CardioExchange Archive

High Blood Pressure in ICU Linked to Better Outcome: Using data from nearly 120,000 patients admitted to the ICU for chest pain, Swedish investigators found, somewhat unexpectedly, that high systolic blood pressure at the time of admission was associated with improved outcome. The association remained evident even when patients with CHF or who went on to develop CHF were removed from the analysis. The findings, the authors write in their paper in JAMA, should be used only for prognostic purposes: “Our data should not be interpreted as a suggestion not to normalize an elevated BP in patients with acute chest pain.” Nissen and JAMA Editors Weigh In on Avandia: In a commentary in JAMA, Steve Nissen provides a detailed account of events surrounding the Avandia controversy from his perspective as the author of the original meta-analysis that helped start the controversy. Nissen focuses on the deficiencies of the RECORD trial. In an accompanying editorial, JAMA editors Catherine DeAngelis and Phil Fontanarosa propose that, given the deficiencies of RECORD and other industry-sponsored trials, journals should “require that academic researchers have full access to all trial data and that all industry-sponsored trials include independent statistical analysis and assurance.”Improving Informed Consent: The high ideals of patient-centered care are compromised by the deficiencies of informed consent, according to a JAMA commentary by Harlan Krumholz (CardioExchange editor-in-chief). Krumholz proposes sweeping revisions of the current approach to informed consent, utilizing forms “standardized across institutions, with core information written by expert groups.” Krumholz provides a sample informed consent document for elective PCI.Beta-Blocker Inventor Dies: Sir James Black, the pharmacologist who won the Nobel Prize for his invention of beta-blockers, died at the age of 85. In what might be the equivalent of winning back-to-back marathons, Black followed up his earlier invention by playing a key role in the development of cimetidine, the first effective anti-ulcer drug. In 1994, Black delivered the plenary lecture at the American College of Cardiology meeting. (You can read a news report reprinted from 1994 on CardioBrief.)

AHA Scientific Statement on Medication Errors in Acute CV Medicine: “Cardiovascular medications are the most common drug class associated with medication errors, and cardiovascular patients remain at high risk in the acute hospital phase, even with the current safety strategies,” said Andrew Michaels, chair of the writing committee for a new AHA scientific statement published in Circulation. According to the statement, by following eight recommendations — from using a simple weight check to using computerized medication orders — healthcare professionals can help reduce medication errors among hospitalized heart and stroke patients.BNP-Guided HF Therapy: Porapakkham et al performed a meta-analysis of randomized controlled trials that tested the use of BNP to guide treatment of heart failure. BNP-guided therapy was associated with a reduction in all-cause mortality, particularly in patients under the age of 75. However, the investigators found no reduction in hospitalizations. The paper appears in Archives of Internal Medicine.

FDA Warns About High Dose Simvastatin– The FDA issued a drug safety communication today about an ongoing review of high dose simvastatin and increased risk of myopathy based on data from the Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) trial.FDA Panel Supports Expanded Indication for CRT-Ds– The FDA’s Circulatory System Devices Panel voted unanimously to support a broader indication for Boston Scientific CRT-D devices. The expanded indication, based on data from the MADIT-CRT trial, would include  NYHA Class I and II patients with LBBB, LVEF ≤ 30% and QRS duration ≥ 130ms. (Boston Scientific press release)FDA Delays Watchman Approval– The FDA has told Atritech Inc that it will have to perform another study to confirm the safety and efficacy of the Watchman Left Atrial Appendage Closure Technology before the device can gain market approval. (Atritech press release)

If you work for the NIH, you’re not allowed to bet on your favorite NCAA basketball team. But here at CardioExchange, you can channel your enthusiasm into a different set of brackets.

The elegant simplicity of March Madness, despite the chaos, is that we get our questions answered: “Who’s better? Syracuse or Georgetown? UCLA or USC? Kansas or Kentucky?” Teams are ranked and placed in brackets, face-off over three weeks, and one team is left undefeated at the end of the Tournament. This year, the ides of March bring us not just to beginning of the NCAA’s March Madness Tournament, but also to the end of the ACC’s Scientific Session. There was no tournament at the ACC, but we did see the results of several interesting head-to-head comparisons:

• Lenient vs. strict heart-rate control for A-Fib in RACE II
• Ablation vs. anti-arrhythmic drug therapy for persistent A-Fib in CABANA
• Sirolimus-eluting stents vs. zotarolimus-eluting stents for PCI in SORT OUT III
• Dual-antiplatelet therapy with clopidrogrel and aspirin vs. aspirin monotherapy after DES placement for PCI from REAL-LATE and ZEST-LATE

This led me to wonder: What if we could set-up head-to-head, comparative-effectiveness research, tournament style? Which “games” would you be most interested in seeing?

Was the valsartan effect on diabetes incidence in NAVIGATOR substantial enough that you’d want to compare valsartan to any of the other ARBs for glucose intolerant hypertensive patients?
Do you want to see amiodarone and dronedarone compared head-to-head for maintenance of sinus rhythm for patients after cardioversion of A-Fib?

What head-to-head comparisons would best inform your clinical practice? Fill in your brackets!

The AHA and the ACC released new practice guidelines for the management and treatment of thoracic aortic disease. Here is a press release about the guidelines. Here is the Executive Summary, with links to the full text, a slide set, and other material.

STOP-AF: The STOP-AF trial compared a novel cryoballoon ablation technology with antiarrhythmic drug (AAD) therapy in 245 AF patients who had failed at least one AAD. Treatment success was achieved in 69.9% of cryoballoon patients versus 7.3% of AAD patients, a highly significant difference (p<0.001). Phrenic nerve palsy occurred in 13.5% of cryoballoon patients and 7.3% of AAD patients. The study was presented on Monday at the ACC.

