Friday, 25 February 2011
Monday, 21 February 2011
JOURNAL SNIPPETS 2 February 2011
Arch Intern Med 14 Feb 2011 Vol 171
196 Miriam Johnson and Richard Lehman compiled the first book on Heart Failure and Palliative Care five years ago, aimed mainly at a UK audience. It's not known if it's sold any copies in the USA, but a new survey of resource use in the last 6 months of life among Medicare beneficiaries with heart failure shows a huge rise in hospice use by these patients between the beginning of 2000 and the end of 2007. The official Medicare policy remains to distinguish between "palliative" and "curative" treatments, but it is good to see that such distinctions seem to be little heeded in this group, who have also been given more intensive medical treatment as well. It had been hoped to say goodbye forever to this gloomy subject, but the need to identify patient-important symptomatic outcomes in heart failure remains huge, as does the need to provide better end-of-life care: so there maybe more to write about this matter
http://archinte.ama-assn.org/cgi/content/abstract/171/3/196
211 The Canadian health system is very different, but the same trends can be observed there too. Hospital admissions in the last 6 months of HF are decreasing, but costs are increasing. Commissioners take note: there are no cheap ways of helping heart failure patients to live longer, or die better.
http://archinte.ama-assn.org/cgi/content/abstract/171/3/211
196 Miriam Johnson and Richard Lehman compiled the first book on Heart Failure and Palliative Care five years ago, aimed mainly at a UK audience. It's not known if it's sold any copies in the USA, but a new survey of resource use in the last 6 months of life among Medicare beneficiaries with heart failure shows a huge rise in hospice use by these patients between the beginning of 2000 and the end of 2007. The official Medicare policy remains to distinguish between "palliative" and "curative" treatments, but it is good to see that such distinctions seem to be little heeded in this group, who have also been given more intensive medical treatment as well. It had been hoped to say goodbye forever to this gloomy subject, but the need to identify patient-important symptomatic outcomes in heart failure remains huge, as does the need to provide better end-of-life care: so there maybe more to write about this matter
http://archinte.ama-assn.org/cgi/content/abstract/171/3/196
211 The Canadian health system is very different, but the same trends can be observed there too. Hospital admissions in the last 6 months of HF are decreasing, but costs are increasing. Commissioners take note: there are no cheap ways of helping heart failure patients to live longer, or die better.
http://archinte.ama-assn.org/cgi/content/abstract/171/3/211
Thursday, 17 February 2011
PAEDIATRIC HEART SERVICES
PCTs agree to consult on children's congenital heart services
HSJ 16 February, 2011 By Ben Clover
A joint committee of primary care trusts has given the go-ahead for a consultation on plans for greater centralisation of paediatric cardiac care.
HSJ 16 February, 2011 By Ben Clover
A joint committee of primary care trusts has given the go-ahead for a consultation on plans for greater centralisation of paediatric cardiac care.
Tuesday, 15 February 2011
COCHRANE REVIEWS
The Cochrane Library produces world-leading systematic reviews and research on evidence-based health care through seven comprehensive databases. Below we’ve highlighted relevant reviews for the cardiology community:
Active chest compression-decompression for cardiopulmonary resuscitation
Exercise based rehabilitation for heart failure
Beta-blockers for congestive heart failure in children
Visit The Cochrane Library and sign up for regular free podcasts and our monthly journal club, where readers can discuss new Cochrane Reviews, download resources and ask questions to review authors. Also of Interest – Watch these informative videos to learn more about The Cochrane Library!
Accessing The Cochrane Library
Resources for Librarians
What's New with The Cochrane Collaboration
CENTRAL Database
Active chest compression-decompression for cardiopulmonary resuscitation
Exercise based rehabilitation for heart failure
Beta-blockers for congestive heart failure in children
Visit The Cochrane Library and sign up for regular free podcasts and our monthly journal club, where readers can discuss new Cochrane Reviews, download resources and ask questions to review authors. Also of Interest – Watch these informative videos to learn more about The Cochrane Library!
Accessing The Cochrane Library
Resources for Librarians
What's New with The Cochrane Collaboration
CENTRAL Database
NATIONAL HEART MONTH - USA
February is National Heart Month in America so to enable you to help your researchers and clinicians working in this field we have compiled a selection of articles that we think they will find of use. All the articles highlighted below are available free online. DOWNLOAD PDF -
Free articles on Cardiac CareFamily presence during cardiopulmonary resuscitation: Using evidence-based knowledge to guide the advanced practice nurse in developing formal policy and practice guidelines Christopher T. Doolin, Lisa D. Quinn, Lesley G. Bryant, et al. Journal of the American Academy of Nurse Practitioners
The six-minute walk test: a useful metric for the cardiopulmonary patient T. Rasekaba, A. L. Lee, M. T. Naughton, et al. Internal Medicine Journal
Short-term Outcome of Infants Presenting to Pediatric Intensive Care Unit with New Cardiac Diagnoses Giridhar Dhandayuthapani, Shanta Chakrabarti, Aruna Ranasinghe, et al.Congenital Heart Disease
Perceived Quality of Care and Lifestyle Counseling Among Patients With Heart Disease Elizabeth A. Jackson, Sangeetha Krishnan, Nancy Meccone, et al. Clinical Cardiology
Biomarkers of Heart Failure Pam R. Taub, Paulette Gabbai-Saldate, Alan Maisel Congestive Heart Failure
Knowledge of risk factors, and warning signs of stroke: a systematic review from a gender perspective Nanette Stroebele, Falk Müller-Riemenschneider, Christian H. Nolte, et al. International Journal of Stroke
News and Issues that Affect Organ and Tissue Transplantation This month, 'The AJT Report' takes a look at some of the popular and reliable online resources available to transplant patients and donors, and features a study reporting high survival rates in heart transplant patients with hypertrophic cardiomyopathy.
