News Release

News tips from the care and outcomes meeting

Peer-Reviewed Publication

American Heart Association

Highlights of the American Heart Association’s 3rd Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Sept. 30-Oct. 1, 2001, Washington, D.C.

To highlight some of the research at the meeting, News Media Relations has prepared news tips on some of the abstracts that will be presented. Abstract numbers are listed for each tip. Note: Stories are embargoed until the poster session begins at 5 p.m. Sunday, Sept. 30. For more information call Bridgette McNeill at 214-706-1135 or Carole Bullock at 214-706-1279:

P15 – Less educated African-Americans likely to drop out of weight loss programs. Drop-out rates in obesity treatment programs are often high, and low attendance is tied to poor results. To identify factors that might influence dropping out or skipping sessions, researchers analyzed attendance patterns at a 10-week weight loss program advertised to African-Americans. More than 60 of the 211 subjects had dropped out by the end of the first class. Independent predictors of dropping out included being younger, having less than a high school education and working in a clerical occupation. Of the subjects who continued the weight-loss program, the attendance rate was just 63 percent (6 of 10 classes). Lower attendance was associated with higher diastolic blood pressure, weight gain in the previous six months and a tendency to view the program as requiring a lot of effort. Shiriki K. Kumanyika, University of Pennsylvania School of Medicine, Philadelphia, 215-898-2629; skumanyi@cceb.med.upenn.edu.

P27 – Do women have more adverse outcomes than men following stroke? About 500,000 Americans have a stroke each year, yet little is known about gender differences in outcomes among patients. In a study of almost 75,000 patients with a primary diagnosis of stroke, 56 percent of them women, researchers found that women were 1.2 times more likely to die than men. Men were 3.6 times more likely to have heart complications and 1.4 times more likely to have kidney failure. The women were significantly older – 78-years-old on average compared to the men who were an average age of 73. In addition, women had more incidence of another disease. When those variables were factored in, there were no significant differences in outcome, leading to the conclusion that gender differences in outcome after stroke are due to age and overall health. Allan L. Anderson, Medical City Dallas Hospital, Dallas, 972-566-6626; aanderson@nthc.com

P33 – Do racial differences in cardiac revascularization use affect outcomes for African-Americans? While studies have found that African-Americans with coronary artery disease are less likely than whites to undergo cardiac revascularization procedures, the impact of these care differences on recovery remains unclear. In a study of 1,392 patients treated from 1998-2000, researchers studied the patients’ physical and mental functions at their initial assessment and six months later. African-Americans had fewer procedures, 58 percent vs. 71 percent. After accounting for patient demographics, clinical factors and functional status at baseline, they found that while the African-Americans undergo fewer cardiac revascularization procedures than whites, their improvement after six months is similar. Padma Kaul, Duke Clinical Research Institute, Duke University Medical Center Durham, N.C., 919-668-8830; Kaul0002@onyx.dcri.duke.edu.

P56 – A quick start is the “formula” for successful cholesterol control. Lowering low-density lipoprotein (LDL), the so-called bad cholesterol, through diet is a cost-effective first step to prevent heart disease. Yet many patients who could significantly reduce their LDL through diet alone are non-compliant and end up taking drugs to lower their cholesterol. Scientists at Ross Products, a division of Abbott Labs, wondered if a new nutritionally complete, low-fat liquid formula diet (LFD) that can shorten the diet trial phase to just 10 days might be more effective. They compared 55 patients on the LFD with 28 subjects on the American Heart Association’s low-fat “Step 1” diet. They found that 65 percent of the LFD group achieved a significant drop in their LDL cholesterol after just 10 days, compared to just 46 percent in the standard diet group. All subjects then followed the low-fat diet for three months. The researchers found that the liquid diet group maintained lower cholesterol levels through three months of follow up than subjects who did not get the short, quick diet challenge. Vikkie A. Mustad, Ross Products Division, Abbott Labs, Columbus, Ohio, 614-624-6355; vikkie.mustad@rossnutrition.com.

P66 – Socioeconomic factors becoming less significant in revascularization procedures. Researchers analyzed records of more than 7 million heart attack patients treated with either balloon angioplasty or bypass surgery from 1988 to 1997. They found that total revascularization procedures nearly doubled (from 15.6 percent to 30.5 percent). Angioplasty increased by 120 percent and coronary artery bypass surgery grew by 60 percent. During that same time, in-hospital death rate dropped by 33 percent. They also found that older patients, women, blacks and those without private insurance were less likely to have the procedures and more likely to die in the hospital than younger, white, male patients. However, although blacks and whites had different rates of revascularization, they had similar death rates overall. In addition, the data seem to suggest that although the gap between favored and less favored patients still exists it has narrowed during the past decade. This suggests that clinical factors rather than socioeconomic characteristics of patients were increasingly more important determinants of who undergoes revascularization. Jing Fang, Albert Einstein College of Medicine, Bronx, NY, 718-430-2316; fang@aecom.yu.edu.

P83 – Which heart failure patients get which medications? Results from a national study. Aspirin therapy is widely believed to help heart attack patients by making the blood less likely to clot, reducing the risk of second heart attacks. Another class of drugs, blood-thinning agents such as warfarin, are also known to reduce risk. Researchers reviewed the records of 23,434 heart failure patients with known coronary artery disease. They found that 65 percent of the patients were advised to take aspirin or warfarin. However, the drugs were used significantly less frequently in African-Americans, women and people over age 85. They were used much more often in heart failure patients who had suffered a heart attack and in those who had coronary artery disease severe enough to require surgery or balloon-angioplasty to bypass or reopen clogged blood vessels. Researchers say that although these drugs are more frequently given to the sickest patients, they are underused in other important populations. Frederick A. Masoudi, University of Colorado Health Sciences Center, Aurora, Colo., 303-724-1178; fred.masoudi@uchsc.edu.

P84 – Why is beta-blocker use so low? Recent research data show that beta-blockers reduce death and hospitalization for patients with heart failure and poor left ventricular function. But has the latest research changed medical practice? The National Heart Failure project is working to assess and improve care for these debilitating conditions, which are expected to increase with the aging population. As part of this effort up to 800 Medicare heart failure discharges were sampled systematically for each state, the District of Columbia and Puerto Rico. In an analysis of 8,756 of those patients, researchers found that the use of beta-blockers remains low and is lowest in the elderly and in blacks. These findings suggest that many patients would benefit from efforts to translate the latest research into practice. Frederick A. Masoudi, University of Colorado Health Sciences Center, Aurora, Colo., 303-724-1178; fred.masoudi@uchsc.edu.

P86 – To pump or not to pump? The surprising patients who benefit most from coronary bypass without a heart-lung machine. There is increasing enthusiasm for coronary artery bypass surgery that sidesteps the traditional heart-lung machine, which keeps the heart pumping. But is the operation too risky for some patients? Researchers who analyzed data from 482 patients, 274 of them getting surgery without the machine (off-pump), found that although patients receiving off-pump surgery tended to be sicker, they had less post-operation kidney failure and stroke, spent less time in intensive care and were less likely to be readmitted after discharge. Because traditional coronary artery bypass graft surgery is not detrimental to most patients, off-pump surgery provides the greatest benefit for the sickest patients. Dale R. Levy, University Hospitals, Cleveland, Ohio, 216-844-4820; dale.levy@uhhs.com.

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