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 Man's Best Friend

February 1, 1996 - The health benefits of owning a dog are just now being appreciated by medical science. This study looked at the impact of pet ownership on survival in patients after an acute heart attack.
     The CAST trial studied 369 patients for one year. They had detailed physical and psycho-social exams. There were 20 deaths (5%) during that year. Nineteen of 263 patients who did not own dogs died, compared to only one of 86 patients who did own dogs. Analysis - considering all factors - showed that patients likely to die had the following characteristics: Lower ejection fraction, too-fast heart rate, diabetes, less human contact, and not owning a dog. There were no other major differences between dog owners and non-owners. Cat ownership was not associated with better survival.
     This study agrees with others showing that social support, whether human or canine, is an important part of survival after a heart attack.
Title: Pet ownership, social support, and one-year survival after acute myocardial infarction in the Cardiac Arrhythmia Suppression Trial (CAST)
Authors: Friedmann E, Thomas SA, Am J Cardiol 1995 Dec 15; 76:1213-1217
Source: Journal Watch: Cardiology 1 February 1996

 Test May Predict One Year Mortality

October 13, 1998 - A new test that measures swings in heart rate during the day may identify CHFers who are at highest risk of dying from heart failure within a year.
     The test measures HRV or Heart Rate Variability. That's the amount by which heart rate changes from slow rates to fast rates in one 24-hour period. "The less the heart rate varies over 24 hours, the more likely a person will die of heart failure," says the study's lead author Dr. James Nolan.
     In this study, people with the lowest HRV - whose fastest heart rate was not much different from their slowest heart rate during the day - were 3 times more likely to die than people with higher HRV. The annual death rate of people with the lowest HRV was 51% compared to 6% for those with the highest HRV. People whose HRV was between the two extremes had an annual death rate of 13%.
     Nolan says, that the message to doctors is to measure HRV in their heart failure patients. If it's high, the person is probably going to do well. If it's low, the doctor should adjust treatment to try to prevent worsening CHF and death.
     The trial studied 433 people with symptoms of severe heart disease, averaging 62 years of age. Their average EF was 41%. Heart electrical activity was recorded by a small portable ECG worn by each person for a full day. Patients did their normal daily activities. The recorded ECGs were then analyzed.
     Patients were followed for an average of 482 days after their monitoring. Fifty-four deaths occurred during this time, with a total death rate of 10%.
     Other predictors of heart failure death found in this study were certain creatinine and blood sodium levels. Cardiothoracic ratio, left ventricular end-diastolic size, nonsustained ventricular tachycardia, and blood potassium were related to sudden cardiac death.
     "If part of your heart is damaged, quality of life is maintained at the expense of overworking the surviving parts of your heart. There are no 'down' times where the heart beat can slow down, allowing the heart to rest," says Nolan. "That may lead to declining heart function and death from CHF. Drugs like beta-blockers and digoxin, and simple things like exercise training, improve heart rate variability," Nolan says.
PMID: 9769304, UI: 98443498

 CgA Level May Predict Risk Of Death

June 28, 2002 - High blood levels of a protein called chromogranin-A (CgA) in CHFers indicates higher risk of death, say Italian researchers. Dr. Roberto Ferrari measured blood levels of CgA and other hormones in 160 heart failure patients. Only heart class and CgA were independent predictors of mortality. The higher the CgA level, the worse the heart failure.

 Heart failure class  CgA blood level 
 class 1 110 ng/ml
 class 2 147 ng/ml
 class 3 279 ng/ml
 class 4 545 ng/ml

Source: Eur Heart J 2002;23:967-974.