Special issue on Pediatric Cardiac Support Systems Read these articles published in Artificial Organs containing research findings making a significant impact on the treatment of pediatric cardiac patients worldwide.
Free articles on Cardiac CareFamily presence during cardiopulmonary resuscitation: Using evidence-based knowledge to guide the advanced practice nurse in developing formal policy and practice guidelines Christopher T. Doolin, Lisa D. Quinn, Lesley G. Bryant, et al. Journal of the American Academy of Nurse Practitioners
The six-minute walk test: a useful metric for the cardiopulmonary patient T. Rasekaba, A. L. Lee, M. T. Naughton, et al. Internal Medicine Journal
Short-term Outcome of Infants Presenting to Pediatric Intensive Care Unit with New Cardiac Diagnoses Giridhar Dhandayuthapani, Shanta Chakrabarti, Aruna Ranasinghe, et al.Congenital Heart Disease
Perceived Quality of Care and Lifestyle Counseling Among Patients With Heart Disease Elizabeth A. Jackson, Sangeetha Krishnan, Nancy Meccone, et al. Clinical Cardiology
Biomarkers of Heart Failure Pam R. Taub, Paulette Gabbai-Saldate, Alan Maisel Congestive Heart Failure
Knowledge of risk factors, and warning signs of stroke: a systematic review from a gender perspective Nanette Stroebele, Falk Müller-Riemenschneider, Christian H. Nolte, et al. International Journal of Stroke
News and Issues that Affect Organ and Tissue Transplantation This month, 'The AJT Report' takes a look at some of the popular and reliable online resources available to transplant patients and donors, and features a study reporting high survival rates in heart transplant patients with hypertrophic cardiomyopathy.
Special issue on Pediatric Cardiac Support Systems Read these articles published in Artificial Organs containing research findings making a significant impact on the treatment of pediatric cardiac patients worldwide.
JOURNAL SNIPPETS February 2011
JAMA 9 Feb 2011 Vol 305
585 Last week we learned that elevation of cardiac troponins happens in up to 30% of percutaneous coronary procedures, but seems to have little prognostic importance. This week a study looks at enzyme elevations in coronary artery bypass surgery and comes to a less reassuring conclusion. The main end-point is 30-day mortality and this shows a strong correlation with increasing levels of creatine kinase. Surprisingly, perhaps, the correlation with levels of troponin-1 is much weaker.
http://jama.ama-assn.org/content/305/6/585.abstract
BMJ 12 Feb 2011 Vol 342
371 A couple of weeks ago, the NEJM published a remarkable opinion piece suggesting that out-of-hospital cardiopulmonary resuscitation using chest compression lacks any evidence base and is in need of a randomised controlled trial. One respondent on doc2doc suggested that this was a bit like the suggestion in a Christmas issue of the BMJ for an RCT of jumping from a plane with or without a parachute. Not so: we know the results of that from the invariable observation of splats on the ground versus intact people under billowy silk umbrellas, whereas since CPR was devised 40 years ago, nobody has dared leave any pulseless patient without it. Maybe one in ten really has a pulse or will get one back anyway, and the rest will die, as they do following CPR. This study is consistent with the hypothesis of a useless procedure - it shows that if you improve the quality of CPR by real-time feedback, you do not improve patient outcomes.
http://www.bmj.com/content/342/bmj.d512.full
372 A mercury sphygmomanometer fitted with a large adult cuff was often the default method of measuring office blood pressure. After several years of backing this up with ambulatory BP monitoring before starting people on lifelong treatment, it has now moved towards encouraging home BP measurement, though the quality of most electronic sphygmomanometers on sale to the public (see British Hypertension Society website) is variable. These issues are very well summarised in the editorial on p.343 (provocatively subtitled "Must be done carefully, or not at all"), in response to this groundbreaking Canadian study of conventional versus automated BP measurement in primary care patients with systolic hypertension. The new "gold standard" - if there is such a thing - for BP measurement in primary care may be the use of BpTRU device in a room uninhabited by scary health professionals of any kind. The device automatically takes the BP at preset intervals and calculates the average of five readings. These are usually significantly lower than doctor measurements and correlate well with home measurements. It could be suggested that for most practices, the barrier will be finding a quiet room rather than buying a BpTRU machine.
http://www.bmj.com/content/342/bmj.d286.full
585 Last week we learned that elevation of cardiac troponins happens in up to 30% of percutaneous coronary procedures, but seems to have little prognostic importance. This week a study looks at enzyme elevations in coronary artery bypass surgery and comes to a less reassuring conclusion. The main end-point is 30-day mortality and this shows a strong correlation with increasing levels of creatine kinase. Surprisingly, perhaps, the correlation with levels of troponin-1 is much weaker.
http://jama.ama-assn.org/content/305/6/585.abstract
BMJ 12 Feb 2011 Vol 342
371 A couple of weeks ago, the NEJM published a remarkable opinion piece suggesting that out-of-hospital cardiopulmonary resuscitation using chest compression lacks any evidence base and is in need of a randomised controlled trial. One respondent on doc2doc suggested that this was a bit like the suggestion in a Christmas issue of the BMJ for an RCT of jumping from a plane with or without a parachute. Not so: we know the results of that from the invariable observation of splats on the ground versus intact people under billowy silk umbrellas, whereas since CPR was devised 40 years ago, nobody has dared leave any pulseless patient without it. Maybe one in ten really has a pulse or will get one back anyway, and the rest will die, as they do following CPR. This study is consistent with the hypothesis of a useless procedure - it shows that if you improve the quality of CPR by real-time feedback, you do not improve patient outcomes.
