(HealthDay News) -- An infusion of glucose, insulin and potassium, a treatment thought to help people right after they have had a heart attack, actually increases the immediate risk of heart failure and death for some patients, a new study shows.
Previous research has produced mixed results, with smaller studies supporting the use of GIK therapy, as the treatment is known, and one larger study showing no effect on the death risk 30 days after a heart attack.
However, patients with an ST-segment elevation myocardial infarction, a type of heart attack commonly known as STEMI that shows a particular electrical pattern, should not be given the infusion right away because that increased risk lingers for them in the first three days after diagnosis, the researchers said in a statement.
"GIK therapy increased levels of glucose, potassium, and net fluid gain post-infusion, all three of which predicted death after adjusting for multiple confounders. Adjusting for glucose, potassium, and net fluid gain eliminated the apparent increase in mortality at 3 days observed with GIK infusion, suggesting a direct association with these factors. Administration of GIK infusion within 4 hours of symptom onset yielded no benefit compared with later initiation," the authors wrote.
Their report is published in the Nov. 28 issue of the Journal of the American Medical Association.
The research team, which included scientists from Argentina and Emory University in Atlanta, analyzed data from two separate trials of almost 23,000 STEMI patients. Although the researchers found no difference in outcome at 30 days and six months, when they looked at the first few days following a heart attack, they discovered an increased risk of both heart failure and death in the patients who received the infusions. In the first three days, there were 1,509 incidents of heart failure or death (15.8 percent) in the infusion group, compared with 1,388 incidents of heart failure or death (14.5 percent) in the control group.
The researchers noted that this largest-ever analysis "demonstrates that GIK infusion has no effect on any important clinical endpoint through 30 days following STEMI. However, contrary to our pre-specified hypothesis, we observed a higher rate of death and the composite of death or heart failure at 3 days in patients allocated to GIK therapy compared with control."
More information
The American Heart Association has more on heart attack treatments.
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Wednesday, November 28, 2007
Monday, November 26, 2007
Tooth Decay Is Kids' Stuff
(HealthDay News) -- The dental health of Americans is improving as people take better care of their teeth. But that encouraging trend doesn't extend to some of the country's most vulnerable individuals -- children.
Studies have found that baby tooth decay is on the rise. One federal report found that decay in baby teeth among 2- to 5-year-olds increased from 24 percent to 28 percent from 1988 to 2004.
This decay can have unwanted lasting effects on a child's overall heath, ranging from impairment of permanent teeth to systemic illness caused by infection from bacteria in the mouth.
Jean Connor, a dental hygienist in Cambridge, Mass., and president of the American Dental Hygienists Association, said parents need to teach their children that a clean mouth is just as desirable as clean ears or hands or feet.
"It's just another part of the body that must be kept clean," Connor said. "If you have a dirty mouth, you're carrying bacteria and infections around."
Baby teeth are often thought of as disposable or temporary. But if left to decay, those teeth can fill the mouth with bacteria that could harm the permanent teeth as they come in. And if baby teeth are pulled early due to decay, the permanent teeth behind them can come in crooked.
Oral cleanliness can come from a variety of techniques. Parents should teach their kids how to brush and floss and also how to keep their mouth clean by watching what they eat.
This care can start even before a child is born, said Diann Bomkamp, a dental hygienist in St. Louis, and president-elect of the American Dental Hygienists Association (ADHA).
Expecting mothers can give their unborn children an advantage by taking special care of their dental health during pregnancy, Bomkamp said.
"If the pregnant woman does not have good dental care, she could have more of the decay-producing bacteria in her mouth, and it's very likely she could pass these bugs on to her child," Bomkamp said.
Once the child is born, parents should start keeping the mouth clean even before the first baby tooth has erupted.
The ADHA recommends thoroughly cleaning an infant's gums after each feeding with a water-soaked infant washcloth or gauze pad to stimulate the gum tissue and remove food.
"Even before they have teeth, you can clean out their mouths and get the kids used to the idea of it," Connor said.
When the baby's teeth begin to erupt, parents should brush them gently with a small, soft-bristled toothbrush using a pea-sized amount of fluoridated toothpaste.
At age 2 or 3, a parent can begin to teach their child proper brushing techniques. However, the child will need help with brushing and flossing up through age 7 or 8. By then, they will have developed the dexterity to do it alone.
