Title: Association of Early Follow-Up After Acute Myocardial Infarction With Higher Rates of Medication
Date Posted: 3/10/2008
Author(s): Daugherty SL, Ho PM, Spertus JA, et al.
Citation: Arch Intern Med 2008;168:485-491.
Study Question: What is the relationship between early outpatient follow-up after acute myocardial infarction (AMI) and use of evidence-based therapies?
Methods: A total of 1,516 patients hospitalized with AMI participated in the multicenter Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery registry. Early follow-up was defined as patient-reported visits with a primary care physician or cardiologist within 1 month after discharge. The primary outcomes were use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and statins in eligible patients at 6 months. Multivariable analyses assessed the association between early follow-up and medication use at 6 months, adjusting for patient and clinical characteristics. Secondary analyses compared medication use at 6 months for patients receiving collaborative follow-up from a single provider versus those receiving follow-up from both provider types.
Results: Among the cohort, 34% reported no outpatient follow-up during the month following discharge. Rates of medication prescription among appropriate candidates were similar at hospital discharge for both follow-up groups. Compared with those not receiving early follow-up, those receiving early follow-up were more likely to be prescribed beta-blockers (80.1% vs. 71.3%; p = 0.001), aspirin (82.9% vs. 77.1%; p = 0.01), or statins (75.9% vs. 68.6%; p = 0.005) at 6 months. In multivariable analyses, a persistent relationship remained between early follow-up and beta-blocker use (risk ratio [RR], 1.08; 95% confidence interval [CI], 1.02-1.15). In secondary analyses, statin use was higher in patients receiving collaborative follow-up (RR, 1.11; 95% CI, 1.01-1.22).
Conclusions: Early outpatient follow-up and collaborative follow-up after AMI are associated with higher rates of evidence-based medication use. Although further studies should assess whether this relationship is causal, these results support current guideline recommendations for follow-up after AMI.
Perspective: This prospective observational study demonstrated a modest advantage of early follow-up post-MI, but which could infer a significant clinical outcome benefit. I suspect it underestimates the value of the cardiologist assessment and opportunity for referral to cardiac rehabilitation, smoking cessation, and education. Our experience is that early follow-up by a nurse practitioner can be effective as well. Melvyn Rubenfire, M.D., F.A.C.C.
Tuesday, March 11, 2008
Monday, March 10, 2008
Gmail - MedWire Cardiology News - 10 March 2008
Gmail - MedWire Cardiology News - 10 March 2008
CRT reverses dyssynchrony-induced molecular cardiac abnormalitiesCardiac resynchronization therapy reverses molecular stress response and cell survival abnormalities that accompany cardiac dyssynchrony, preliminary study findings indicate.http://www.medwire-news.md/38/73566/Cardiology_News/CRT_reverses_dyssynchrony-induced_molecular_cardiac_abnormalities_.html
Starting to drink alcohol in middle age has heart benefitsPeople who begin drinking moderate amounts of alcohol in middle age have lower rates of cardiovascular disease morbidity than nondrinkers who continue to abstain from drinking alcohol, findings from the ARIC study show.http://www.medwire-news.md/38/73567/Cardiology_News/Starting_to_drink_alcohol_in_middle
_age_has_heart_benefits.html
Cardiovascular risk lowered by anti-rheumatic drugsThe risk for a patient with rheumatoid arthritis experiencing a major cardiovascular event can be significantly lowered with appropriate risk factor management and treatment with disease-modifying anti-rheumatic drugs, say researchers.http://www.medwire-news.md/38/73568/Cardiology_News/Cardiovascular_risk_lowered_by_anti-rheumatic_drugs.html
CRT reverses dyssynchrony-induced molecular cardiac abnormalitiesCardiac resynchronization therapy reverses molecular stress response and cell survival abnormalities that accompany cardiac dyssynchrony, preliminary study findings indicate.http://www.medwire-news.md/38/73566/Cardiology_News/CRT_reverses_dyssynchrony-induced_molecular_cardiac_abnormalities_.html
Starting to drink alcohol in middle age has heart benefitsPeople who begin drinking moderate amounts of alcohol in middle age have lower rates of cardiovascular disease morbidity than nondrinkers who continue to abstain from drinking alcohol, findings from the ARIC study show.http://www.medwire-news.md/38/73567/Cardiology_News/Starting_to_drink_alcohol_in_middle
_age_has_heart_benefits.html
Cardiovascular risk lowered by anti-rheumatic drugsThe risk for a patient with rheumatoid arthritis experiencing a major cardiovascular event can be significantly lowered with appropriate risk factor management and treatment with disease-modifying anti-rheumatic drugs, say researchers.http://www.medwire-news.md/38/73568/Cardiology_News/Cardiovascular_risk_lowered_by_anti-rheumatic_drugs.html
Sunday, March 9, 2008
Myoblast Autologous Grafting in Ischemic Cardiomyopathy (MAGIC)
Myoblast Autologous Grafting in Ischemic Cardiomyopathy (MAGIC)
Interpretation
The results of this small, but first-of-its-kind clinical trial indicate that there was no additional benefit of autologous skeletal myoblasts in improving regional or global LV function in patients with severe ischemic cardiomyopathy, compared with CABG alone.