http://www.bmj.com/content/342/bmj.d512.full
372 A mercury sphygmomanometer fitted with a large adult cuff was often the default method of measuring office blood pressure. After several years of backing this up with ambulatory BP monitoring before starting people on lifelong treatment, it has now moved towards encouraging home BP measurement, though the quality of most electronic sphygmomanometers on sale to the public (see British Hypertension Society website) is variable. These issues are very well summarised in the editorial on p.343 (provocatively subtitled "Must be done carefully, or not at all"), in response to this groundbreaking Canadian study of conventional versus automated BP measurement in primary care patients with systolic hypertension. The new "gold standard" - if there is such a thing - for BP measurement in primary care may be the use of BpTRU device in a room uninhabited by scary health professionals of any kind. The device automatically takes the BP at preset intervals and calculates the average of five readings. These are usually significantly lower than doctor measurements and correlate well with home measurements. It could be suggested that for most practices, the barrier will be finding a quiet room rather than buying a BpTRU machine.
http://www.bmj.com/content/342/bmj.d286.full
CARDIO HORIZON SCANNING FEB 2011
Articles include the following
Cardiovascular Horizon Scanning Volume 3 Issue 2
Multiple risk factor interventions for primary prevention of coronary heart disease
Exercise on prescription: changes in physical activity and health-related quality of life
Efficacy of quantified home-based exercise and supervised exercise
Improving cardiovascular health at population level
NHS failing to screen for deadly heart condition
Considerable uncertainty remains in the evidence for primary prevention of cardiovascular disease
Parental history and myocardial infarction
The association of breast arterial calcification and coronary heart disease
Conventional versus automated measurement of blood pressure in primary care
Early life socioeconomic adversity is associated in adult life with chronic inflammation, carotid artherosclerosis, poorer lung function and decreased cognitive performance: a cross-sectional, population-based study
Further dissemination
Cardiovascular Horizon Scanning Volume 3 Issue 2
Posted: 14 Feb 2011 07:50 AM PST
Filed under: Cardiovascular diseases, Volume 3 Issue 2
Multiple risk factor interventions for primary prevention of coronary heart disease
Posted: 11 Feb 2011 09:37 AM PST
Source: Cochrane Database of Systematic Reviews 2011, issue 1
Follow this link for fulltext
Date of publication: January 2011
Publication type: Systematic review
In a nutshell: The evidence from this Cochrane systematic review suggests that multiple risk factor interventions using counselling and educational methods to change behaviour do not reduce coronary heart disease (CHD) mortality and morbidity. However, they may be effective in reducing mortality in high-risk hypertensive and diabetic populations. It concludes that health promotion interventions have limited use in general populations.
Length of publication: 175 pages
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Cardiovascular diseases, Volume 3 Issue 2 Tagged: behaviour change, CHD, health promotion, risk factors
Exercise on prescription: changes in physical activity and health-related quality of life
Posted: 11 Feb 2011 07:06 AM PST
Source: European Journal of Public Health, 2011, 21 (1), p. 56-62
Follow this link for fulltext
Date of publication: January 2011
Publication type: Research
In a nutshell: This study analysed changes in physical activity among participants of five Exercise on Prescription (EoP) programmes in Denmark. EoP helped to contribute to improved levels of physical activity and health-related quality of life.
Length of publication: 7 pages
Some important notes: You will need an NHS Athens username and password to access this article. Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Cardiovascular diseases, Physical activity, Volume 3 Issue 2 Tagged: behaviour change, Exercise, lifestyle
Efficacy of quantified home-based exercise and supervised exercise
Posted: 10 Feb 2011 09:49 AM PST
Source: Circulation, 2011, 123 (5) p. 491-498
Follow this link for fulltext
Date of publication: February 2011
Publication type: Research
In a nutshell: This clinical trial compared home-based and supervised exercise programmes among peripheral artery disease patients. The results of the study found that a home-based exercise programme had high adherence and was effective in improving claudication measures and increasing daily ambulatory activity.
Length of publication: 8 pages
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.
Acknowledgement: American Heart AssociationFiled under: Cardiovascular diseases, Volume 3 Issue 2 Tagged: claudication, peripheral artery disease, Physical activity
Improving cardiovascular health at population level
Posted: 10 Feb 2011 09:25 AM PST
Source: BMJ 2011; 342:d442 (Online First)
Follow this link for fulltext
Date of publication: February 2011
Publication type: Research
In a nutshell: The Cardiovascular Health Awareness Program (CHAP) was implemented as an intervention to reduce morbidity from cardiovascular disease among older adults in 39 communities in Canada. This collaborative, community-based health promotion and prevention programme was found to reduce cardiovascular morbidity at a population level.
Length of publication: 8 pages
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Canada, Cardiovascular diseases, Prevention, Volume 3 Issue 2 Tagged: community-based programmes, education, health promotion, Risk assessment
NHS failing to screen for deadly heart condition
Posted: 10 Feb 2011 09:16 AM PST
Source: National Institute for Health and Clinical Excellence
Follow this link for fulltext
Date of publication: January 2011
Publication type: Press release
In a nutshell: 100.000 people are at risk of developing familial hypercholesterolaemia (FH) as trusts fail to act on NICE guidelines which call for early diagnosis. A UK-wide audit found that very few families were systematically genetically screened for the inherited condition.
Length of publication: 1 webpage
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Cardiovascular diseases, Diagnosis, Volume 3 Issue 2 Tagged: familial hypercholesterolaemia, family history, genetics, screening
Considerable uncertainty remains in the evidence for primary prevention of cardiovascular disease
Posted: 10 Feb 2011 07:30 AM PST
Source: The Cochrane Library
Follow this link for fulltext
Date of publication: 14 January 2011
Publication type: Editorial
In a nutshell: This editorial is written by Carl Heneghan, Director of the Centre for Evidence Based Medicine, and Clinical Reader in the Department of Primary Health Care, University of Oxford. It is based on the evidence from two new Cochrane reviews of preventive strategies: multiple risk factor interventions for primary prevention of CHD, and statins for the primary prevention of CVD.