Parents also should be cautious about inadvertently sharing their own mouth's bacteria with their child, through even the most seemingly innocuous behavior.
"Decay bugs can be transmitted through sharing food and drink, through sharing a toothbrush or sharing utensils," Bomkamp said. "Even blowing on food, your saliva can be transmitted to the child."
Watching what children eat also can help protect them from developing cavities or large amounts of decay bacteria in their mouths. This includes making sure that kids are fed regular meals throughout the day, especially breakfast, to keep them from feeling the need to snack on unhealthy foods.
One recent study found that the odds of decay in baby teeth were greater in the children with poor eating habits. Children who don't eat breakfast every day had higher levels of tooth decay, the study found, as did those who don't eat five servings of fruits and vegetables a day.
"If they're eating several snacks a day, they probably aren't eating foods that are good for them," Bomkamp said.
Also, don't let a young child go to bed with a bottle, Bomkamp said, and avoid allowing them to run around with sippy cups filled with sugary juices.
Another potential problem is the increased use of bottled water, she said. Tap water in almost all U.S. cities contains fluoride, which helps prevent tooth decay. "Most bottled water doesn't have the fluoride levels we'd like to see," Bomkamp said.
Dental hygienists also urge parents to get their kids in to see a dentist as early as possible, within six months of the eruption of their first baby tooth or by their first birthday.
"Parents often don't think to take their child to the dentist until it's too late to prevent problems," Connor said.
More information
To learn more, visit the American Dental Hygienists Association.
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Studies have found that baby tooth decay is on the rise. One federal report found that decay in baby teeth among 2- to 5-year-olds increased from 24 percent to 28 percent from 1988 to 2004.
This decay can have unwanted lasting effects on a child's overall heath, ranging from impairment of permanent teeth to systemic illness caused by infection from bacteria in the mouth.
Jean Connor, a dental hygienist in Cambridge, Mass., and president of the American Dental Hygienists Association, said parents need to teach their children that a clean mouth is just as desirable as clean ears or hands or feet.
"It's just another part of the body that must be kept clean," Connor said. "If you have a dirty mouth, you're carrying bacteria and infections around."
Baby teeth are often thought of as disposable or temporary. But if left to decay, those teeth can fill the mouth with bacteria that could harm the permanent teeth as they come in. And if baby teeth are pulled early due to decay, the permanent teeth behind them can come in crooked.
Oral cleanliness can come from a variety of techniques. Parents should teach their kids how to brush and floss and also how to keep their mouth clean by watching what they eat.
This care can start even before a child is born, said Diann Bomkamp, a dental hygienist in St. Louis, and president-elect of the American Dental Hygienists Association (ADHA).
Expecting mothers can give their unborn children an advantage by taking special care of their dental health during pregnancy, Bomkamp said.
"If the pregnant woman does not have good dental care, she could have more of the decay-producing bacteria in her mouth, and it's very likely she could pass these bugs on to her child," Bomkamp said.
Once the child is born, parents should start keeping the mouth clean even before the first baby tooth has erupted.
The ADHA recommends thoroughly cleaning an infant's gums after each feeding with a water-soaked infant washcloth or gauze pad to stimulate the gum tissue and remove food.
"Even before they have teeth, you can clean out their mouths and get the kids used to the idea of it," Connor said.
When the baby's teeth begin to erupt, parents should brush them gently with a small, soft-bristled toothbrush using a pea-sized amount of fluoridated toothpaste.
At age 2 or 3, a parent can begin to teach their child proper brushing techniques. However, the child will need help with brushing and flossing up through age 7 or 8. By then, they will have developed the dexterity to do it alone.
Parents also should be cautious about inadvertently sharing their own mouth's bacteria with their child, through even the most seemingly innocuous behavior.
"Decay bugs can be transmitted through sharing food and drink, through sharing a toothbrush or sharing utensils," Bomkamp said. "Even blowing on food, your saliva can be transmitted to the child."
Watching what children eat also can help protect them from developing cavities or large amounts of decay bacteria in their mouths. This includes making sure that kids are fed regular meals throughout the day, especially breakfast, to keep them from feeling the need to snack on unhealthy foods.
One recent study found that the odds of decay in baby teeth were greater in the children with poor eating habits. Children who don't eat breakfast every day had higher levels of tooth decay, the study found, as did those who don't eat five servings of fruits and vegetables a day.