 EKG Helps Predict Mortality

July 17, 2002 - In heart failure patients, a long QRS duration (over 120 milliseconds) predicts increased risk of death and of sudden death. Dr. Steven Singh studied data from 669 CHFers, dividing them into those with QRS duration less than 120 ms and those with a QRS of 120 ms or more.
     Overall death rate was higher in patients with a longer QRS (49% versus 34%), as was the sudden death rate (25% versus 17%). Left bundle branch block also predicted higher risk of death, but not from sudden death.
     QRS over 120 ms predicted higher risk of death regardless of ejection fraction but only predicted sudden death when ejection fraction was less than 30%. Type of cardiomyopathy and whether patients took amiodarone or not did not matter. Pacemakers using resynchronization may improve these patients' prognosis.
Source: Am Heart J 2002;143:1085-1091

 LBBB Helps Predict Mortality

July, 2002 - We studied whether LBBB affects mortality in heart failure patients. We studied data from the Italian Network on CHF Registry.
     We studied one-year follow-up data on 5517 CHFers. Average age was 63 years and 1295 were women. Twenty-eight percent were class 3 or class 4. The main cause of heart failure was ischemic heart disease in 2512 patients (46%), DCM in 1988 patients (36%), and high blood pressure in 714 patients (13%). The others (5%) had various causes. Patients with heart failure from valve disease were not included.
     Complete LBBB was seen in 1391 patients (25%). Older patients and women were more likely to have LBBB. CHFers with LBBB were 36% more likely to die in the first year from any cause, and were 35% more likely to suffer sudden death (relative risk). This increased risk remained after adjusting for age, underlying heart disease, heart failure severity, and meds.
     659 of 5517 patients (12%) died during the one-year follow-up period, with 46% being sudden deaths. The one-year all-cause mortality for LBBB patients was 16%, and 12% for patients with right bundle branch block.
     LBBB indicates higher risk of death in heart failure patients regardless of age, CHF severity, and drug prescriptions. Pacemakers using resynchronization may improve these patients' prognosis.
Title: Left Bundle-Branch Block (LBBB) Is Associated With Increased 1-Year Sudden and Total Mortality Rate in 5517 Outpatients With Congestive Heart Failure: A Report From the Italian Network on Congestive Heart Failure
Authors: Samuele Baldasseroni,Cristina Opasich, Marco Gorini, Donata Lucci, Niccolo Marchionni, Maurizio Marini, Carlo Campana, Giampaolo Perini, Antonella Deorsola, Giulio Masotti, Luigi Tavazzi, Aldo P. Maggioni
Source: Am Heart J 143(3):398-405, 2002

 Tylenol Plus Coumadin - Deadly?

March 4, 1998 - Coumadin helps prevent stroke but increases risk of bleeding, especially at an INR higher than 4. We need to be able to spot patients whose INR might be too high. What should we be looking for? We did this in an outpatient anticoagulant therapy unit, looking for factors that raised the risk of high INR.
     We followed outpatients from April of 1995 to March of 1996 who had a target INR of 2 to 3 and could be interviewed within 24 hours of their blood testing. "Case" patients had INR greater than 6. "Control" patients were randomly selected and had INR between 1.7 and 3.3. Factors we looked for that might raise INR included drug use, diet, illness, and drinking alcohol.
     93 cases and 196 controls were interviewed. Tylenol (acetaminophen) use was analyzed and in those taking 9g (18 extra-strength Tylenol) per week or more, the odds of having an INR greater than 6 were 10 times higher. Other factors that increased INR in Coumadin (warfarin) users were advanced malignancies, recent diarrhea, and not taking the proper Coumadin dose. Higher vitamin K intake and chronic alcohol use of 1/2 to 2 drinks per day were associated with decreased INR.
Title: Acetaminophen and Other Risk Factors for Excessive Warfarin Anticoagulation
Author: Elaine M. Hylek, MD, MPH; Heather Heiman, BS; Steven J. Skates, PhD; Mary A. Sheehan, RN; Daniel E. Singer, MD
JAMA 1998;279:657-662