Length of publication: 1 web page
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Cardiovascular diseases, Prevention, Volume 3 Issue 2 Tagged: evidence, preventative services, Prevention
Parental history and myocardial infarction
Posted: 10 Feb 2011 06:18 AM PST
Source: Reuters 27.1.11
Follow this link for fulltext
Date of publication: 27 January 2011
Publication type: News item
In a nutshell: Reports on the findings of the INTERHEART study, published recently in the Journal of the American College of Cardiology. 12 000 participants from 52 countries were studied, and across all nationalities, the risk of heart disease was almost doubled in those with a family history of heart attack.
Length of publication: 1 web page
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.
Acknowledgement: Journal of the American College of Cardiology (JACC), 2011, 57, pp 619-627Filed under: Cardiovascular diseases, Volume 3 Issue 2 Tagged: family history, risk factors
The association of breast arterial calcification and coronary heart disease
Posted: 10 Feb 2011 04:01 AM PST
Source: Obstetrics and Gynecology, 2011, 117 (2 part 1) p. 233-241
Follow this link for fulltext
Date of publication: February 2011
Publication type: Research
In a nutshell: The objective of this study was to determine whether mammography could be an early prediction tool for the development of coronary heart disease (CHD). The study found that the presence of breast arterial calcifications on mammograms indicated a significantly increased risk of developing CHD or a stroke, and could therefore be used as a marker.
Length of publication: 9 pages
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Cardiovascular diseases, Prevention, Volume 3 Issue 2 Tagged: CHD, mammography, risk markers, risk prediction tools
Conventional versus automated measurement of blood pressure in primary care
Posted: 10 Feb 2011 03:23 AM PST
Source: BMJ 2011;342:d286 (Online First)
Follow this link for fulltext
Date of publication: 7th February 2011
Publication type: Research
In a nutshell: The objective of this randomised controlled trial was to compare the quality and accuracy of manual office blood pressure and automated office blood pressure. Primary care practices in five Canadian cities were randomly allocated to the use of either manual or automated office blood pressure.
Length of publication: 9 pages
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Canada, Cardiovascular diseases, Prevention, Volume 3 Issue 2 Tagged: BP monitoring
Early life socioeconomic adversity is associated in adult life with chronic inflammation, carotid artherosclerosis, poorer lung function and decreased cognitive performance: a cross-sectional, population-based study
Posted: 09 Feb 2011 07:14 AM PST
Source: BMC Public Health, 2011, 11:42
Follow this link for fulltext
Date of publication: 17 January 2011
Publication type: Journal article
In a nutshell: The Scottish Psychosocial and Biological Determinants of Ill-health (pSoBid) Study was conducted to examine links between early life adversity, intermediary phenotypes and markers of ill-health in adulthood, including artherosclerosis.
Length of publication: 16 pages
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Cardiovascular diseases, Volume 3 Issue 2 Tagged: health inequalities, risk factors
Further dissemination
Posted: 08 Feb 2011 05:44 AM PST
If you think someone would benefit from receiving this posting, please e-mail them the link to this blog and suggest that they sign up to the e-mail newsletter to stay up to date with new content.Filed under: Cardiovascular diseases, Volume 3 Issue 2
Cardiovascular Horizon Scanning Volume 3 Issue 2
Multiple risk factor interventions for primary prevention of coronary heart disease
Exercise on prescription: changes in physical activity and health-related quality of life
Efficacy of quantified home-based exercise and supervised exercise
Improving cardiovascular health at population level
NHS failing to screen for deadly heart condition
Considerable uncertainty remains in the evidence for primary prevention of cardiovascular disease
Parental history and myocardial infarction
The association of breast arterial calcification and coronary heart disease
Conventional versus automated measurement of blood pressure in primary care
Early life socioeconomic adversity is associated in adult life with chronic inflammation, carotid artherosclerosis, poorer lung function and decreased cognitive performance: a cross-sectional, population-based study
Further dissemination
Cardiovascular Horizon Scanning Volume 3 Issue 2
Posted: 14 Feb 2011 07:50 AM PST
Filed under: Cardiovascular diseases, Volume 3 Issue 2
Multiple risk factor interventions for primary prevention of coronary heart disease
Posted: 11 Feb 2011 09:37 AM PST
Source: Cochrane Database of Systematic Reviews 2011, issue 1
Follow this link for fulltext
Date of publication: January 2011
Publication type: Systematic review
In a nutshell: The evidence from this Cochrane systematic review suggests that multiple risk factor interventions using counselling and educational methods to change behaviour do not reduce coronary heart disease (CHD) mortality and morbidity. However, they may be effective in reducing mortality in high-risk hypertensive and diabetic populations. It concludes that health promotion interventions have limited use in general populations.
Length of publication: 175 pages
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Cardiovascular diseases, Volume 3 Issue 2 Tagged: behaviour change, CHD, health promotion, risk factors
Exercise on prescription: changes in physical activity and health-related quality of life
Posted: 11 Feb 2011 07:06 AM PST
Source: European Journal of Public Health, 2011, 21 (1), p. 56-62
Follow this link for fulltext
Date of publication: January 2011
Publication type: Research
In a nutshell: This study analysed changes in physical activity among participants of five Exercise on Prescription (EoP) programmes in Denmark. EoP helped to contribute to improved levels of physical activity and health-related quality of life.