"If they're eating several snacks a day, they probably aren't eating foods that are good for them," Bomkamp said.
Also, don't let a young child go to bed with a bottle, Bomkamp said, and avoid allowing them to run around with sippy cups filled with sugary juices.
Another potential problem is the increased use of bottled water, she said. Tap water in almost all U.S. cities contains fluoride, which helps prevent tooth decay. "Most bottled water doesn't have the fluoride levels we'd like to see," Bomkamp said.
Dental hygienists also urge parents to get their kids in to see a dentist as early as possible, within six months of the eruption of their first baby tooth or by their first birthday.
"Parents often don't think to take their child to the dentist until it's too late to prevent problems," Connor said.
More information
To learn more, visit the American Dental Hygienists Association.
more discussion: Forum
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Friday, November 23, 2007
Health Tip: Eat Healthy When You Eat Out
(HealthDay News) - When it's time to eat out, you may think it's too difficult to stick to a diet or to watch those calories.
The U.S. Department of Agriculture, which offers these eating-out tips, begs to differ:
The U.S. Department of Agriculture, which offers these eating-out tips, begs to differ:
- Order water, skim milk, unsweetened tea, or other drinks low in sugar and calories.
- Order a small salad as an appetizer, which will help fill you up before the main meal.
- Order salad dressings and other fattening sauces on the side.
- Order entrees that include vegetables.
- Order dishes that are steamed, baked or broiled, not fried.
- Order a small or medium-sized portion -- or even a children's meal -- instead of a regular adult portion.
- Order something from the menu, instead of visiting the all-you-can eat buffet.
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Tuesday, November 20, 2007
Health Tip: Taking a Home Pregnancy Test
(HealthDay News) - Many women take a home pregnancy test when they suspect they may be pregnant.
The U.S. Department of Health and Human Services offers these suggestions to ensure that home pregnancy test results are as accurate as possible:
The U.S. Department of Health and Human Services offers these suggestions to ensure that home pregnancy test results are as accurate as possible:
- Always follow the directions on the box, and make sure that the test has not expired.
Take the test first thing in the morning. - Wait at least one week after your missed period.
- Hormonal levels that indicate pregnancy vary in every woman. If your test is negative but you still have symptoms, wait a few days and try another test.
- Different brands may react differently with different women. Try a different brand if you doubt that results of the first test are accurate.
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Friday, November 16, 2007
Inflammation Can't Explain Depression's Link to Heart Disease
(HealthDay News) -- Depression is known to hike the risk of cardiovascular disease, but don't put all the blame on any concurrent rise in inflammation.So concludes a study led by Dr. Viola Vaccarino, a professor of medicine at Emory University, in Atlanta.
That means that it's back to the drawing board in terms of unraveling the depression-heart disease link, according to Vaccarino.
"That depression is a factor in cardiovascular disease is clear. What is not clear is what kind of mechanism is involved," she said.
The Emory group, as well as researchers from five other medical institutions, studied the possible role of inflammation in a group of 559 women who were referred for heart tests because of blockage in a coronary artery. All the women had a standard test for depression at the start of the study and were followed for an average of about six years.
They were divided into three groups on the basis of those tests: those who clearly were depressed by diagnosis and previous treatment; those who might be depressed because of either a diagnosis or treatment; and those who had no indicator of depression.
The researchers made frequent measurements of two molecules linked to the inflammatory response -- C-reactive protein (CRP) and interleukin-6.
There were 79 major events of cardiovascular disease during the study, 23 of them fatal.
As expected, the incidence of such events was 2.5 times higher in women with depression.
There was no comparable increase in women classified as possibly depressed.
The team found that women diagnosed as depressed had a 70 percent higher level of C-reactive protein and a 25 percent higher level of interleukin-6 compared to women who were not depressed. Women classified as possibly depressed had elevated levels of both markers, but to a lesser extent.
The bottom line, according to the researchers, was that while inflammation was tied to heart risk, it failed to explain most of the cardiovascular danger posed by depression.
"Despite being associated with each other, depression and inflammation predicted future events for the large part independently," the researchers wrote. "Thus, despite a clear relationship between depression and inflammation, the latter plays only a minor role in the higher risk of adverse outcomes for women with depression."
The finding is something of as surprise, said Dr. David S. Sheps, professor of medicine at the University of Florida at Gainesville, a member of the research team.
