ACE inhibitors came along to make people feel better and live longer, and they were added for long-term benefit. The third group of drugs to be used were beta blockers."
Dobutamine is a beta blocker that has been found to improve symptoms, but it has also been associated with an increased risk of death and cardiovascular problems. In the latest trial, participants with decompensated heart failure received levosimendan or dobutamine intravenously.
"The common practice has been to give dobutamine in the belief that the heart is like a battery that has lost its charge," Hobbs said. "By giving dobutamine, you would recharge it. That didn't actually happen [in previous studies]. It appeared to be associated with complications, longer hospital stays and more mortality."
In another previous study, careful analysis indicated that levosimendan was associated with a lower risk of death than dobutamine. "It did have the different mechanism of action, and it was felt that might translate into improved safety," Hobbs said. But it proved to be no better in the new trial.
In the 180 days after drug infusion, the death rate was 26 percent among patients who got levosimendan and 28 percent in those getting dobutamine. There was no statistical difference between other endpoints, such as incidence of breathing difficulties and days spent out of the hospital.
Participants who got levosimendan were less likely to experience cardiac failure but more likely to experience the abnormal heartbeat called atrial fibrillation, low blood levels of potassium, and headache.
"The bottom line on all of this is that it is hard to show benefit for what we do for acute decompensated heart failure," Hobbs said.
SOURCES: Robert Hobbs, M.D., cardiologist, Cleveland Clinic; May 2, 2007, Journal of the American Medical Association
Publish Date: May 02, 2007
There. More in a minute.