Length of publication: 7 pages
Some important notes: You will need an NHS Athens username and password to access this article. Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Cardiovascular diseases, Physical activity, Volume 3 Issue 2 Tagged: behaviour change, Exercise, lifestyle
Efficacy of quantified home-based exercise and supervised exercise
Posted: 10 Feb 2011 09:49 AM PST
Source: Circulation, 2011, 123 (5) p. 491-498
Follow this link for fulltext
Date of publication: February 2011
Publication type: Research
In a nutshell: This clinical trial compared home-based and supervised exercise programmes among peripheral artery disease patients. The results of the study found that a home-based exercise programme had high adherence and was effective in improving claudication measures and increasing daily ambulatory activity.
Length of publication: 8 pages
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.
Acknowledgement: American Heart AssociationFiled under: Cardiovascular diseases, Volume 3 Issue 2 Tagged: claudication, peripheral artery disease, Physical activity
Improving cardiovascular health at population level
Posted: 10 Feb 2011 09:25 AM PST
Source: BMJ 2011; 342:d442 (Online First)
Follow this link for fulltext
Date of publication: February 2011
Publication type: Research
In a nutshell: The Cardiovascular Health Awareness Program (CHAP) was implemented as an intervention to reduce morbidity from cardiovascular disease among older adults in 39 communities in Canada. This collaborative, community-based health promotion and prevention programme was found to reduce cardiovascular morbidity at a population level.
Length of publication: 8 pages
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Canada, Cardiovascular diseases, Prevention, Volume 3 Issue 2 Tagged: community-based programmes, education, health promotion, Risk assessment
NHS failing to screen for deadly heart condition
Posted: 10 Feb 2011 09:16 AM PST
Source: National Institute for Health and Clinical Excellence
Follow this link for fulltext
Date of publication: January 2011
Publication type: Press release
In a nutshell: 100.000 people are at risk of developing familial hypercholesterolaemia (FH) as trusts fail to act on NICE guidelines which call for early diagnosis. A UK-wide audit found that very few families were systematically genetically screened for the inherited condition.
Length of publication: 1 webpage
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Cardiovascular diseases, Diagnosis, Volume 3 Issue 2 Tagged: familial hypercholesterolaemia, family history, genetics, screening
Considerable uncertainty remains in the evidence for primary prevention of cardiovascular disease
Posted: 10 Feb 2011 07:30 AM PST
Source: The Cochrane Library
Follow this link for fulltext
Date of publication: 14 January 2011
Publication type: Editorial
In a nutshell: This editorial is written by Carl Heneghan, Director of the Centre for Evidence Based Medicine, and Clinical Reader in the Department of Primary Health Care, University of Oxford. It is based on the evidence from two new Cochrane reviews of preventive strategies: multiple risk factor interventions for primary prevention of CHD, and statins for the primary prevention of CVD.
Length of publication: 1 web page
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Cardiovascular diseases, Prevention, Volume 3 Issue 2 Tagged: evidence, preventative services, Prevention
Parental history and myocardial infarction
Posted: 10 Feb 2011 06:18 AM PST
Source: Reuters 27.1.11
Follow this link for fulltext
Date of publication: 27 January 2011
Publication type: News item
In a nutshell: Reports on the findings of the INTERHEART study, published recently in the Journal of the American College of Cardiology. 12 000 participants from 52 countries were studied, and across all nationalities, the risk of heart disease was almost doubled in those with a family history of heart attack.
Length of publication: 1 web page
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.
Acknowledgement: Journal of the American College of Cardiology (JACC), 2011, 57, pp 619-627Filed under: Cardiovascular diseases, Volume 3 Issue 2 Tagged: family history, risk factors
The association of breast arterial calcification and coronary heart disease
Posted: 10 Feb 2011 04:01 AM PST
Source: Obstetrics and Gynecology, 2011, 117 (2 part 1) p. 233-241
Follow this link for fulltext
Date of publication: February 2011
Publication type: Research
In a nutshell: The objective of this study was to determine whether mammography could be an early prediction tool for the development of coronary heart disease (CHD). The study found that the presence of breast arterial calcifications on mammograms indicated a significantly increased risk of developing CHD or a stroke, and could therefore be used as a marker.
Length of publication: 9 pages
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Cardiovascular diseases, Prevention, Volume 3 Issue 2 Tagged: CHD, mammography, risk markers, risk prediction tools
Conventional versus automated measurement of blood pressure in primary care
Posted: 10 Feb 2011 03:23 AM PST
Source: BMJ 2011;342:d286 (Online First)
Follow this link for fulltext
Date of publication: 7th February 2011
Publication type: Research
In a nutshell: The objective of this randomised controlled trial was to compare the quality and accuracy of manual office blood pressure and automated office blood pressure. Primary care practices in five Canadian cities were randomly allocated to the use of either manual or automated office blood pressure.
Length of publication: 9 pages
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Canada, Cardiovascular diseases, Prevention, Volume 3 Issue 2 Tagged: BP monitoring
Early life socioeconomic adversity is associated in adult life with chronic inflammation, carotid artherosclerosis, poorer lung function and decreased cognitive performance: a cross-sectional, population-based study
Posted: 09 Feb 2011 07:14 AM PST
Source: BMC Public Health, 2011, 11:42
Follow this link for fulltext
Date of publication: 17 January 2011
Publication type: Journal article
In a nutshell: The Scottish Psychosocial and Biological Determinants of Ill-health (pSoBid) Study was conducted to examine links between early life adversity, intermediary phenotypes and markers of ill-health in adulthood, including artherosclerosis.