 Sleep, Breathing and CHF

1999 - Sleep apnea is a disruption of normal breathing during sleep. About 40% of heart failure patients may suffer sleep apnea compared to 6% of the general population. Some Canadian researchers say a simple treatment for sleep apnea can also improve heart function.
     In a study at Toronto Hospital, 9 heart failure patients and 9 healthy people used a breathing aid called a CPAP (Continuous Positive Airway Pressure) device 6 hours a night for 3 months. The CPAP is a portable low-pressure air generator connected by tubing to a nose mask.
     The study found that heart failure patients showed improvement in heart function following regular use of the CPAP breathing aid. Heart failure patients on maximum drug therapy who used CPAP every night had definite improvement in heart function and a stronger diaphragm (breathing muscle).
     There are 2 types of sleep apnea. Central sleep apnea is most commonly found in CHFers. Patients stop breathing and begin to suffocate, causing them to startle awake. Obstructive sleep apnea is most common in overweight people who snore and have large soft palates and fat around the neck. When neck muscles relax during sleep, the weight of the oversized neck narrows the airway and the tongue and soft palate seal the airway - it's the same as being choked.
     When breathing is interrupted, the body's nervous system - sensing a disruption in the oxygen supply - tells the heart to beat faster to send more blood to the body's tissues. When the sleeper finally manages to draw a breath, the startle reflex may also cause the heart to beat faster briefly, putting still more strain on the weakened heart.
Author: James B. Lam, MD, from Cardiovascular Institute of the South/Morgan City


February 8, 2000 - Treating sleep apnea in CHFers may reduce deaths and complications. Dr. Shahrokh Javaheri says that sleep apnea irritates the heart's pumping chambers by reducing arteries' ability to transport oxygen. He studied the effect of CPAP given to 29 male CHFers who had 15 or more episodes of apnea per hour.
     After the treatment, disordered breathing was virtually gone in 16 of the 29 patients, reducing apnea index from 36 to 4 per hour. Arousal index and oxygen saturation also improved. Ventricular arrhythmias also decreased in patients who responded well to CPAP.
     Dr. Javaheri said, "We hope that treating sleep apnea in CHF patients will improve their quality of life. Sleep apnea has many symptoms that overlap with heart failure, such as fatigue," he added, "so it is important for doctors to consider this in their diagnosis, and treat accordingly."
Source: Circulation 2000:101;392-397

 Compliance Pays Off

August 9, 1999 - Heart patients who strictly follow drug-taking instructions may double their chance of survival compared to those who do not. This is true even when patients are instructed to take a placebo. "Adherence to meds instructions may be one sign of a generally healthy behavior pattern," says study author Dr. Jane Irvine.
     In this study, Irvine followed the 2-year compliance pattern of 1100 patients recovering from heart attack to either amiodarone or placebo. They found that frequent skipping of medication - whether amiodarone or placebo - was associated with twice the risk of death compared to complete compliance. Women were less likely to stick to prescribed medications than men. Poor compliance increased with advancing age.
     The reason for improved outcomes in patients taking placebo is unknown. Researchers guess that patients who follow the prescribed treatment plan may be more intent on improving their health in other ways as well, including diet and exercise. They point out that compliant patients participated in about twice the number of enjoyable social activities than patients with poor pill-taking habits.
Source: Psychosomatic Medicine 1999;61

 Home Care Helps

November 9, 1999 - Follow-up home care by a cardiac nurse reduces risk of death and hospitalization in CHFers, Australian investigators reported at the AHA 72nd scientific sessions. In a group of 100 patients receiving intensive follow-up at home by a cardiac care nurse, risk of death was reduced 33% and hospital readmission was reduced 40% compared to a group of 100 similar patients who got standard care.
     Patients getting home-based care received a home visit by a cardiac nurse 7 to 14 days after leaving the hospital. Each patient had a thorough assessment. Nurses did a physical exam, home assessment, and counseling about how to manage heart failure at home.
     On the other hand, patients getting standard care got some personal care assistance as needed and periodic visits by a general nurse. Visits by the cardiac nurses averaged 2 hours. Visits by the general nurses averaged 10 to 15 minutes.
     Dr. Simon Stewart said, "There was a significant increase in event-free survival, with 12 fewer deaths at 6 months" in patients getting home-based intervention. He added that there were 60% less hospital days and better quality of life.
     Dr. Stewart added that while initial costs were much higher for the intervention group, after a 10 month follow-up hospital costs for the home-care group were about half those of the usual-care group.
Source: Reuters