This was despite the fact that the highest dose of myoblasts was associated with a significant antiremodeling effect at 6 months, as evidenced by a reduction in both LVEDV and LVESV, when compared with placebo.
There was no increase in the incidence of MACE or arrhythmias with myoblast injections, although there was a nonsignificant doubling of arrhythmias in the myoblast groups.
Although this was a negative study, cardiac cell therapy is a fascinating, and rapidly evolving field. It is left to be seen if future clinical trials, with optimization of the best cells, their method of harvesting and delivery, and their functional integration in the myocardium, will be able to demonstrate improved patient outcomes in the days ahead.
Interpretation
The results of this small, but first-of-its-kind clinical trial indicate that there was no additional benefit of autologous skeletal myoblasts in improving regional or global LV function in patients with severe ischemic cardiomyopathy, compared with CABG alone.
This was despite the fact that the highest dose of myoblasts was associated with a significant antiremodeling effect at 6 months, as evidenced by a reduction in both LVEDV and LVESV, when compared with placebo.
There was no increase in the incidence of MACE or arrhythmias with myoblast injections, although there was a nonsignificant doubling of arrhythmias in the myoblast groups.
Although this was a negative study, cardiac cell therapy is a fascinating, and rapidly evolving field. It is left to be seen if future clinical trials, with optimization of the best cells, their method of harvesting and delivery, and their functional integration in the myocardium, will be able to demonstrate improved patient outcomes in the days ahead.
Friday, March 7, 2008
Angiotensin II Vaccine Lowers Blood Pressure
Physician's First Watch for March 7, 2008David G. Fairchild, MD, MPH, Editor-in-Chief
A vaccine against angiotensin II lowers blood pressure, reports Lancet.
In a phase II (safety and efficacy) study sponsored by the developer, European researchers randomized 72 patients with mild-to-moderate hypertension to one of two doses of vaccine (100 or 300 μg) or to placebo. The vaccine consists of virus-like particles linked to angiotensin II; injections were given at weeks 0, 4, and 12.
By week 14, about 20% of vaccine recipients had experienced transient flu-like symptoms, and all had antibodies against angiotensin II. Those who received the 300-μg regimen had significant drops in mean BP compared with placebo recipients, especially early in the morning (–25 mm Hg systolic, –13 mm Hg diastolic).
Commentators wonder about the hazards of a treatment whose effects are not immediately reversible (the antibody's half-life after the third injection was 17 weeks). However, they find the exploratory trial "promising."
Lancet abstract (Free abstract; full text requires subscription)
Lancet comment (Subscription required
A vaccine against angiotensin II lowers blood pressure, reports Lancet.
In a phase II (safety and efficacy) study sponsored by the developer, European researchers randomized 72 patients with mild-to-moderate hypertension to one of two doses of vaccine (100 or 300 μg) or to placebo. The vaccine consists of virus-like particles linked to angiotensin II; injections were given at weeks 0, 4, and 12.
By week 14, about 20% of vaccine recipients had experienced transient flu-like symptoms, and all had antibodies against angiotensin II. Those who received the 300-μg regimen had significant drops in mean BP compared with placebo recipients, especially early in the morning (–25 mm Hg systolic, –13 mm Hg diastolic).
Commentators wonder about the hazards of a treatment whose effects are not immediately reversible (the antibody's half-life after the third injection was 17 weeks). However, they find the exploratory trial "promising."
Lancet abstract (Free abstract; full text requires subscription)
Lancet comment (Subscription required
Thursday, March 6, 2008
Case Studies IncorporatingACC/AHA Practice Guidelines
Perioperative Guidelines Case Studies
Case Studies IncorporatingACC/AHA Practice Guidelines
Cardiosource
Case Studies IncorporatingACC/AHA Practice Guidelines
Cardiosource
Wednesday, March 5, 2008
Sunday, March 2, 2008
Loud Snoring Associated With Higher Stroke And Heart Disease Risk
01 Mar 2008
If you are a loud snorer there is a good chance your risk of stroke and heart disease is higher compared to people who do not snore, say Hungarian scientists after a new study on 12,643 participants.
You can read about this in the journal Sleep.
The authors explain that everybody snores to some extent at some period in their lives.
Estimates indicate that approximately 40% of men and 24% of women snore regularly.
Although previous studies had indicated there may be a link between habitual snoring and stroke and heart attack risk, this one has more compelling evidence.
The scientists interviewed 12,643 people at home about their snoring - they The represented 0.16% of the Hungarian population over the age of 18 years according to age, sex, and 150 sub-regions of the country.
The scientists report that, according to their study, 37% of men and 21% of women reported loud snoring with breathing pauses. 26% of the respondents reported having hypertension (high blood pressure), 3% had had myocardial infarction and 4% a stroke.
They found that a loud snorer has a 67% higher risk of having a stroke compared to people who do not snore, the risk of heart attack is 34% higher for loud snorers. It seems that quiet snorers do not run a higher risk of heart disease and/or stroke compared to people who do not snore, the scientists said.