Length of publication: 16 pages
Some important notes: Please contact your local NHS library if you cannot access the full text. Follow this link to find your local NHS library.Filed under: Cardiovascular diseases, Volume 3 Issue 2 Tagged: health inequalities, risk factors
Further dissemination
Posted: 08 Feb 2011 05:44 AM PST
If you think someone would benefit from receiving this posting, please e-mail them the link to this blog and suggest that they sign up to the e-mail newsletter to stay up to date with new content.Filed under: Cardiovascular diseases, Volume 3 Issue 2
Wednesday, 9 February 2011
NHS EVIDENCE
Antiplatelet dosage for PCIOverview: Percutaneous coronary intervention (PCI) is an important advance in the treatment of patients with acute coronary syndromes, with or without ST segment elevation. Despite the capacity of PCI to reduce major cardiovascular events, the risk of thrombotic complications remains an important concern. Hence, attention is being focused on the development of fast-acting anti-platelet regimens that achieve high levels of platelet inhibition.
Current advice: Aspirin, in combination with clopidogrel – a thienopyridine adenosine diphosphate receptor antagonist – prevents major thrombotic events in patients undergoing PCI and has been the standard of care for more than a decade.NICE guidance on the early management of unstable angina and non ST segment elevation myocardial infarction recommends offering a single loading dose of 300 mg aspirin and continuing aspirin indefinitely.For patients with no contraindications, who may undergo PCI within 24 hours of admission to hospital, NICE recommends offering a 300 mg loading dose of clopidogrel. The guidance states that there is emerging evidence about the use of a 600 mg loading dose of clopidogrel for patients undergoing PCI within 24 hours of admission. However, NICE was not able to formally review all the evidence and was therefore unable to recommend this at the time of guidance publication (March 2010).
New evidence: The CURRENT-OASIS 7 trial (The Lancet Volume 376, Issue 9748) assessed whether doubling of the loading and maintenance dose of clopidogrel for 7 days was better than the standard dose and if high dose aspirin was better than low dose aspirin in patients undergoing PCI.A 7 day double dose clopidogrel regimen (600 mg on day 1, 150 mg on days 2 to 7, then 75 mg daily) was associated with a reduction in cardiovascular events and stent thrombosis compared to the standard dose (300 mg on day 1 then 75 mg daily). The analysis suggests a clear benefit in the 17,236 patients who underwent a PCI procedure.
Using the CURRENT/OASIS 7 trial definition, major bleeding was more common with double than standard dose clopidogrel. Before PCI, rates of ischaemic events or major bleeding did not differ between the groups.The researchers conclude that a double-dose clopidogrel regimen (600 mg loading dose) can be considered for all patients with acute coronary syndromes treated with an early invasive strategy and intended early PCI.Efficacy and safety did not differ between high dose (300 to 325 mg daily) and low dose (75 to 100mg daily) aspirin. However, since the dose comparison was for only 30 days, use of low-dose aspirin is still thought to be reasonable for long-term therapy.
New evidence: The CURRENT-OASIS 7 trial (The Lancet Volume 376, Issue 9748) assessed whether doubling of the loading and maintenance dose of clopidogrel for 7 days was better than the standard dose and if high dose aspirin was better than low dose aspirin in patients undergoing PCI.A 7 day double dose clopidogrel regimen (600 mg on day 1, 150 mg on days 2 to 7, then 75 mg daily) was associated with a reduction in cardiovascular events and stent thrombosis compared to the standard dose (300 mg on day 1 then 75 mg daily). The analysis suggests a clear benefit in the 17,236 patients who underwent a PCI procedure.
Using the CURRENT/OASIS 7 trial definition, major bleeding was more common with double than standard dose clopidogrel. Before PCI, rates of ischaemic events or major bleeding did not differ between the groups.The researchers conclude that a double-dose clopidogrel regimen (600 mg loading dose) can be considered for all patients with acute coronary syndromes treated with an early invasive strategy and intended early PCI.Efficacy and safety did not differ between high dose (300 to 325 mg daily) and low dose (75 to 100mg daily) aspirin. However, since the dose comparison was for only 30 days, use of low-dose aspirin is still thought to be reasonable for long-term therapy.
Commentary:"CURRENT-OASIS 7 is the latest in a long list of trials that tests the impact of dual anti-platelet therapy on efficacy, and since most trials look at the effect of increased therapy to prevent stent thrombosis (or its surrogate acute myocardial infarction/death), also importantly bleeding. A number of studies and retrospective analyses of large trials have shown the benefit of 600 mg over 300 mg.
"I see two problems with this study. First, two things were changed at once (so we don't really know which change, aspirin or clopidogrel, was beneficial in this study) and secondly, increasing the loading dose of clopidogrel to 150 mg with maintenance of 150 mg, if this is thought to be of value (and the trial suggests it might be), was associated with extra bleeding risk.
"So how should we use this study as applied to UK practice? In patients presenting with acute coronary syndrome who are at a low risk of bleeding (i.e. normal renal function, body weight of more than 60kg and no evidence of GI tract disease), it might be reasonable to give 600 mg clopidogrel loading but then to increase the maintenance clopidogrel dose to 150 mg for one week (only) and to maintain the patient on 75 mg aspirin and 75 mg clopidogrel." - Tony Gershlick, Professor of Interventional Cardiology, University of Leicester.
"I see two problems with this study. First, two things were changed at once (so we don't really know which change, aspirin or clopidogrel, was beneficial in this study) and secondly, increasing the loading dose of clopidogrel to 150 mg with maintenance of 150 mg, if this is thought to be of value (and the trial suggests it might be), was associated with extra bleeding risk.
"So how should we use this study as applied to UK practice? In patients presenting with acute coronary syndrome who are at a low risk of bleeding (i.e. normal renal function, body weight of more than 60kg and no evidence of GI tract disease), it might be reasonable to give 600 mg clopidogrel loading but then to increase the maintenance clopidogrel dose to 150 mg for one week (only) and to maintain the patient on 75 mg aspirin and 75 mg clopidogrel." - Tony Gershlick, Professor of Interventional Cardiology, University of Leicester.