FDA to Review ACCORD Data: Following the presentation and publication in the New England Journal of Medicine on Sunday of ACCORD, which found no benefit for fenofibrate when given on top of statins in patients with type 2 diabetes, the FDA announced that it would review data from the trial, but stated that “at this time, FDA has made no new conclusions or recommendations regarding the combination use of simvastatin or other statin drugs and fenofibrate.”

Boston Scientific Suspends ICD Sales: Boston Scientific announced on Monday that it was suspending all sales of its ICDs and CRT-Ds. The suspension took place after the company “determined that some manufacturing process changes were not submitted for approval” to the FDA.

Medtronic Investigated by U.S. Attorney: In its most recent quarterly report, Medtronic disclosed that it was under investigation by the U.S. Attorney’s office in Massachusetts over the company’s relationship to cardiologists at the Lahey Clinic. (More details are available at CardioBrief.)

See previous posts (ACC Day 1 and Day 2)

Several Fellows in Cardiology who are attending this week’s ACC meeting are blogging together right here. The Fellows include Shane LaRue, Justin Bachmann, Nihar Desai, Shanti Bansal, and Hansie Mathelier. Check back often to learn about the biggest buzz at the ACC — whether it’s a poster, a presentation, or the word in the hallways.

Hansie Mathelier
3/16  7:05 p.m.

The day started a little later, secondary to having to check out of my hotel. I stayed at a middle scale hotel chain, but I think the fact that it is 100 less a night than their local competitors shows… Next time I am in ATL I might stay in Buckhead.

Off to the conference where the number of people present is noticeably less compared to the days prior. Started the day with a presentation from surgeons. The discussion got heated over the STITCH trial. Also the sole cardiologist talked about how perhaps there should VAD centers. Snuck over to hear Topol talk about personalized medicine but missed the last 10 min b/c over txting with a cofellow I heard that there were raised voices between two prominent surgeons. I am a sucker for a good academic fight.

Lunch time was a good discussion about diabetes and heart failure. Favorite part was a cardiologist from the audience who encouraged talking to the patient as the number one factor in patient outcomes. He challenged anyone in the audience if they were able to modify their patient profile as he did.

…currently on the plane waiting for the door to close….

Nihar Desai
3/16  2:34 p.m.

Dear all,
What a meeting! I am in a cab headed to the airport, just collecting my thoughts and putting together my reflections on ACC 2010….

Overall, I would say I am both exhausted and reinvigorated, tired after busy, long days, but inspired after seeing so much great science, spending time with collaborators and “non-institutional” mentors, and catching up with friends.

Safe travels and all best.

Shane LaRue
3/16  11:52 a.m.

Justin — I am with you on the smoking ban.  Last summer I moved from a place with a ban (Madison) to one where the ban becomes effective next year (St. Louis). I  am still caught off guard every time people are smoking in bars.

This reminds me, the thing I’ve found most annoying at the meeting is the disclosure ‘flash’.  We all understand the role industry plays in funding studies and our education.  But, if I am going to give you 12 to 30 minutes of my attn, I would like to be able to read who funds your research and pays you to speak.

As for accommodations, I am staying at a lower end chain hotel by Turner Field ( spent all of my conference $ for the year going to TCT, so I’m on my own dime – cue th eviolins). So, as I was checking in, the woman behind the counter was showing the other the crack pipe found in a room the night before. Awesome.

Currently in a session reviewing antiplt therapy and pci.  Interested to see where prasugrel and ticagrelor will go. Also, are people feeling better about using PPIs and clopidogrel?

A final nice touch by the organizers — $10 to check your bag here at the conference and they will get it to your plane. Odds on my bag being in St Louis when I get there?

Safe travels all.

Justin Bachmann
3/16  11:02 a.m.

Well, I’m worn out.  I went to the afternoon General Cardiology session and heard a nice talk on preop risk stratification. Then it was over to the exhibit hall to try out some of the portable briefcase-like echo machines. They are incredibly handy. I suspect they will be the wave of the future.  It would be nice to have one sitting around Parkland. I could carry it around on rounds and have real-time data.

Then I was off to the convocation, which was a nice ceremony, and some ACC social events up on the suite level of the Marriott. After that an Irish bar with my cofellows and faculty at UT-Southwestern. I reek of cigarettes. It makes me miss the public smoking ban back in Dallas.

Speaking of which, I just returned to the W hotel to find that they burned some sort of incense mixture in my room. I’m sneezing like crazy. The place is like an MC Escher drawing. I keep finding light switches in strange places. I’ll flip one and all of the sudden a metal sculpture on the wall will light up. It would probably take me a good three or four days to figure this place out. Where are the rest of you staying? Are you happy with your lodgings? When I show up to the conference tomorrow smelling like a sandalwood tree, now you know why.

Hansie Mathelier
3/16  12:14 a.m.

My Top Ten Events of the Day (not as creative as “Letterman”)
10. When I go a lecture/spotlight, the ability to sit is key.
9. Before buying coffee or food, scope out multiple venues. My “soup in a pot” was 10x better than my random turkey sandwich
8. Realizing perhaps 10 creative thoughts are ambitious
7. While walking in the exhibit hall trying to make my way to “Heart Songs 3” … being tempted to do the Bruce protocol or checking my cholesterol.
6. Realizing that the South can get as cold as the North. Wondering in the back of your mind if you brought the weather with you.
5. Figuring out what you want to further investigate when you go home….
4. Running into colleagues, friendly faces, and old friends among 10,000 people
3.Trying to figure out how many sessions you can cram into tomorrow before returning to reality.
2. To see a co-chair of a session correct a speaker’s recommendation in order to prevent dissemination of wrong info…. It was awesome!!! Makes you realize why they have co-chairs.
1. My brain hurts from all the education and loving it!!