 CHF and Brain Function

March 8, 2000 - Blood flow through the brain is reduced in patients with chronic heart failure. The worse the heart class and EF, the worse the loss of blood to the brain. This may explain the cognitive defects - problems with memory and problem solving - seen in CHFers.
     Dr. Dimitrios Georgiadis used ultrasound to measure arteries in the brain and their reaction to carbon dioxide in 50 CHFers. For comparison, they also studied 20 age-matched controls and 20 young controls (average age 29 years). "Brain artery reaction was much reduced in all CHF patients compared to controls; especially in class 4 as compared to class 2 & class 3 CHF patients," they said. As CHF worsened, so did brain reaction to carbon dioxide.
     Dr. Georgiadis' concludes that in patients with chronic heart failure, reduced blood flow to the brain may cause reduced ability to reason and remember.
     In an editorial, Dr. C. Mathias said that although drugs may improve heart function, they may not help this if blood flow to the brain does not improve, or if blood pressure drops too low.
Source: Eur Heart J 2000;21:407-413

 Low Blood Pressure Hurts Thinking In CHF

December 10, 2001 - Dr. Giuseppe Zuccala in Rome studied the link between blood pressure and mental function in 13,635 elderly patients. The study group included 1583 CHF patients; none had Alzheimer's disease.
     Mental functioning was impaired more often in CHFers than in other patients. Heart failure class had no bearing on blood pressure, but systolic blood pressure below 130mmHg predicted impaired thinking.
     Dr. Zuccala said that, "studies have given conflicting results" on the links between blood pressure and reduced mental function. Many reports have "suggested that high blood pressure is associated with later dementia," he noted. "However, other reports say there is a period of low blood pressure just before the dementia," he added.
     "Our findings suggest that it is not just low blood pressure but low pressure in the setting of reduced heart function that promotes dementia," Dr. Zuccala said. "The mental function of CHF patients probably should be monitored on a regular basis to identify reduced mental ability before it becomes permanent," he said.
Source: Neurology 2001;57:1945-1946, 1986-1992

 NSAIDs Raise Risk Of CHF Episodes

February 11, 2002 - CHF patients taking an NSAID are almost 10 times more likely to have a CHF episode than those not taking an NSAID. Dr. Bruno Stricker studied NSAID use in CHFers by reviewing outcomes of 7277 adults in a heart failure study. He found that NSAID use did not seem to cause first-time heart failure but did heavily contribute to relapses in those who already had CHF.
Source: Arch Intern Med 2002;162:265-270

 Sex Is As We Thought - A Good Thing!

November 28, 2000 - Men may cut their risk of heart attack or stroke in half by having sex 3 or 4 times a week. Dr. Shah Ebrahim reported on a survey of 2400 healthy men in the Welsh town of Caerphilly. One of the questions asked was whether the men had sex once, twice, or 3 or more times a week.
     "When the men were followed-up over the next 10 years, we found that men who had 3 or more orgasms a week were only half as likely to have had a heart attack or a stroke," said Dr. Ebrahim. "In the past, we thought useful exercise had to be at least 3 times a week and last 20 minutes or more," Dr. Ebrahim said. "We now think maybe even mild physical activity has some heart-protective effect."
Source: Reuters Health

 Sodium And Heart Disease

December 2, 1999 - The risk of death from heart disease increases 61% for every 100 mmol increase in sodium intake in overweight adults. "This study is the first to show a positive relationship between dietary sodium intake and risk for heart disease in adults," says Dr. Jiang He.
     Researchers studied data on sodium intake and heart disease collected from 1971 to 1992 as part of the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. During a 19-year follow-up, the 14,407 participants had 680 strokes and 1727 coronary events from heart disease, and 895 died of heart disease.
     Sodium intake was not linked to heart disease in non-overweight adults. However, in overweight people a 100 mmol increase in dietary sodium increased risk of stroke by 32%, risk of death from stroke by 89%, risk of death from heart disease by 61%, and risk of death from any cause by 39%.
Source: JAMA 1999;282:2027-2034

