theHeart.org - Brain/Kidney/Peripheral

Latest European and US STEMI guidelines compared and contrasted

Fri, 06 Nov 2009 17:15:26 EST

The latest recommendations for the treatment of ST-elevation MI issued by American cardiology associations and the European Society of Cardiology are compared and contrasted in a new paper.

Enrollment halts in randomized trial of CPR for out-of-hospital arrest

Fri, 06 Nov 2009 16:00:39 EST

No survival differences after out-of-hospital cardiac arrest were seen at a preliminary DSMB review in the ROC PRIMED trial, which compared early vs delayed post-CPR assessment for defibrillation and tested the effectiveness of a device for optimizing intrathoracic pressure during CPR.

Serum phosphorous, kidney function predict CAC

Thu, 05 Nov 2009 17:00:00 EST

The Spokane Heart Study finds a connection between kidney function, serum phosphorus, and the risk of coronary artery calcification.

Prehospital triage "immediately successful" in boosting rates of thrombolytic therapy for stroke

Thu, 05 Nov 2009 11:00:44 EST

Toronto researchers report that a citywide prehospital protocol raised their rates of thrombolytic treatment to among the highest in North America, underlining, they say, the critical importance of organized stroke care.

Off-pump CABG shows no benefit over on-pump approach: ROOBY study

Wed, 04 Nov 2009 17:00:00 EST

A 2203-patient randomized trial of off-pump vs on-pump CABG surgery found no differences in neuropsychological outcomes and worse overall outcomes for the off-pump group at one-year follow-up.

Adding fuel to the J-curve fire; debate is reignited

Wed, 04 Nov 2009 14:30:56 EST

More discussion about the J-curve in hypertension is published this week; one expert believes the undue attention being paid to this subject might discourage doctors from treating high blood pressure aggressively.

No CV risk reduction with B vitamins posttransplant

Wed, 04 Nov 2009 13:15:27 EST

In keeping with all the other evidence showing no effects of homocysteine-lowering with B vitamins, the FAVORIT study now confirms that this lack of benefit is also seen in renal-transplant recipients.

US updates advice on perioperative beta-blocker use in noncardiac surgery

Tue, 03 Nov 2009 14:30:32 EST

A US update on the perioperative use of beta blockers for noncardiac surgery is, says the lead author, "similar" to recent European guidance on this issue.

FDA expands exenatide use; warns of renal-failure risk

Tue, 03 Nov 2009 13:15:00 EST

The FDA has issued a warning about exenatide the same day the agency approved its first-line use along with diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus.

CORONA analysis reopens door for statins in heart failure

Tue, 03 Nov 2009 10:45:33 EST

Statins for heart failure? After they failed to show much effect in two large randomized trials? Yes—maybe; at least in patients with ischemic heart failure who start the drugs early enough, suggests a post hoc analysis based on one of the trials.

Combined home/GP hypertension control program successful in Pakistan

Mon, 02 Nov 2009 17:00:00 EST

A synergistic approach of educating general practitioners about hypertension control together with a program to send lay workers into people's homes to educate them about the management of high blood pressure has proven successful in low- to middle-income households in Pakistan.

No TREAT: Darbepoetin alfa fails to reduce CV or renal events in anemic diabetics with CKD

Fri, 30 Oct 2009 20:41:45 EDT

No differences were seen between groups, except in strokes, which were twice as high in the active-treatment group. Anticipated improvements in fatigue scores were modest and not clinically meaningful, investigators say.

Imaging study shows plaque regression with niacin vs placebo

Fri, 30 Oct 2009 16:00:00 EDT

Just weeks before ARBITER-HALTS�6 results come out at AHA 2009, an MRI study suggests that niacin is better than placebo in statin-treated patients with low HDL, at least for reducing carotid wall area. Experts say they'd also like to see insights into niacin effects on lipid-rich plaque volumes—the more commonly seen end point with MRI.

Lifestyle-based diabetes prevention seen to endure for at least a decade

Fri, 30 Oct 2009 10:00:00 EDT

The protective effects of diet modification, exercise, and other lifestyle changes against new-onset diabetes showcased in the three-year Diabetes Prevention Program continued out to 10 years in a follow-up analysis.