For more evidence relating to cardiovascular health visit NHS Evidence - Cardiovascular.
NICE guidance on the early management of unstable angina and non ST segment elevation myocardial infarction is due to be updated in March 2013.
Eyes on Evidence helps contextualise significant new evidence, highlighting areas that could signal a change in clinical practice. It does not constitute formal NICE guidance. The commentaries included are the opinions of contributors and do not necessarily reflect the views of NICE.
Wednesday, 2 February 2011
CARDIOVASCULAR DISEASE
Cardiovascular Disease in Public Health E-Newsletter
Effect of cocoa products on blood pressure: systematic review and meta-analysis
Database of Abstracts of Reviews of Effects
Effect of cocoa products on blood pressure: systematic review and meta-analysis
Database of Abstracts of Reviews of Effects
Tuesday, 1 February 2011
JOURNAL SNIPPETS January 2011
JAMA 26 Jan 2011 Vol 305
391 Stroke medicine grew up in the 1990s: like heart failure medicine, it shone welcome light on a large and neglected group of patients with organ damage who had been written off as unsalvageable. This was a Very Good Thing in itself, but its proponents then went on to declare that good stroke care could only be provided in designated stroke units, and went on to run some not-very-randomised trials to prove it. They also began to talk up the evidence for the benefits of immediate thrombolysis, which are real but extremely modest. These fashions spread to the USA following recommendations of the Brain Attack Commission in 2000, and this study evaluates the effect in New York State in 2005-6, comparing mortality and the use of thrombolysis in 31,000 patients with stroke, equally divided between hospitals with or without stroke units. There was a large difference in thrombolysis use - 4.8% in stroke units, versus 1.7% elsewhere; but a very small difference in mortality at 30 days - 10.7% versus 12.5%. It would be nice if someone could go on to look at a wider range of patient-important outcomes too.
NEJM 27 Jan 2011 Vol 364
303 One of the nightmare jobs you are glad someone else does is finding veins in haemodialysis patients. Someone who does this from time to time will be very glad to read this study showing that recombinant tissue plasminogen activator is twice as good as heparin at keeping central venous lines open and three times as good at preventing bacteraemia. Luck will be needed to get hospital trust to meet the extra cost.
http://www.nejm.org/doi/full/10.1056/NEJMoa1011376
313 The New England Journal allows you free access to this paper on Ventricular Tachyarrhythmias after Cardiac Arrest in Public versus at Home and in case you are inclined to spurn this generous offer, take a look at these excerpts from the editorial about it by Gust H Bardy M.D.:
If CPR were a drug or a surgical procedure, its value would be tested prospectively, but it has not been. Could it be that innovation in the field is hampered by a reluctance to let go of an entrenched approach that has only the appearance of value?
Knowledge of the absolute measured value of CPR would have a profound influence on the direction of research on sudden cardiac arrest and the conservation of resources. More than 40 years after its inception, CPR has never been compared with no CPR in a randomized trial involving patients with sudden cardiac arrest. Although not performing CPR is a heretical idea, it is not unethical; clinical equipoise does exist for the comparison of chest compression with no compression.
Click the links and read on
http://www.nejm.org/doi/full/10.1056/NEJMoa1010663
http://www.nejm.org/doi/full/10.1056/NEJMe1012554
351 Chronic thromboembolic pulmonary hypertension sounds nasty and almost bound to be underdiagnosed, and indeed it is both. It is fairly easy to spot when it follows acute pulmonary embolism as it does in 2-4% of PEs. But we simply don't know how often it occurs without overt PE, because much of it may lie hidden as "idiopathic" pulmonary hypertension and not present until right heart failure has set in. By which time it is a bit late: the "heroic" treatment is surgical: "Pulmonary thromboendarterectomy is performed with the use of cardiopulmonary bypass with intermittent circulatory arrest to permit dissection from the main pulmonary arteries to the subsegmental branches." Not surprisingly, it doesn't always work, and many patients are too sick to have it done.
http://www.nejm.org/doi/full/10.1056/NEJMra0910203
Lancet 29 Jan 2011 Vol 377
393 Eltrombopag! Eltrombopag! O keep it in your doctor's bag! was sang when first encountered this orally available thrombopoeitin receptor agonist. It makes you make platelets and so reverses chronic immune thrombocytopenia - as long as you keep taking the tablets. The Lancet has decided to print the RAISE study as it first appeared on their website, despite some second thoughts by its authors - if you like this kind of thing, it's all explained in an editorial by Lancet house staff on p.360. Apparently they made some claims about the inferiority of eltrombopag's main competitor drug, romiplostim, which may not be sustainable. Plus failing to mention that their patients were splenectomised. Naughtiness.Eltrombopag! Eltrombopag! Doctor will keep it in his bag,Depending on what it might cost him -He might just plump for romiplostim.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60959-2/abstract
BMJ 29 Jan 2011 Vol 342
275 And of course I have to declare an interest in the Easily Missed series, which I helped to set up. I think I may even have suggested Joint Hypermobility Syndrome and I'm certainly glad that it produced such a good contribution, well illustrated and a bit longer than most. Please let's have your further submissions to keep this series going indefinitely - after all, there's no end to what you can miss in medicine. But don't be surprised if we keep your article short and down to ten references.
