Nancy
Well-known member
Here are the summaries of a couple of interesting articles which appeared in our paper this morning.
Device May Aid Heart Patients
Story Filed: Tuesday, March 19, 2002 2:47 PM EST AP Medical Editor ATLANTA (AP) -- Routinely implanting pager-size defibrillators in heart attack survivors to stop cardiac arrest reduces their chance of dying by a surprising one-third and could benefit millions of Americans, a major study found. The devices, like the one given to Vice President Dick Cheney last summer, constantly check for abnormal beats and zap the heart back to normal in case of cardiac arrest. About 250,000 people collapse with cardiac arrest outside hospitals in the United States each year, and 95 percent of them die. ``We are talking about preventing the sudden death of people who are active and functioning,'' said Dr. Arthur J. Moss of the University of Rochester ``The opportunity here is quite profound.'' His study, released Tuesday, suggests the implanted defibrillators should be much more widely used and considered for all who meet just two simple criteria: a history of heart attack and evidence of resulting heart weakness. Heart specialists called the results important, but some wondered whether fine-tuning the criteria might better target their use so that fewer people will need them. Until now, the devices have been reserved for the rare few who survive cardiac arrest or are found to be at high risk through electrophysiological testing, which involves deliberately trying to trigger heart rhythm problems with a catheter that is snaked into the heart. Moss presented the results at a meeting of the American College of Cardiology in Atlanta, and they will also be published in Thursday's issue of the New England Journal of Medicine. The $7 million study was financed by Indianapolis-based Guidant Corp., which makes the defibrillators. Moss said at least 2 million Americans -- and perhaps more -- could benefit from the defibrillators, and there will be 300,000 more every year. ``Electricity saves lives. That's what we've heard today,'' said Dr. Douglas Zipes of Indiana University, president of the cardiology college, who nonetheless worried about ``the profound economic implications'' of implanting so many defibrillators. The devices cost about $20,000, though higher demand could eventually drive that down. With surgery and a one-night hospital stay to install them, the total cost is $40,000 to $60,000. In addition to Guidant, they are made by St. Jude Medical and Medtronic. Dr. Sidney Smith, research director of the American Heart Association, called the findings ``very impressive'' but added, ``We are talking about a lot of people who would receive defibrillators. We need to identify a subset who would benefit the most.'' Moss's study involved 1,232 heart attack survivors who also had diminished heart pumping power, a common consequence of the damage caused by a heart attack. The doctors studied people whose ejection fractions were 30 percent or less. Ejection fraction is the amount of blood pumped from the heart with each beat. It is measured with a routine echocardiogram. Normal is 50 percent or more. The volunteers were randomly assigned to get an implanted defibrillator or standard drug treatment. The study was stopped in November when it became clear that those getting the devices were doing much better. After an average of 20 months, the death rate from any cause was 14 percent in those who received defibrillators and 20 percent in people who did not. The difference translates into a 31 percent reduction in risk of death. Moss said this improvement in survival is the biggest since the introduction of beta blocker drugs for heart disease in the 1970s. The implanted devices work the same as the external defibrillators that are now becoming standard equipment in sports arenas, airport terminals and other public places. Cardiac arrest happens most often after age 60. Doctors estimate that half of all cases result from electrical disturbances that send the heart into chaotic quivering. Defibrillators are designed to correct these. The rest occur after heart attacks, when sudden blockages cut off the heart's blood supply. EDITOR'S NOTE: Medical Editor Daniel Q. Haney is medical editor of The Associated Press.