"We know from other studies that there is a relationship between depression and elevation of certain inflammatory molecules, but no one knows for sure what the mechanism is," Sheps said.
"What is clear is that inflammation does not play a substantial role," Vaccarino said. "We need to look at other things. Perhaps there is a change in the ability of platelets to aggregate." Platelets are blood cells that can form clots to block arteries. "And there could be other pathways," she said.
More information
There's more on C-reactive protein and heart disease at the American Heart Association.
Monday, November 12, 2007
Arthritis Takes Major Toll on Workplace
(HealthDay News) -- Arthritis-related disability can have a major impact on a person's employment, forcing them to change work hours, the type and nature of their work, or even lose their job, a Canadian study reports.
The study tracked 490 people with osteoarthritis (OA) and inflammatory arthritis (IA) for more than four years. During that time, 63 percent of the participants remained employed, but work changes were common: 45 percent reduced their work hours due to arthritis; 52 percent switched their type of work; 18 percent weren't able to seek and accept promotions and job transfers; and 41 percent weren't able to take on additional responsibilities.
In addition, many of the participants used vacation time and missed work to deal with their arthritis.
"We know that arthritis can result in people having to leave their jobs. This research focuses our attention on the workplace itself and highlights how common a wide range of work transitions are in the lives of people with arthritis," Monique A.M. Gignac, senior scientist at the Toronto Western Research Institute and associate professor in the department of health sciences at the University of Toronto, said in a prepared statement.
"By studying these changes, we hope to identify those that allow people to remain employed longer, as well as types of transitions that signal problems that need to be addressed with early intervention and treatment," she said.
The study was expected to be presented Nov. 10 at an American College of Rheumatology meeting in Boston.
Arthritis affects about 46 million Americans.
More information
The U.S. Centers for Disease Control and Prevention has more about arthritis.
The study tracked 490 people with osteoarthritis (OA) and inflammatory arthritis (IA) for more than four years. During that time, 63 percent of the participants remained employed, but work changes were common: 45 percent reduced their work hours due to arthritis; 52 percent switched their type of work; 18 percent weren't able to seek and accept promotions and job transfers; and 41 percent weren't able to take on additional responsibilities.
In addition, many of the participants used vacation time and missed work to deal with their arthritis.
"We know that arthritis can result in people having to leave their jobs. This research focuses our attention on the workplace itself and highlights how common a wide range of work transitions are in the lives of people with arthritis," Monique A.M. Gignac, senior scientist at the Toronto Western Research Institute and associate professor in the department of health sciences at the University of Toronto, said in a prepared statement.
"By studying these changes, we hope to identify those that allow people to remain employed longer, as well as types of transitions that signal problems that need to be addressed with early intervention and treatment," she said.
The study was expected to be presented Nov. 10 at an American College of Rheumatology meeting in Boston.
Arthritis affects about 46 million Americans.
More information
The U.S. Centers for Disease Control and Prevention has more about arthritis.
Thursday, November 08, 2007
Stem Cells Show Early Promise for Heart Problems
(HealthDay News) -- Scientists are edging toward a better understanding of how stem cells might one day restore function to damaged hearts.
Several studies presented Wednesday at the American Heart Association annual meeting, in Orlando, Fla., addressed different aspects of this promise.
One study found that patients' own stem cells, when injected into the heart after treatment for a heart attack, improved the heart's ability to pump effectively. But this finding is fairly preliminary.
"We're still learning. The area of stem cells still needs lots of understanding," said Dr. Robert Bonow, immediate past president of the heart association and chief of cardiology at Northwestern Memorial Hospital in Chicago. "What are the right kinds of cells? How do we train them into cells that are viable and make people better? What are the right kinds of patients? We really don't know that. We're waiting for more data."
The first study involved 80 patients who had recently received treatment (clot-busting drugs and angioplasty) for an ST elevation heart attack (STEMI), the more serious type of heart attack. The patients were randomly assigned to receive either injections of their own bone marrow cells or a placebo.
After six months, patients who had received bone marrow cell therapy saw their global ejection fraction, a measure of the heart's pumping function, improve from 59 percent to 67 percent. The ejection fraction remained unchanged in the placebo group.
"In conclusion, intracoronary injection of autologous [from the patient] bone marrow cells improves left ventricular systolic function in STEMI patients who are treated initially with thrombolytic therapy followed by [angioplasty] two to six days after a heart attack," said Dr. Heikki Huikuri, lead investigator of the trial and professor of medicine and director of the cardiology sector at the University of Oulu Hospital in Finland. "This appears to be a safe therapy."