http://www.bmj.com/content/342/bmj.c7167.extract
Arch Intern Med 24 Jan 2011 Vol 171
134 A drug that produces a 41% reduction in recurrent cardiovascular events following myocardial infarction - now wouldn't that get some marketing! The only drug that comes near that is alcohol - which does get a lot of marketing, but not for that reason. Here there is no drug at all: just talking. Mind you, quite a lot of talking, in the form of 20 two-hour sessions of traditional cognitive behavioural therapy in the first year after MI. Now let's say this was a new antiplatelet drug produced by pharma, and sold at £115 per month (a generous estimate of the cost of the CBT): every post-infarct patient would be clamouring for it to be funded by the NHS. But it's only CBT, which is also the best treatment for lots of other things. So forget about ever being able to get it.
http://archinte.ama-assn.org/cgi/content/abstract/171/2/134
391 Stroke medicine grew up in the 1990s: like heart failure medicine, it shone welcome light on a large and neglected group of patients with organ damage who had been written off as unsalvageable. This was a Very Good Thing in itself, but its proponents then went on to declare that good stroke care could only be provided in designated stroke units, and went on to run some not-very-randomised trials to prove it. They also began to talk up the evidence for the benefits of immediate thrombolysis, which are real but extremely modest. These fashions spread to the USA following recommendations of the Brain Attack Commission in 2000, and this study evaluates the effect in New York State in 2005-6, comparing mortality and the use of thrombolysis in 31,000 patients with stroke, equally divided between hospitals with or without stroke units. There was a large difference in thrombolysis use - 4.8% in stroke units, versus 1.7% elsewhere; but a very small difference in mortality at 30 days - 10.7% versus 12.5%. It would be nice if someone could go on to look at a wider range of patient-important outcomes too.
NEJM 27 Jan 2011 Vol 364
303 One of the nightmare jobs you are glad someone else does is finding veins in haemodialysis patients. Someone who does this from time to time will be very glad to read this study showing that recombinant tissue plasminogen activator is twice as good as heparin at keeping central venous lines open and three times as good at preventing bacteraemia. Luck will be needed to get hospital trust to meet the extra cost.
http://www.nejm.org/doi/full/10.1056/NEJMoa1011376
313 The New England Journal allows you free access to this paper on Ventricular Tachyarrhythmias after Cardiac Arrest in Public versus at Home and in case you are inclined to spurn this generous offer, take a look at these excerpts from the editorial about it by Gust H Bardy M.D.:
If CPR were a drug or a surgical procedure, its value would be tested prospectively, but it has not been. Could it be that innovation in the field is hampered by a reluctance to let go of an entrenched approach that has only the appearance of value?
Knowledge of the absolute measured value of CPR would have a profound influence on the direction of research on sudden cardiac arrest and the conservation of resources. More than 40 years after its inception, CPR has never been compared with no CPR in a randomized trial involving patients with sudden cardiac arrest. Although not performing CPR is a heretical idea, it is not unethical; clinical equipoise does exist for the comparison of chest compression with no compression.
Click the links and read on
http://www.nejm.org/doi/full/10.1056/NEJMoa1010663
http://www.nejm.org/doi/full/10.1056/NEJMe1012554
351 Chronic thromboembolic pulmonary hypertension sounds nasty and almost bound to be underdiagnosed, and indeed it is both. It is fairly easy to spot when it follows acute pulmonary embolism as it does in 2-4% of PEs. But we simply don't know how often it occurs without overt PE, because much of it may lie hidden as "idiopathic" pulmonary hypertension and not present until right heart failure has set in. By which time it is a bit late: the "heroic" treatment is surgical: "Pulmonary thromboendarterectomy is performed with the use of cardiopulmonary bypass with intermittent circulatory arrest to permit dissection from the main pulmonary arteries to the subsegmental branches." Not surprisingly, it doesn't always work, and many patients are too sick to have it done.
http://www.nejm.org/doi/full/10.1056/NEJMra0910203
Lancet 29 Jan 2011 Vol 377
393 Eltrombopag! Eltrombopag! O keep it in your doctor's bag! was sang when first encountered this orally available thrombopoeitin receptor agonist. It makes you make platelets and so reverses chronic immune thrombocytopenia - as long as you keep taking the tablets. The Lancet has decided to print the RAISE study as it first appeared on their website, despite some second thoughts by its authors - if you like this kind of thing, it's all explained in an editorial by Lancet house staff on p.360. Apparently they made some claims about the inferiority of eltrombopag's main competitor drug, romiplostim, which may not be sustainable. Plus failing to mention that their patients were splenectomised. Naughtiness.Eltrombopag! Eltrombopag! Doctor will keep it in his bag,Depending on what it might cost him -He might just plump for romiplostim.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60959-2/abstract
BMJ 29 Jan 2011 Vol 342
275 And of course I have to declare an interest in the Easily Missed series, which I helped to set up. I think I may even have suggested Joint Hypermobility Syndrome and I'm certainly glad that it produced such a good contribution, well illustrated and a bit longer than most. Please let's have your further submissions to keep this series going indefinitely - after all, there's no end to what you can miss in medicine. But don't be surprised if we keep your article short and down to ten references.
http://www.bmj.com/content/342/bmj.c7167.extract
Arch Intern Med 24 Jan 2011 Vol 171
134 A drug that produces a 41% reduction in recurrent cardiovascular events following myocardial infarction - now wouldn't that get some marketing! The only drug that comes near that is alcohol - which does get a lot of marketing, but not for that reason. Here there is no drug at all: just talking. Mind you, quite a lot of talking, in the form of 20 two-hour sessions of traditional cognitive behavioural therapy in the first year after MI. Now let's say this was a new antiplatelet drug produced by pharma, and sold at £115 per month (a generous estimate of the cost of the CBT): every post-infarct patient would be clamouring for it to be funded by the NHS. But it's only CBT, which is also the best treatment for lots of other things. So forget about ever being able to get it.
http://archinte.ama-assn.org/cgi/content/abstract/171/2/134
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