9 a.m. Abstract 20649 – Some ICD recipients may not get optimal medical therapy
Guidelines recommending optimal medical therapy are not always followed for patients receiving implantable cardioverter-defibrillators (ICDs), a new study found.
Researchers examined optimal medical therapy — beta blocker and angiotensin converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) at discharge — among ICD patients with ejection fractions below 35 percent. Of the 231,725 patient stays analyzed, 73.1 percent of the patients received optimal medical therapy at discharge, 63.1 percent received ACEI, 16.6 percent received ARB and 87.8 percent received a beta blocker. Patients least likely to receive optimal medical therapy were those whose care was directed by a surgeon and those patients with a prior ICD. Race wasn't predictive.
"Despite guideline recommendations, more than one-quarter of ICD recipients are not medically optimized at the time of ICD implantation," researchers said. "These results highlight patient and provider characteristics that may be targets of quality improvement efforts to minimize gaps in heart failure care."
Amy Miller, M.D., Ph.D., Brigham & Women's Hospital, Boston, Mass.; (617) 525-6768; almiller@partners.org.
9:15 a.m. Abstract 15309 – Animal study finds promising anti-arrhythmic agent
The drug ghrelin reduced irregular heart rhythm by preventing the acute heart attack-induced loss of the protein phosphorylated connexin43 (Cx43) in rats, according to a new study.
Ghrelin is a group of hormones secreted primarily by stomach cells and has been implicated in the stimulation of fat storage and food intake.
Researchers exposed 52 rats to 30 minutes of ischemia, induced by blocking the left coronary artery. The rats were randomized into two groups: 26 received ghrelin and 26 got saline during 30 minutes of coronary artery ligation.
Ghrelin increased high-frequency (HF) power and decreased the low-frequency (LF)-to-HF ratio of heart rate variability. Rapid heartbeat occurred less often in rats receiving ghrelin compared to those on saline. Rats getting the drug showed only a slight loss of Cx43 in left ventricles while rats on saline had a marked reduction.
The findings suggest ghrelin could have potential as a new anti-arrhythmic medication, researchers said.
Takeshi Soeki, M.D., Ph.D., University of Tokushima, Tokushima, Japan; (011) 81886337851; soeki@clin.med.tokushima-u.ac.jp.
9:30 a.m. Abstract 18482/P2022 – Mobile phone-based telemonitoring improves blood pressure control
A fully automated mobile phone-based telemonitoring system that actively engages patients in their care significantly improved blood pressure control among diabetics with uncontrolled systolic hypertension.
Patients received pre-programmed cell phones that automatically transmitted readings from a Bluetooth-enabled home blood pressure monitor.
Feedback is provided on the cell phone screen, instantaneously reporting the current blood pressure along with messages ranging from congratulations to a prompt to take additional readings over a certain period to get a reliable overall reading. If the blood pressure values are too high, patients are asked to make a follow-up appointment with their physician.
- At 12 months, systolic blood pressure significantly dropped by 9.1 mm Hg in the telemonitoring group compared to a 1.6 mm Hg decrease in those monitoring their blood pressure at home in the standard manner.
- Blood pressure control was achieved in 37 percent of the phone-based telemonitoring patients and only 14.2 percent of the controls.
If a three-day or two-week average exceeds a prespecified average, the doctor is notified. Physicians can review the results of their patients' blood pressure on a Web-based server.
The researchers are analyzing the possible reasons for the drop in blood pressure in patients using the telemonitoring system.
Alexander G. Logan, M.D., University of Toronto, Toronto; (416) 586-5187; logan@lunenfeld.ca.
11:45 a.m. Abstract 23153 – Large study finds no significant statins-cancer link
A large new investigation found no difference in cancer risk between statin and non-statin users for up to 10 years.
Statins are a class of cholesterol-lowering medications.
In the study, researchers paired older adult statin patients with non-statin users and followed them for up to 10 years. Researchers retrospectively analyzed more than 11 million patient records from a large database covering January 1990-February 2009.
Propensity scoring methods matched 45,857 comparison pairs of statin vs. non-statin patients. Before matching, cancer occurred in 23,906 of 203,763 (11.7 percent) statin users and in 17,457 of 159,004 (11.0 percent) non-statin users. After matching, cancer incidence in statin patients fell to 11.4 percent vs. 11.1 percent in non-statin users. Pairs were followed up for an average of eight years. Based on these results, no increased risk of cancer associated with statin use was found.
Paul Cload, Ph.D., GE HealthCare, Chalfont St Giles, Bucks, United Kingdom; paul.cload@ge.com.
Author disclosures are on the abstracts.
Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.
NR10-1152 (SS10/Wednesday News Tips)
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