 CHF Control Via The Web

February 21, 2000 - Congestive heart failure can mean that one day you're fine but the next day you're gasping for air. If doctors could get some kind of early warning, they might prevent those hospital visits by adjusting patients' meds before CHF gets out of control.
     In an ongoing experiment, doctors are implanting tiny monitors inside the hearts of 120 patients to record every twinge, 24 hours a day. When one of these patients sits in front of a doctor's wireless transmitter, the monitor beams its recordings into a computer for study.
     Soon, these patients won't even have to leave home. They will spend 5 minutes a day beaming their "Chronicle" heart monitor recordings to a doctor's office via secure web site over their own home telephone line.
     "We believe it's the next generation of care," says Michael Colson of Medtronic, which is developing the Chronicle system. "This is the future for chronic disease management," adds Dr. Richard Miller, who is using a simpler online monitor called the Health Buddy.
     Why concentrate first on heart failure? CHF is so severe that studies should be able to quickly prove whether monitors really help. Worsening heart failure sneaks up on patients, who also may have a hard time sticking to complex drug schedules and low-sodium diet. Plus, patients often wait as long as 5 days after getting worse, to call a doctor.
     At-home follow-up does help. Nurses at one hospital telephoned hundreds of patients several times a month to ask them about symptoms and body weight. By adjusting meds and alerting doctors to early problems, the telephone program reduced re-hospitalizations by 79%.
     However, all that calling takes a lot of time, so Miller turned to the Health Buddy, made by Health Hero Network. You connect the answering machine-size gadget to a telephone line. Nurses' questions travel by phone line to the patient's Health Buddy video screen. Patients click a few buttons to respond to a secure Internet site.
     Miller says that patients love it. "They feel as though they're in touch with a caregiver on a daily basis," he says. The FDA just approved a Health Buddy version that transmits diabetics' blood-sugar test results straight to doctors.
     Medtronic's Chronicle is a pacemaker-like device that a surgeon places inside the heart to measure pressure and other readings that used to require a cath. Doctors download the recordings each week and then change patient meds if needed. Medtronic hopes to sell patients at-home transmitters soon. Point the antenna at your chest and the recordings beam over a phone line to the doctor.
Source: The Associated Press

 Phone Calls Help Control CHF

March 25, 2001 - Intervention as simple as phone calls from a nurse can help keep CHFers out of the hospital and lower their medical costs. This study included 358 patients who were followed for 6 months after being sent home from 2 different hospitals.
     Patients got either standard follow-up care or they got printed educational material plus an average of 17 phone calls over 6 months from a nurse checking on their health and offering advice. Calls began about 5 days after they left the hospital.
     Hospital re-admission for heart failure was 36% lower in patients getting the calls. In phone-call-patients who were re-hospitalized for heart failure, the average number of days spent in the hospital was 46% lower than for the standard care group. Hospital costs for patients re-admitted for heart failure were 45% lower for the phone-call group.
     This study shows that a low-cost, low-tech method can have positive results in treating heart failure. The phone care group's care actually saved twice as much money as it cost, according to San Diego State University researchers. "I think the results are due to the phone calls, but what aspect of the calls caused the results, we can't be sure," they said.
Source: Associated Press
Source: Archives of Internal Medicine

 Treating Anemia Helpful

May 31, 2001 - Heart failure patients with anemia that are treated with erythropoetin and IV iron have improved heart function. Dr. Donald Silverberg studied 32 patients with class 3 to class 4 heart failure. The patients had hemoglobin levels between 10 and 11.5g/dL. They were randomly assigned to get injected erythropoietin and IV iron, or no anemia treatment at all.
     Hemoglobin levels increased in treated patients. During an average follow-up of 8 months, heart class improved 42% in treated patients. In untreated patients, heart class worsened by 11%. Blood levels of creatinine did not change in treated patients but rose 29% in untreated patients - this indicates worsening kidney function.
     The number of days spent in the hospital during the study - compared to the period before entering the study - was 79% less in treated patients and 58% higher in untreated patients.
Source: J Am Coll Cardiol 2001;37:1775-1780