Study Questions Bypass-Mental Link
Story Filed: Tuesday, March 19, 2002 4:00 PM EST CHICAGO (AP) -- The loss of mental sharpness suffered by many heart-bypass patients several months after surgery may not be caused by the heart-lung machine used in the operating room after all, a study suggests. The research found that mental decline also occurred in bypass patients who had been put on a newer device that does not require stopping the heart. Tens of thousands of bypass patients each year suffer mental decline after surgery, including difficulty thinking and remembering. The condition may not show up for several months and can last for years. One leading theory is that the heart-lung machine is the culprit. The Dutch study compared results in heart-lung machine patients with those put on an ``off-pump'' device that only partially immobilizes the heart. Off-pump patients had less mental decline than heart-lung patients at three months, but the differences became negligible a year after surgery. The Dutch researchers said one possible explanation is that the off-pump device might also contribute to mental decline. But they also theorized that anesthesia, used in both procedures, or the trauma of surgery itself might affect mental functioning. American Heart Association spokesman Dr. Irving Kron, a University of Virginia cardiologist, said the study adds to the mystery. The study appears in Wednesday's Journal of the American Medical Association. In an accompanying editorial, Drs. Daniel Mark and Mark Newman of Duke University called the results inconclusive. They said that patients in the Dutch study were generally younger and healthier than the typical U.S. heart-bypass patient. Heart-lung machines are used to put oxygen into the blood and circulate it. The heartbeat is stopped with medication, and a thin tube is inserted into the aorta during the procedure. Many doctors believe the machine can dislodge tiny bits of fatty plaque from diseased arteries, or cause tiny blood clots or air bubbles to flow to the brain and cause strokes or other brain damage. Studies have shown off-pump devices have fewer complications and involve shorter hospital stays, but the effects on mental decline are unclear. Approximately 571,000 heart-bypass operations were performed nationwide in 1999, about 10 percent with off-pump devices. That portion has climbed steadily and is projected to reach 50 percent by 2005, according to Mark and Newman. The Dutch study involved 281 patients at University Medical Center in Utrecht, where an off-pump device called the Octopus cardiac stabilizer was invented. The device uses two small suction pods to immobilize a small part of the heart during surgery. The university gets royalties from the worldwide sale of the device, which is marketed by Medtronic. Patients underwent mental tests before and after bypass surgery. Three months after surgery, 21 percent of off-pump patients showed mental decline, compared with 29 percent of heart-lung patients. At one year, mental decline was present in nearly 31 percent of off-pump patients and 33.6 percent of heart-lung patients, a negligible difference, the researchers said. The editorial noted that elderly people in general are prone to mental decline after major surgery, and not just after heart bypass operations.
Device May Aid Heart Patients
Story Filed: Tuesday, March 19, 2002 2:47 PM EST AP Medical Editor ATLANTA (AP) -- Routinely implanting pager-size defibrillators in heart attack survivors to stop cardiac arrest reduces their chance of dying by a surprising one-third and could benefit millions of Americans, a major study found. The devices, like the one given to Vice President Dick Cheney last summer, constantly check for abnormal beats and zap the heart back to normal in case of cardiac arrest. About 250,000 people collapse with cardiac arrest outside hospitals in the United States each year, and 95 percent of them die. ``We are talking about preventing the sudden death of people who are active and functioning,'' said Dr. Arthur J. Moss of the University of Rochester ``The opportunity here is quite profound.'' His study, released Tuesday, suggests the implanted defibrillators should be much more widely used and considered for all who meet just two simple criteria: a history of heart attack and evidence of resulting heart weakness. Heart specialists called the results important, but some wondered whether fine-tuning the criteria might better target their use so that fewer people will need them. Until now, the devices have been reserved for the rare few who survive cardiac arrest or are found to be at high risk through electrophysiological testing, which involves deliberately trying to trigger heart rhythm problems with a catheter that is snaked into the heart. Moss presented the results at a meeting of the American College of Cardiology in Atlanta, and they will also be published in Thursday's issue of the New England Journal of Medicine. The $7 million study was financed by Indianapolis-based Guidant Corp., which makes the defibrillators. Moss said at least 2 million Americans -- and perhaps more -- could benefit from the defibrillators, and there will be 300,000 more every year. ``Electricity saves lives. That's what