Bonow added: "The findings are interesting but preliminary. The ejection fraction showed a meaningful increase, but they were normal to begin with. We need more time and more information."
The study was funded by the Finnish Academy of Science and Boston Scientific Inc.
Two other studies presented Wednesday in late-breaking sessions at the AHA meeting showed less convincing results. These studies looked at a different population than the Finnish study: patients with chronic scar tissue from a prior heart attack.
The first study involved injecting patients' own skeletal muscle stem cells directly into the heart. The trial, in 23 heart-failure patients, was primarily designed to assess safety, but the researchers also looked at effectiveness.
"These cells are not designed to be heart tissue, but they do contract and have some electrical activity," Bonow explained.
At one year, the procedure proved safe and, the study authors said, resulted in improvements in pumping function and better quality of life.
The study, however, was not "blinded," meaning that any improvements could be due to a placebo effect. Decreases in the heart's size were minimal, Bonow said.
"This doesn't lead anywhere right now," Bonow said.
The study was funded by Mytogen Inc., a biotech company developing cell-based therapies.
The final study, which involved injecting patients' own stem cells into heart scar tissue, found that it did not affect heart muscle functioning.
"It was safe but didn't improve systolic function, didn't reduce infarct size and didn't influence global left ventricular function," said study lead author Dr. Manuel Galinanes, professor of cardiac surgery at the University of Leicester in England.
More information
Basic facts about stem cell therapy are provided by the U.S. National Institutes of Health.
Several studies presented Wednesday at the American Heart Association annual meeting, in Orlando, Fla., addressed different aspects of this promise.
One study found that patients' own stem cells, when injected into the heart after treatment for a heart attack, improved the heart's ability to pump effectively. But this finding is fairly preliminary.
"We're still learning. The area of stem cells still needs lots of understanding," said Dr. Robert Bonow, immediate past president of the heart association and chief of cardiology at Northwestern Memorial Hospital in Chicago. "What are the right kinds of cells? How do we train them into cells that are viable and make people better? What are the right kinds of patients? We really don't know that. We're waiting for more data."
The first study involved 80 patients who had recently received treatment (clot-busting drugs and angioplasty) for an ST elevation heart attack (STEMI), the more serious type of heart attack. The patients were randomly assigned to receive either injections of their own bone marrow cells or a placebo.
After six months, patients who had received bone marrow cell therapy saw their global ejection fraction, a measure of the heart's pumping function, improve from 59 percent to 67 percent. The ejection fraction remained unchanged in the placebo group.
"In conclusion, intracoronary injection of autologous [from the patient] bone marrow cells improves left ventricular systolic function in STEMI patients who are treated initially with thrombolytic therapy followed by [angioplasty] two to six days after a heart attack," said Dr. Heikki Huikuri, lead investigator of the trial and professor of medicine and director of the cardiology sector at the University of Oulu Hospital in Finland. "This appears to be a safe therapy."
Bonow added: "The findings are interesting but preliminary. The ejection fraction showed a meaningful increase, but they were normal to begin with. We need more time and more information."
The study was funded by the Finnish Academy of Science and Boston Scientific Inc.
Two other studies presented Wednesday in late-breaking sessions at the AHA meeting showed less convincing results. These studies looked at a different population than the Finnish study: patients with chronic scar tissue from a prior heart attack.
The first study involved injecting patients' own skeletal muscle stem cells directly into the heart. The trial, in 23 heart-failure patients, was primarily designed to assess safety, but the researchers also looked at effectiveness.
"These cells are not designed to be heart tissue, but they do contract and have some electrical activity," Bonow explained.
At one year, the procedure proved safe and, the study authors said, resulted in improvements in pumping function and better quality of life.
The study, however, was not "blinded," meaning that any improvements could be due to a placebo effect. Decreases in the heart's size were minimal, Bonow said.
"This doesn't lead anywhere right now," Bonow said.
The study was funded by Mytogen Inc., a biotech company developing cell-based therapies.
The final study, which involved injecting patients' own stem cells into heart scar tissue, found that it did not affect heart muscle functioning.
"It was safe but didn't improve systolic function, didn't reduce infarct size and didn't influence global left ventricular function," said study lead author Dr. Manuel Galinanes, professor of cardiac surgery at the University of Leicester in England.