 Coxsackie Virus May Cause Much IDCM

November 20, 2000 - Japanese researchers report that active coxsackie virus is found in the heart tissue of many IDCM patients. This suggests that "an anti-viral drug for coxsackie B virus should be used in managing this disease." says Dr. Shigekazu Fujioka.
     The researchers looked for evidence of viral infection in large heart tissue specimens from surgeries done to reduce heart size in 26 IDCM patients. More than 1/3 of the patients tested positive for plus-strand enteroviral RNA. In 78% of these patients, minus-strand enteroviral RNA was also detected. This means those patients still had an active viral infection.
     The only viruses detected in the patients were coxsackie B viruses, such as B3 and B4. Dr. Fujioka says these results show that enteroviruses such as coxsackie B viruses play a strong role in the cause of idiopathic dilated cardiomyopathy.
Source: J Am Coll Cardiol 2000;36:1920-1926

 Talk To Your Doctor About End of Life Care

January 22, 2001 - [Read more about discussing end-of-life care here] Doctors should begin discussion about end-of-life care with their older patients. A new study reports that older or chronically ill patients who had such conversations with their PCP were happy they did.
     "Doctors think patients should start such conversations. Patients think their doctors should bring it up, so these important talks are not happening," said study author William Tierney. "What's more, doctors believe their patients won't like talking about it. They think patients will worry needlessly, especially older patients,".
     Tierney surveyed 686 patients who were at least 75 years old, or at least 50 years old with serious chronic illness. Their 87 PCPs were also surveyed. Results showed that 98% of these patients had never talked to their doctor about which life-saving interventions they wanted or did not want when dying, if they were unable to communicate their wishes.
     During the study, 110 patients had such discussions started by their primary care doctor. The survey showed that 51% of these patients rated their later office visits as excellent. Of the patients who had regular office visits but no such discussion, only 34% rated visits as excellent.
     "This suggests that elderly or chronically ill patients are more satisfied with their doctor when advance directives are discussed," writes Tierney. "Primary care physicians should start these discussions."
     The simplest advance directive is called a living will. Tierney says, "This type of advance directive is really too vague to do anybody any good." Instead, he suggests that patients ask their doctors for specific forms covering a broader range of topics that give clear direction to doctors.
Source: Journal of General Internal Medicine 2001;16

 Drinking Does Not Help Men With CAD

April 3, 2000 - Light drinking does not have the same cardiovascular benefits in men with CAD (coronary artery disease) that it may have in other men. Moderate and heavy drinking increase risk of death in these men, according to the results of a recent British study.
     Drs. A. Shaper and S. Wannamethee examined the effects of drinking alcohol on risk of death in 7169 men, including 655 with established CAD. The group was followed for 12 years. "Using occasional drinkers as the reference group; lifelong non-drinkers, occasional drinkers, and light drinkers all had similar risk of death," the investigators report. Moderate to heavy drinking (3 or more drinks per day) increased risk of death by 50% in men with a history of heart attack.
     Although light drinking showed no benefit on mortality in men with CAD, "giving up smoking cut the risk of death in half" in this population, the researchers say. They recommend that "time would be better spent assisting such men to stop smoking rather than trying to encourage them to drink."
Source: Heart 2000;83:394-399

 New Procedure Shrinks Heart

1999 - A new procedure to help HCM (hypertrophic cardiomyopathy) has been developed by cardiologists at The DeBakey Heart Center in Houston. "With this procedure, we reduce the bulk of the heart muscle by injecting pure alcohol into the heart's core," said Dr. William Spencer. HCM may cause the wall between the right and left sides of the heart (septum) to enlarge, resulting in reduced blood flow. Symptoms include shortness of breath, weakness, dizziness, and chest pain.
     During the 2-hour procedure, a balloon is inserted into the proper artery, then 200-proof alcohol is injected through a catheter. The balloon prevents the alcohol from flowing back and killing needed muscle, while the overgrown heart muscle is killed with the alcohol. Although nearly half the patients required pacemakers afterward, Spencer said the results have been dramatic. "Many of our patients experienced relief just minutes after the procedure and can breathe again without chest pain," Spencer said.
     Update  June 3, 2000 - Cincinnati cardiologist Dr. Dean Kereiakes now also performs this procedure.
Source: Scanned from a local newspaper and sent to me by a reader