Combination drugs for weight loss

Thu, 29 Oct 2009 15:30:33 EDT

Two studies presented this week have shown positive effects on weight loss using a combination of agents.

Non-CV mortality also important in dialysis patients

Wed, 28 Oct 2009 14:15:19 EDT

Physicians may tend to overlook risk factors for noncardiovascular mortality in patients starting dialysis, since the emphasis in the past has always been on cardiovascular risk, researchers say.

GLP-1 analog liraglutide promising in obesity

Thu, 22 Oct 2009 18:30:00 EDT

A drug originally developed to treat diabetes may have promise as an obesity therapy, a new study shows. Those taking liraglutide, a GLP-1 analog, lost more weight than those on an established obesity medication, orlistat.

HCM transmitted by sperm donation: A case report

Thu, 22 Oct 2009 15:45:36 EDT

The donor, who was later shown to be affected by a novel beta-myosin heavy-chain mutation that causes HCM, is responsible for at least nine children known to be genetically affected with HCM.

Simple cooling methods improve neurologic outcomes after cardiac arrest, new review confirms

Thu, 22 Oct 2009 11:00:03 EDT

A new literature review confirms that conventional cooling methods work safely to improve survival and reduce brain damage after cardiac arrest.

New analyses from ECASS 3 support use of tPA up to 4.5 hours after stroke

Thu, 22 Oct 2009 08:30:55 EDT

Investigators show benefits of thrombolysis after stroke across a variety of subgroups; although not all end points reached statistical significance, trends favored treatment with tPA. The message, though, remains to treat as soon as possible, they say.

Iloprost prevents contrast-induced nephropathy in high-risk patients undergoing coronary intervention

Wed, 21 Oct 2009 13:00:34 EDT

Intravenously administered iloprost, a prostacyclin analog, may help prevent contrast-induced nephropathy in patients with renal dysfunction undergoing coronary procedures, a new pilot study suggests.

Cardiovascular disease increases risk of hip fracture

Tue, 20 Oct 2009 16:00:00 EDT

Swedish researchers have confirmed a link between stroke and subsequent hip fracture in older people and identified for the first time that a diagnosis of heart failure also increases the risk for this fracture. They also identify a large genetic component to this association, via their use of a twin registry.

Omega-3s no help to SSRI-treated CHD patients

Tue, 20 Oct 2009 16:00:00 EDT

The researchers suggest further study is still needed, as it is unclear whether higher doses of omega-3 fatty acids or setraline, longer treatment, or a different ratio of EPA to DHA would produce favorable results.

Data from 1.23 million patients confirms warfarin increases mortality in trauma patients

Tue, 20 Oct 2009 13:45:55 EDT

Warfarin use is rising in both older and younger patients. How much does the anticoagulant contribute to the risk of traumatic injuries?

Transfusion in acute HF: No extra mortality risk

Mon, 19 Oct 2009 11:00:10 EDT

Blood transfusions for anemia in acute decompensated heart failure don't exacerbate outcomes, as may happen in some ACS cases, suggests a one-year experience of hospitals in Israel. On the contrary�.�.�.�

No link seen between heart failure and coffee intake

Fri, 16 Oct 2009 10:15:02 EDT

With few studies in the literature specifically looking at the issue, a prospective, population-based study in Sweden has found no significant rise or fall in risk of heart-failure hospitalization or death at increasing levels of coffee intake.

Can statins prevent and treat infection?

Thu, 15 Oct 2009 14:45:36 EDT

Results from a new meta-analysis show the pleiotropic effects of statins are useful in the treatment and prevention of different infections, including bacteremia, pneumonia, and sepsis.

Endovascular repair of aortic aneurysm reduces short-term mortality

Thu, 15 Oct 2009 14:15:51 EDT

The OVER study of abdominal aortic aneurysm shows that endovascular grafting has a lower mortality rate at 30 days than traditional open surgery.

Racial background woefully underreported in CV trials

Thu, 15 Oct 2009 13:15:10 EDT

Two-thirds of the 156 trials considered by the AHA in preparing a recent guideline failed to even record the ethnic backgrounds of participants, a new study has found. The researchers call for the reporting of race/ethnicity to be mandatory in all clinical trials, and they suggest medical journals should enforce this policy.