The authors concluded "Snoring is frequent in the Hungarian adult population, and loud snoring with breathing pauses, in contrast with quiet snoring, is associated with an increased risk of cardiovascular disease and increased health-care utilization."
"Cardiovascular Disease and Health-Care Utilization in Snorers: a Population Survey"
Andrea Dunai, MD, Andras P. Keszei, MD, PhD, Maria S. Kopp, MD,PhD, Colin M. Shapiro, MBBCh, PhD, FRCPC, Istvan Mucsi, MD, PhD, Marta Novak, MD, PhD
SLEEP Volume 31, Issue 03, Pages 411-416
Click here to view abstract online
If you are a loud snorer there is a good chance your risk of stroke and heart disease is higher compared to people who do not snore, say Hungarian scientists after a new study on 12,643 participants.
You can read about this in the journal Sleep.
The authors explain that everybody snores to some extent at some period in their lives.
Estimates indicate that approximately 40% of men and 24% of women snore regularly.
Although previous studies had indicated there may be a link between habitual snoring and stroke and heart attack risk, this one has more compelling evidence.
The scientists interviewed 12,643 people at home about their snoring - they The represented 0.16% of the Hungarian population over the age of 18 years according to age, sex, and 150 sub-regions of the country.
The scientists report that, according to their study, 37% of men and 21% of women reported loud snoring with breathing pauses. 26% of the respondents reported having hypertension (high blood pressure), 3% had had myocardial infarction and 4% a stroke.
They found that a loud snorer has a 67% higher risk of having a stroke compared to people who do not snore, the risk of heart attack is 34% higher for loud snorers. It seems that quiet snorers do not run a higher risk of heart disease and/or stroke compared to people who do not snore, the scientists said.
The authors concluded "Snoring is frequent in the Hungarian adult population, and loud snoring with breathing pauses, in contrast with quiet snoring, is associated with an increased risk of cardiovascular disease and increased health-care utilization."
"Cardiovascular Disease and Health-Care Utilization in Snorers: a Population Survey"
Andrea Dunai, MD, Andras P. Keszei, MD, PhD, Maria S. Kopp, MD,PhD, Colin M. Shapiro, MBBCh, PhD, FRCPC, Istvan Mucsi, MD, PhD, Marta Novak, MD, PhD
SLEEP Volume 31, Issue 03, Pages 411-416
Click here to view abstract online
Saturday, March 1, 2008
Medwire - 29.02.08
Minority of CHD patients do recommended exercise
29 February 2008
Study findings reveal that patients with coronary heart disease often do not comply with physical activity recommendations, and are less likely to do so than individuals without CHD.
Information, reassurance, and support aid post-CABG recovery
29 February 2008
The results of a small, qualitative UK survey show that patients undergoing coronary bypass grafting surgery who may feel anxious or depressed about their recovery can be helped if they remain optimistic and are given information, reassurance, and support from the healthcare team and their social network.
Persistent hyperglycemia in AMI predicts in-hospital mortality
29 February 2008
Persistent hyperglycemia determined by multiple glucose assessments during hospitalization for acute myocardial infarction better predicts mortality than hyperglycemia on admission, research shows.
29 February 2008
Study findings reveal that patients with coronary heart disease often do not comply with physical activity recommendations, and are less likely to do so than individuals without CHD.
Information, reassurance, and support aid post-CABG recovery
29 February 2008
The results of a small, qualitative UK survey show that patients undergoing coronary bypass grafting surgery who may feel anxious or depressed about their recovery can be helped if they remain optimistic and are given information, reassurance, and support from the healthcare team and their social network.
Persistent hyperglycemia in AMI predicts in-hospital mortality
29 February 2008
Persistent hyperglycemia determined by multiple glucose assessments during hospitalization for acute myocardial infarction better predicts mortality than hyperglycemia on admission, research shows.
Thursday, February 28, 2008
Medwire -
Meta-analysis shows PCI beats medical therapy for late reperfusion
28 February 2008
Patients who undergo percutaneous coronary intervention more than 12 hours after suffering an acute myocardial infarction have improved cardiac function and survival compared with those who receive medical management, a meta-analysis indicates.
Chest pain causes sustained psychological distress
28 February 2008
Chest pain causes significant anxiety and depression even after people have been told that is not due to cardiovascular disease, say UK researchers.
Eye disease more than doubles MI risk
28 February 2008
The progressive eye disease age-related macular degeneration doubles the risk for death due to cardiovascular disease, reveals a study from Australia.
28 February 2008
Patients who undergo percutaneous coronary intervention more than 12 hours after suffering an acute myocardial infarction have improved cardiac function and survival compared with those who receive medical management, a meta-analysis indicates.
Chest pain causes sustained psychological distress
28 February 2008
Chest pain causes significant anxiety and depression even after people have been told that is not due to cardiovascular disease, say UK researchers.
Eye disease more than doubles MI risk
28 February 2008
The progressive eye disease age-related macular degeneration doubles the risk for death due to cardiovascular disease, reveals a study from Australia.
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