 Cholesterol Drugs & Arrhythmia

September 1, 2000 - Belgian researchers say that cholesterol-lowering drugs reduce ventricular arrhythmias in patients with CAD. In this observational study, Dr. Johan DeSutter studied 78 CAD patients with life-threatening ventricular arrhythmias who had ICDs. Twenty-seven of these patients were on cholesterol-lowering drugs, and 51 were not.
     The researchers were looking for arrhythmia episodes that triggered the ICDs, heart-related death, and hospitalization. After 490 days of follow-up, 35 patients (45%) had ventricular arrhythmias that triggered their ICDs. Patients taking cholesterol-lowering drugs had a significantly lower rate of arrhythmia episodes (22%) than patients not taking such drugs (57%).
     When the team looked at cardiac death and hospitalization, only 15% of the patients taking cholesterol-lowering drugs were affected versus 45% of patients not taking such drugs.
Source: J Am Coll Cardiol 2000;36:766-775

 Finding Out About Your Doctor

January 2, 2001 - Medicare patients might soon be able to get information about doctors who have made mistakes. This reverses a policy that kept medical mistakes secret for more than 20 years.
     Under new government rules, patients will be told if their care met recognized standards, and if there has been any action against their doctors or hospitals. Under current law, medical quality experts can only release information about a doctor with the doctor's consent. (Jon - permission is never given - duh!) The new policy eliminates that kind of doctor veto power.
Source: New York Times
Source: AP

 Anthracycline Risk For CHF In Children

January 19, 2001 - Heart failure is a "considerable and serious" problem in children with cancer who were treated with anthracycline. It is worst in those who receive total doses over 300mg per meters squared.
     Dr. L. Kremer studied the risk of heart failure in a group of 607 children treated with anthracyclines between 1976 and 1996. The children were followed for over 6 years, and nearly 25% were followed for more than 10 years. The main factor dividing the children into high and low-risk groups for anthracycline-caused heart failure was the total dose of anthracycline taken over time.
     Children who received a total dose of 300mg per meters squared (or more) were 12 times more likely to develop heart failure than those who received a lower overall dose. "The risk of anthracycline-caused CHF also increased with time," reaching 2% after 2 years and 5% at 15 years.
      So even though years past the cancer treatment, there is still a risk of heart failure caused by that earlier treatment.
Source: J Clin Oncol 2001;19:191-196

 Cancer Drug Damage Can be Predicted

May 7, 2002 - Two new studies suggest that new guidelines are needed to monitor people who receive anthracyclines (cancer drugs), which places them at risk both short-term and long-term for heart failure. The first study suggests that heart failure from anthracyclines may not show up until at least 3 months after treatment, and that increased risk persists even after 3 years.
     The second study suggests that troponin I levels immediately after chemotherapy may predict risk of later heart failure. Dr. Benny Jensen says that monitoring the heart during and right after chemo treatment misses the highest-risk periods. He says, "Current monitoring recommendations should be changed."
     In a blinded study, 120 breast cancer patients had a progressive worsening in heart function starting 3 months or more after starting epirubicin treatment. The drug's effect on heart function was closely linked to the cumulative dose, with older women being more affected. By 3 years after treatment, 59% had suffered a 25% decrease in heart function, and within 5 years, 20% of those treated with high-dose epirubicin had severe cardiomyopathy. "The patients did not spontaneously recover," Jensen said. It took ACE inhibitor use to improve heart function.
     In the second study, high blood levels of troponin I (TnI) identified patients at future risk for CHF after anthracycline treatment, even when heart function was still normal. The Italian team measured TnI blood levels in 211 patients with poor-prognosis breast cancer during and shortly after high-dose chemo, which included anthracyclines in half the patients. The others had received anthracyclines earlier.
     All patients had normal TnI levels before each treatment. One-third of patients had high TnI levels after treatment. There was a strong link between high levels of TnI and reduced heart function. Daniela Cardinale said, "It can permit cancer doctors to change or stop chemo treatments." Cardiologists will also know which patients to watch very closely.
Source: Medscape, by Laurie Barclay & Ann Oncology. 2002;13: 699-709, 710-715

