admin | August 31, 2009

Given that vascular surgery patients continue to have a high rate of perioperative cardiovascular complications, the current trial sought to evaluate the role of routine coronary angiography and revascularization if needed in patients undergoing major vascular surgery, with an RCRI ≥2.

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admin | August 31, 2009

A man and woman have filed a suit against Bayer, alleging they were not warned of possible side effects in a drug used to control bleeding in coronary artery bypass grafting.

Don Juan Brown and Jean N. Snyder claim their use of Trasylol led to renal damage, renal insufficiency and multi-system organ failure.

Trasylol, which was approved by the FDA in 1993, is usually supplied as a colorless, sterile isotomic solution that is administered through an IV during coronary artery bypass grafting, according to the complaint filed Aug. 20 in St. Clair County Circuit Court.

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admin | August 31, 2009

In stable coronary artery disease (CAD), analysis has shown a 27% reduction of total mortality from exercise, compared to more aggressive intervention. At least four mechanisms are at play: better endothelial (coronary artery inner lining) function, reduced rate of coronary deposits, reduced clotting risk, and improved new arterial growth.

When compared to balloon angioplasty with or without a stent, 12-months of exercise therapy in stable CAD patients was associated with higher event-free survival. From an article published in a European medical journal in 2004 (R. Hambrecht, University of Liepzig, Germay)

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admin | August 27, 2009

In the Prospective Evaluation of EECP in Congestive Heart Failure (PEECH) trial, EECP improved exercise duration, symptom status, and QOL in patients with mild-to-moderate heart failure who were already receiving optimal medical therapy. The PEECH trial, reported at the 2005 ACC meeting by Arthur M. Feldman, MD, PhD, FACC, enrolled 187 patients with ischemic or nonischemic heart failure and New York Heart Association (NYHA) class II or III symptoms. All patients had LVEF ≤35% (mean, about 26%) despite optimal medical therapy. Patients were randomized to EECP plus optimal pharmacologic therapy for 7 weeks (n = 93) or optimal pharmacologic therapy alone (n = 94). Patients could not be blinded to their randomized therapy, of course, but the study controlled for researcher bias by creating two investigating teams. One team supervised or performed daily EECP treatments; the other team, which was blinded to randomization, performed patient evaluations. The study’s primary endpoint was one of two measures of change in exercise capacity. The first of these, the percentage of patients with at least a 60-second increase in exercise duration from baseline to 6 months, was significantly higher in the EECP group than in the control group (p = 0.016). The second measure, the percentage of patients with at least a 1.25 ml/min/kg increase in peak VO2 from baseline to 6 months, was statistically similar in both groups (Figure 5). The study also demonstrated significant improvements in several secondary endpoints (Figure 6), including mean change in exercise duration, NYHA classification, and QOL, although the latter improvement was not sustained over the long term. Andrew D. Michaels, MD, FACC, of the University of California, San Francisco, was the discussant for Dr. Feldman’s presentation. Although he said the PEECH results are “mixed,” he added “there is still reason for optimism that EECP may be a positive addition to patients with heart failure treated with optimal medical therapy.” However, he acknowledged it was “somewhat concerning” that the only endpoints in PEECH significantly improved by EECP were those subject to a placebo effect. Peak VO2, which is likely not subject to the placebo effect, was unchanged by the therapy. This interview with Dr. Feldman reviews the results of the PEECH trial and evidence suggesting that the benefits observed were not a placebo effect.

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admin | August 27, 2009

BY William Kerr
P&D Correspondent
Published: Wednesday, August 26, 2009 9:21 PM CDT

The vast majority of ideas being discussed so far in the effort toward making health care available to all and cheaper to boot will make little if any change in our current costs and outcomes.

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admin | August 12, 2009

William E. Boden has written an editorial in the New England Journal of Medicine that urges caution about new research on diabetics with coronary disease.

Release Date: June 7, 2009

BUFFALO, N.Y. — In an editorial in the current issue of the New England Journal of Medicine (NEJM), William E. Boden, M.D., professor of medicine and preventive medicine at the University at Buffalo, recommends that the results of the BARI-2D Trial published in that edition must be interpreted with “considerable caution.”

The editorial is titled “Diabetes with Coronary Disease — A Moving Target Amid Evolving Therapies?”

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admin | August 10, 2009

Mon, 08/10/2009 - 05:01 — popdd.com - Health reform is in danger of failing because the focus has been too much on who is covered and not enough on what is covered. Health care reform is primarily about health insurance reform, with the main battle being over coverage and the payment system.

Of course, we need to provide coverage for the 48 million Americans who do not have health insurance. It is morally indefensible that we have not already done so.

Category: Angio/Stent, Buffalo Heart Health, Bypass Surgery, Cardio Rehab, External Counterpulsation, Medicine, Studies | No Comments »
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admin | August 10, 2009

Oh noes resound through the blogosphere today about Obama’s deal with PhRMA, but the drug lobby is just one set of trees in a very big forest. Reform legislation faces the opposition of many powerful interest groups, including the insurance industry and health care providers; Obama’s deal with PhRMA is classic Divide-and-Conquer politics.

Just take the example of one hospital in McAllen, Texas that’s doled out $500,000 in campaign contributions to congresscritters. That’s just ONE hospital, and it happens to be the very facility highlighted in a June New Yorker piece:

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admin | August 6, 2009

The health care debate has been hijacked by fears about cost and how we will pay for universal coverage. Will it cost $1.6 trillion or $900 billion over 10 years? This is beside the point. Every other industrialized nation spends far less (about half) and creates much better health for its citizens. We are next to Cuba in life expectancy, yet they spend $184 per capita annually on health care and we spend over $8,000. The only way this will shift is if we focus on investing in quality not quantity - namely medical care that creates better outcomes through programs that address the causes of chronic illness - diet, sedentary lifestyles, stress, and social disempowerment.

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admin | August 3, 2009

Selecting Optimal Patients for Revascularization: Opportunities to Improve Quality, Costs and Patient Outcomes

Abstract 6224: Widespread Patient Misconceptions Regarding the Benefits of Elective Percutaneous Corornary Intervention

John H Lee¹; Kenny Chuu²; John Spertus²; James H O’Keefe²

¹ Mid America Heart Insitute, Kansas City, MO
² Mid America Heart Insitute, UMKC, Kansas City, MO

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