A fish tale with merit: Omega-3 PUFAs underrated for heart failure

Wed, 14 Oct 2009 12:30:27 EDT

Are the data not shouting loud enough, or is cardiology hard of herring? Omega-3 fatty acids may have only a modest treatment effect in heart failure, but they've performed swimmingly in randomized and observational studies considering how few new HF drugs have been reeled in lately.

Hospital efficiency gauged by resource use vs outcomes

Tue, 13 Oct 2009 16:00:00 EDT

An analysis of Medicare data from heart-failure patients at six California hospitals challenges the notion advanced by some studies that hospital efficiency can be measured by looking back at resource use on behalf of patients who ultimately died.

Diuretics effective as second-line therapy for hypertension

Tue, 13 Oct 2009 12:00:48 EDT

Diuretics, especially hydrochlorothiazide, are as effective when given as second-line therapy for high blood pressure as they are when used as initial treatment, according to the first review to look at this issue.

Hopes build for natriuretic-peptide risk stratification before noncardiac surgery

Tue, 13 Oct 2009 10:00:10 EDT

Could a preoperative blood assay take the place of imaging studies or other more costly assessments of cardiovascular risk? A meta-analysis suggests yes. A massive randomized trial is looking into it now.

Glucocorticoids seen to double risk of atrial arrhythmias

Mon, 12 Oct 2009 16:00:00 EDT

In a case-control study from Denmark, the risk of atrial fibrillation or flutter was significantly increased with current but not previous use of glucocorticoids for chronic obstructive pulmonary disease, rheumatoid arthritis, and other conditions.

New review confirms homocysteine lowering does not prevent CVD events

Thu, 08 Oct 2009 15:30:45 EDT

The latest review to look at the effects of homocysteine lowering with vitamin-B supplementation has come to much the same conclusions as most other studies and analyses in this field.

Lupus anticoagulant a major risk factor for stroke and MI in young women

Wed, 07 Oct 2009 10:00:40 EDT

Results of the RATIO study suggest lupus anticoagulant, but not anticardiolipin or antiprothrombin antibodies, is associated with increased stroke risk and to a lesser extent MI.

China death toll due to hypertension worse than predicted

Tue, 06 Oct 2009 14:15:24 EDT

The first prospective study using real data to inform the number of people suffering from and dying due to high blood pressure in China finds the problem is much worse than previously thought. A number of initiatives are planned to try to tackle this crisis.

Acute heart-failure prediction model blends clinical gestalt with natriuretic peptides

Mon, 05 Oct 2009 17:00:00 EDT

Its developers say the prediction model for guiding management of patients presenting with dyspnea can make a difference when clinicians aren't sure about the diagnosis based on clinical signs. An editorial takes issue.

Philips recalls thousands of AEDs

Mon, 05 Oct 2009 14:00:59 EDT

The automatic external defibrillators were distributed by Philips Medical and Laerdal Medical with model numbers M3860A, M3861A, M3840A, and M3841A.

Stroke reduction with dronedarone shown in post hoc analysis

Fri, 02 Oct 2009 17:15:19 EDT

Investigators say that although the analysis raises the possibility that a drug with antiarrhythmic activity could reduce the risk of stroke, dronedarone is not a replacement for oral anticoagulant therapy or a treatment for stroke prevention.

New "principles" on authorship and COI from PhRMA get mixed response

Fri, 02 Oct 2009 12:00:10 EDT

The "Principles on Conduct of Clinical Trials and Communication of Clinical Trial Results" echo recent standards set by medical journal editors, but some observers say the document, which has no penalty component, lacks real teeth.

REVERSE, MADIT-CRT make case for extending CRT to mild heart failure: Should guidelines change?

Thu, 01 Oct 2009 10:30:49 EDT

Now in print after having been presented at meetings, the REVERSE randomized trial's European-cohort two-year results are consistent with the recently published, much larger MADIT-CRT trial in showing both clinical and LV structural benefits from resynchronization therapy in patients with NYHA class 1-2 heart failure.