More information
Basic facts about stem cell therapy are provided by the U.S. National Institutes of Health.
Monday, November 05, 2007
New Measures Improve Heart Care
(HealthDay News) -- Simplify. Simplify. Simplify.
New research shows this mantra works when it comes to controlling high blood pressure, which is the leading risk factor for premature death worldwide.
A streamlined, "back to the future" approach to treating hypertension helped more patients control their blood pressure than did working with often confusing national guidelines, according to a Canadian study released Sunday at the American Heart Association (AHA) annual meeting in Orlando, Fla.
"This algorithm does result in better blood-pressure control in primary-care settings and, further, it is possible that this protocol or protocols like it may be a paradigm for a range of chronic diseases associated with poor control, especially those associated with risk factors for heart attack and stroke," said study author Dr. Ross D. Feldman, the R.W. Gunton Professor of Therapeutics at the University of Western Ontario.
"Based on the results, this is a very handy algorithm. It's very useful," added Dr. Sidney Smith, past president of the AHA and director of the Center for Cardiovascular Science and Medicine at the University of North Carolina School of Medicine. "But always when you have a clinical trial, adherence rates are higher so it's important to look at this in a real-world setting."
Feldman added: "It's absolutely clear that we're facing an increasing global epidemic of hypertension. On the one hand, it's easy to diagnose and we have many effective treatments, yet in North America and worldwide, only one in three patients have their high blood pressure controlled."
During the first year after diagnosis, only about 50 percent of patients take their drugs and compliance falls off further after that. And a lot of this can be attributed to highly complex prescribing regimens of multiple drugs, adding drugs, switching drugs and more. The end result -- "therapeutic inertia."
The STITCH (Simplified Therapeutic Intervention to Control Hypertension) trial, funded by Pfizer Inc., involved introducing a simplified, four-step algorithm to 45 family practices in southwestern Ontario and comparing that with guidelines-based care, which can involve dozens of choices for doctors to sort through. The new protocol is not dissimilar to strategies employed in the 1960s.
In the STITCH group, 65 percent of patients reduced their blood pressure to the target level, compared with 53 percent in the guidelines group, a 12 percent absolute change in the proportion of patients who managed to control their hypertension.
While this trial involved mainly single-doctor practices, "the real impact of this study would not be in single practices but with the incorporation of the practices into health-care networks," Feldman noted.
A second study presented at the meeting, and also appearing in the Nov. 28 issue of the Journal of the American Medical Association, found that a statewide program in North Carolina cut the time it took to treat patients having a heart attack either with clot-busting drugs or percutaneous coronary intervention (PCI, also known as angioplasty) by up to 32 minutes.
With a heart attack, the sooner the patient's blocked arteries can be reopened, restoring blood flow to the heart, the better. AHA/American College of Cardiology guidelines recommend that drugs be delivered within 30 minutes and PCI accomplished with 90 minutes of the patient entering the hospital door (known as "door-to-balloon" time).
This program involved improvements such as naming a nurse coordinator and establishing a single telephone number to activate the catheterization lab team, at 65 hospitals throughout the state.
At hospitals that offered PCI, the percentage of patients receiving clot-busting therapy within half an hour improved from 35 percent to 52 percent.
Door-to-balloon times improved from 85 minutes to 74 minutes at PCI hospitals. After the program was established, 72 percent of patients received PCI within 90 minutes.
For patients transferred from a non-PCI hospital to a PCI hospital, door-to-balloon times fell from 160 minutes to 128 minutes, and to 106 minutes for hospitals that routinely transferred for PCI.
Mortality rates were not lowered but the study was not sufficiently powered to see this possible effect, noted study senior author Dr. Christopher B. Granger, director of the cardiac care unit at Duke University Medical Center.
"This is the largest regional STEMI [ST-segment-elevation myocardial infarction] reperfusion system in the U.S.," Granger said. "All of the key times were significantly improved. It shows that application of reperfusion on a large scale is possible and should be a high national priority."
Disappointingly, a third study being presented at the meeting found that teaching self-management skills to heart failure patients brought no additional benefit over enhanced patient education.
However, study co-author Dr. James E. Calvin, of Rush University Medical Center in Chicago, said that "in the patients with the poorest functional capacity [who received both training in self-management skills and education], you can see that there's a significant risk reduction for... death and heart failure hospitalization. Treatment may work in patients who need it."