 PPCM & Future Pregnancies

May 24, 2001 - Peripartum cardiomyopathy (PPCM) is a form of heart failure usually caused by the physical stress of pregnancy. Little is known about how later pregnancies come out in women who have had PPCM.
     Researchers found 44 women who had suffered PPCM and who had carried a total of 60 pregnancies afterward. The medical records of these women were studied and the women or their doctors were interviewed.
     In the first post-PPCM pregnancies in these 44 women, 28 were in women whose heart function had already returned to normal - group one. Sixteen pregnancies happened in women who still had weak hearts - group 2.
     The pregnancies caused heart function to weaken in both groups. In post-PPCM pregnancies, heart failure occurred in 21% of group one women and in 44% of group 2 women. Risk of death was zero in group one but was 19% in group 2. Premature delivery was more common in group 2. Later pregnancy in women who have had PPCM is linked to worsening heart function and can cause complications or death.
     While the numbers in this review are small, it shows that post-PPCM pregnancy carries a real risk of heart weakening and even death. Avoiding pregnancy is the safest course for PPCM survivors. Also, women who died following the original PPCM episode could not be included here, so the risks of PPCM are actually higher overall.
Title: Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy
Authors: Elkayam U, Tummala PP, Rao K, et al.
Source: N Engl J Med 344:1567-1571, May 24, 2001, Number 21

 Stopping A-Fib Improves Heart Function

August 3, 2001 - Restoring normal heart rhythm (called sinus rhythm) greatly improves heart function in patients with chronic a-fib. Dr. Jose Azpitarte studied patients with chronic a-fib and the kind of heart problem most CHFers have - systolic dysfunction.
     The study included 15 men and 5 women from age 40 to age 76. Normal rhythm was restored in 17 patients. Four of them went back into a-fib pretty soon; 3 of those had heart failure caused by ischemia.
     After one year, 92% of patients with non-ischemic CHF were still free of a-fib. However, all the patients with ischemic CHF went back into a-fib.
     EF had increased in the 13 patients who stayed in normal rhythm at 6 months. Heart size went down in patients who stayed in normal rhythm. Heart class improved from class 2 to 1 in patients who stayed in normal rhythm. The other patients' heart class worsened slightly.
Source: Chest 2001;120:132-138

 EECP Approved For Heart Failure

June 17, 2002 - Vasomedical's EECP treatment has been FDA-approved for heart failure. See www.eecp.com for details on this treatment.
Source: FDA web site.

 European Doctors Ignore Guidelines

June 24, 2003 - Half of European CHFers don't get best treatment. This survey was presented at the 2003 Heart Failure meeting in Strasbourg, France. It was done by the Study Group on Heart Failure Awareness and Perception in Europe (SHAPE), led by Professor Willem Remme. Almost 3000 PCPs from 9 European countries were included.
     Results showed that PCPs don't follow treatment guidelines. Only 50% start heart failure treatment with an ACE inhibitor. The rest said they preferred to start treatment with a diuretic, which has not been shown to improve survival.
     35% of PCPs thought ACE inhibitors could worsen heart failure and 86% thought beta-blockers could also worsen CHF. Also, 56% would not prescribe aldosterone antagonists. Even when PCPs do prescribe these drugs, they do not prescribe target dose.
     The survey also showed that PCPs are not using the right tests to diagnose heart failure, with 75% relying entirely on signs and symptoms, despite strong guidelines for using echo and BNP testing. Most doctors knew the most common CHF symptoms, like SOB (85%) and swollen ankles (66%), but only 39% knew fatigue was a common symptom.
Source: HeartWire News

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