Time to act: Cardiologists, diabetes docs, and psychiatrists urged to work together to tackle CVD in the mentally ill

Wed, 30 Sep 2009 14:00:04 EDT

Doctors from across the specialties of cardiology, diabetes, and psychiatry are being urged to collaborate to improve care for the mentally ill, who are more likely to die from cardiovascular disease than any other cause.

Pump may not be the culprit in "pump head" after CABG

Wed, 30 Sep 2009 11:15:57 EDT

The decline in cognitive function that is often seen after CABG may not be related to the use of cardiopulmonary bypass or to embolic debris in the bloodstream from the bypass pump, Chinese researchers say.

Only one in eight strokes heralded by TIA

Wed, 30 Sep 2009 10:00:41 EDT

A new study finds only about one in eight strokes are preceded by transient ischemic attack. The results underline the need for a broader approach to primary prevention, researchers say.

Doctor-led "hospital-at-home" care subs for hospitalization in acute heart failure

Tue, 29 Sep 2009 12:00:05 EDT

They lived just as long, but in a small randomized trial, patients with acute decompensated heart failure who received hospital-quality care in their homes as an alternative to hospital admission after presentation to the emergency department benefited in ways missed by those managed as inpatients in the traditional manner.

Skin lesions from heparin more common than thought

Mon, 28 Sep 2009 12:00:00 EDT

A new prospective study has found the incidence of heparin-induced skin lesions to be around 7.5%. Women, the obese, and those on heparin therapy for longest are most at risk.

No relationship between significant carotid stenosis and stroke after cardiac surgery

Mon, 28 Sep 2009 10:00:08 EDT

A large single-center retrospective study finds no association between carotid stenosis and stroke after cardiac surgery. The findings may finally answer the question of whether carotid endarterectomy prior to or during heart surgery provides any benefit.

BNP-boosting gene variant hints at possible screening, cardioprotective roles

Fri, 25 Sep 2009 10:45:02 EDT

A single-nucleotide polymorphism associated with chronically raised natriuretic-peptide levels is common enough to potentially influence interpretation of BNP and NT-proBNP assays under some circumstances, researchers say; there is increasing evidence that the gene variant may enhance survival in some patient groups.

Added to diuretics, low-dose dopamine renoprotective in small acute-HF trial

Mon, 21 Sep 2009 12:30:00 EDT

Better late than never in the age of evidence-based medicine, a randomized test of an established strategy might have confirmed the value of adding dopamine to loop diuretics to allow the latter at reduced, less kidney-damaging dosages.

Pediatric stroke rates may be double previous US estimates

Fri, 18 Sep 2009 12:15:05 EDT

A new analysis searching both ICD-9 codes and imaging data finds a stroke incidence among children roughly double that previously reported.

Cutting salt intake in US could save $50 billion a year

Thu, 17 Sep 2009 11:00:49 EDT

A new economic analysis concludes that regulations to reduce sodium content in processed foods and/or voluntary reductions in salt by companies could save up to $50 billion a year in healthcare costs in the US.

Yet again, CMS declines to expand carotid-stenting coverage

Thu, 17 Sep 2009 10:00:52 EDT

Hopes for expanded Medicare coverage of carotid-stenting procedures beyond patients at high risk for carotid endarterectomy who have symptomatic carotid artery stenosis >70% have been swatted down by the CMS.

Physician, teach thyself: IMPROVE-HF initiative boosts use of evidence-based outpatient care

Wed, 16 Sep 2009 17:45:55 EDT

The two-year prospective registry-based study of a performance-improvement initiative's effectiveness saw significant jumps, >70% in some cases, in the appropriate use of six out of seven measured evidence-based treatments for patients with chronic heart failure.

FAST enough? Intrathoracic monitor bests weight gain in predicting worsening heart failure

Tue, 15 Sep 2009 14:30:51 EDT

Can an intrathoracic fluid-status monitor, added to an already-indicated ICD or CRT-D device in patients with heart failure, serve as the decompensation early-warning system now provided—unreliably but as recommended in the guidelines—by the bathroom scale?