More information
Visit the American Heart Association for more on high blood pressure.
New research shows this mantra works when it comes to controlling high blood pressure, which is the leading risk factor for premature death worldwide.
A streamlined, "back to the future" approach to treating hypertension helped more patients control their blood pressure than did working with often confusing national guidelines, according to a Canadian study released Sunday at the American Heart Association (AHA) annual meeting in Orlando, Fla.
"This algorithm does result in better blood-pressure control in primary-care settings and, further, it is possible that this protocol or protocols like it may be a paradigm for a range of chronic diseases associated with poor control, especially those associated with risk factors for heart attack and stroke," said study author Dr. Ross D. Feldman, the R.W. Gunton Professor of Therapeutics at the University of Western Ontario.
"Based on the results, this is a very handy algorithm. It's very useful," added Dr. Sidney Smith, past president of the AHA and director of the Center for Cardiovascular Science and Medicine at the University of North Carolina School of Medicine. "But always when you have a clinical trial, adherence rates are higher so it's important to look at this in a real-world setting."
Feldman added: "It's absolutely clear that we're facing an increasing global epidemic of hypertension. On the one hand, it's easy to diagnose and we have many effective treatments, yet in North America and worldwide, only one in three patients have their high blood pressure controlled."
During the first year after diagnosis, only about 50 percent of patients take their drugs and compliance falls off further after that. And a lot of this can be attributed to highly complex prescribing regimens of multiple drugs, adding drugs, switching drugs and more. The end result -- "therapeutic inertia."
The STITCH (Simplified Therapeutic Intervention to Control Hypertension) trial, funded by Pfizer Inc., involved introducing a simplified, four-step algorithm to 45 family practices in southwestern Ontario and comparing that with guidelines-based care, which can involve dozens of choices for doctors to sort through. The new protocol is not dissimilar to strategies employed in the 1960s.
In the STITCH group, 65 percent of patients reduced their blood pressure to the target level, compared with 53 percent in the guidelines group, a 12 percent absolute change in the proportion of patients who managed to control their hypertension.
While this trial involved mainly single-doctor practices, "the real impact of this study would not be in single practices but with the incorporation of the practices into health-care networks," Feldman noted.
A second study presented at the meeting, and also appearing in the Nov. 28 issue of the Journal of the American Medical Association, found that a statewide program in North Carolina cut the time it took to treat patients having a heart attack either with clot-busting drugs or percutaneous coronary intervention (PCI, also known as angioplasty) by up to 32 minutes.
With a heart attack, the sooner the patient's blocked arteries can be reopened, restoring blood flow to the heart, the better. AHA/American College of Cardiology guidelines recommend that drugs be delivered within 30 minutes and PCI accomplished with 90 minutes of the patient entering the hospital door (known as "door-to-balloon" time).
This program involved improvements such as naming a nurse coordinator and establishing a single telephone number to activate the catheterization lab team, at 65 hospitals throughout the state.
At hospitals that offered PCI, the percentage of patients receiving clot-busting therapy within half an hour improved from 35 percent to 52 percent.
Door-to-balloon times improved from 85 minutes to 74 minutes at PCI hospitals. After the program was established, 72 percent of patients received PCI within 90 minutes.
For patients transferred from a non-PCI hospital to a PCI hospital, door-to-balloon times fell from 160 minutes to 128 minutes, and to 106 minutes for hospitals that routinely transferred for PCI.
Mortality rates were not lowered but the study was not sufficiently powered to see this possible effect, noted study senior author Dr. Christopher B. Granger, director of the cardiac care unit at Duke University Medical Center.
"This is the largest regional STEMI [ST-segment-elevation myocardial infarction] reperfusion system in the U.S.," Granger said. "All of the key times were significantly improved. It shows that application of reperfusion on a large scale is possible and should be a high national priority."
Disappointingly, a third study being presented at the meeting found that teaching self-management skills to heart failure patients brought no additional benefit over enhanced patient education.
However, study co-author Dr. James E. Calvin, of Rush University Medical Center in Chicago, said that "in the patients with the poorest functional capacity [who received both training in self-management skills and education], you can see that there's a significant risk reduction for... death and heart failure hospitalization. Treatment may work in patients who need it."
More information
Visit the American Heart Association for more on high blood pressure.
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