New ASCOT analysis: Beta blockers not beneficial in hypertensives with tachycardia

Tue, 15 Sep 2009 14:15:57 EDT

Pulse rate should not be the determinant of which drugs are used in hypertension, conclude the authors of a new subgroup analysis of the ASCOT trial.

Conflicts of interest affect best practices in both industry-funded and non-industry-funded trials

Tue, 15 Sep 2009 12:00:19 EDT

Clinicians and researchers need to be more aware before signing on to studies about what potential conflicts might arise with the sponsor and set the ground rules for such areas as access to data, manuscript preparation, and right to publish.

Who should get CRT? Resynchronization benefits seen in heart failure with LVEF >35%

Mon, 14 Sep 2009 17:15:00 EDT

Heart-failure patients with ejection fractions >35% aren't necessarily excluded from the clinical and reverse-remodeling benefits of cardiac resynchronization therapy, suggests yet another study questioning the limits of CRT's current eligibility criteria.

Cardiovascular health of Americans is "at a crossroad"

Mon, 14 Sep 2009 16:00:00 EDT

The number of Americans who have a low cardiovascular risk-factor profile is decreasing, indicating that after two decades of improvement, progress appears to be reversing. The overriding driver of this phenomenon is excessive weight, say the researchers, which in turn contributes to hypertension and diabetes, itself a major contributor to heart disease.

ICDs in women with heart failure? Won't work, suggests meta-analysis

Mon, 14 Sep 2009 16:00:00 EDT

Implantable defibrillators don't cut all-cause mortality in women with systolic heart failure, proclaim five major clinical trials speaking in unison. An editorial writer cries "foul" on the frequent assumption in clinical practice that outcomes data from randomized trials conducted primarily in men should also apply to women.

Sponsorship of med-school textbooks in Denmark exposes vulnerable minds to commercial bias

Mon, 14 Sep 2009 11:45:00 EDT

Results of a new survey showed that a surprising 15% of textbooks had one or more drug or device sponsors and, in two cases, those sponsors had tried to influence the content of the textbooks.

Spin not uncommon in negative RCTs, study shows

Mon, 14 Sep 2009 11:30:00 EDT

French researchers who systematically quantified the prevalence of spin across 72 negative randomized controlled trials say half of the studies put a positive spin on the negative findings in the conclusion sections of the papers.

B-CONVINCED: Maintain beta blockers during acute heart-failure management

Mon, 14 Sep 2009 10:30:00 EDT

Short-term outcomes are the same whether beta blockers are continued or withheld at hospitalization for acute decompensated heart failure, and there are good reasons to continue them, according to researchers.

Darusentan in resistant hypertension: Data published

Sun, 13 Sep 2009 18:30:00 EDT

Further studies will be required to fully determine the role of the investigational agent darusentan in resistant hypertension, say the authors of a phase 3 study with the drug.

Ghost authorship on the wane, but guest authorship still common

Fri, 11 Sep 2009 11:00:38 EDT

UPDATED // Compared with a 1996 survey by JAMA editors, a 2008 survey indicates that the practice of having ghost writers pen papers, then not appear as authors, is down to 8%, from 12% in 1996. The practice of inviting a prominent name to appear in the list of authors, without requiring that person to contribute to the research, has held steady at roughly 20%.

Dronedarone in atrial fib trades efficacy for safety in meta-analysis

Fri, 11 Sep 2009 10:15:53 EDT

The finding, based on eight randomized trials, supports the view that dronedarone is less effective than amiodarone at preventing the arrhythmia's recurrence but doesn't have the older drug's serious toxicities, as suggested by the DIONYSOS trial.

MIST correction published; no new information on disputed echo review for PFO/migraine trial

Wed, 09 Sep 2009 14:30:44 EDT

UPDATED // The correction in Circulation runs over 700 words long, with a four-page data supplement, but includes no details on residual-shunt data allegedly obtained with an "off-protocol" review of the echocardiographic results.

ARB/ACE-inhibitor combo not recommended in CHF

Tue, 08 Sep 2009 15:45:55 EDT

An individual patient-data meta-analysis of the studies to date of angiotensin-receptor blockers and ACE inhibitors in heart failure might help identify those candidates who could benefit from this drug combo, say Swiss researchers. But in the meantime, it should be avoided.