we've heard today,'' said Dr. Douglas Zipes of Indiana University, president of the cardiology college, who nonetheless worried about ``the profound economic implications'' of implanting so many defibrillators. The devices cost about $20,000, though higher demand could eventually drive that down. With surgery and a one-night hospital stay to install them, the total cost is $40,000 to $60,000. In addition to Guidant, they are made by St. Jude Medical and Medtronic. Dr. Sidney Smith, research director of the American Heart Association, called the findings ``very impressive'' but added, ``We are talking about a lot of people who would receive defibrillators. We need to identify a subset who would benefit the most.'' Moss's study involved 1,232 heart attack survivors who also had diminished heart pumping power, a common consequence of the damage caused by a heart attack. The doctors studied people whose ejection fractions were 30 percent or less. Ejection fraction is the amount of blood pumped from the heart with each beat. It is measured with a routine echocardiogram. Normal is 50 percent or more. The volunteers were randomly assigned to get an implanted defibrillator or standard drug treatment. The study was stopped in November when it became clear that those getting the devices were doing much better. After an average of 20 months, the death rate from any cause was 14 percent in those who received defibrillators and 20 percent in people who did not. The difference translates into a 31 percent reduction in risk of death. Moss said this improvement in survival is the biggest since the introduction of beta blocker drugs for heart disease in the 1970s. The implanted devices work the same as the external defibrillators that are now becoming standard equipment in sports arenas, airport terminals and other public places. Cardiac arrest happens most often after age 60. Doctors estimate that half of all cases result from electrical disturbances that send the heart into chaotic quivering. Defibrillators are designed to correct these. The rest occur after heart attacks, when sudden blockages cut off the heart's blood supply. EDITOR'S NOTE: Medical Editor Daniel Q. Haney is medical editor of The Associated Press.
Study Questions Bypass-Mental Link
Story Filed: Tuesday, March 19, 2002 4:00 PM EST CHICAGO (AP) -- The loss of mental sharpness suffered by many heart-bypass patients several months after surgery may not be caused by the heart-lung machine used in the operating room after all, a study suggests. The research found that mental decline also occurred in bypass patients who had been put on a newer device that does not require stopping the heart. Tens of thousands of bypass patients each year suffer mental decline after surgery, including difficulty thinking and remembering. The condition may not show up for several months and can last for years. One leading theory is that the heart-lung machine is the culprit. The Dutch study compared results in heart-lung machine patients with those put on an ``off-pump'' device that only partially immobilizes the heart. Off-pump patients had less mental decline than heart-lung patients at three months, but the differences became negligible a year after surgery. The Dutch researchers said one possible explanation is that the off-pump device might also contribute to mental decline. But they also theorized that anesthesia, used in both procedures, or the trauma of surgery itself might affect mental functioning. American Heart Association spokesman Dr. Irving Kron, a University of Virginia cardiologist, said the study adds to the mystery. The study appears in Wednesday's Journal of the American Medical Association. In an accompanying editorial, Drs. Daniel Mark and Mark Newman of Duke University called the results inconclusive. They said that patients in the Dutch study were generally younger and healthier than the typical U.S. heart-bypass patient. Heart-lung machines are used to put oxygen into the blood and circulate it. The heartbeat is stopped with medication, and a thin tube is inserted into the aorta during the procedure. Many doctors believe the machine can dislodge tiny bits of fatty plaque from diseased arteries, or cause tiny blood clots or air bubbles to flow to the brain and cause strokes or other brain damage. Studies have shown off-pump devices have fewer complications and involve shorter hospital stays, but the effects on mental decline are unclear. Approximately 571,000 heart-bypass operations were performed nationwide in 1999, about 10 percent with off-pump devices. That portion has climbed steadily and is projected to reach 50 percent by 2005, according to Mark and Newman. The Dutch study involved 281 patients at University Medical Center in Utrecht, where an off-pump device called the Octopus cardiac stabilizer was invented. The device uses two small suction pods to immobilize a small part of the heart during surgery. The university gets royalties from the worldwide sale of the device, which is marketed by Medtronic. Patients underwent mental tests before and after bypass surgery. Three months after surgery, 21 percent of off-pump patients showed mental decline, compared with 29 percent of heart-lung patients. At one year, mental decline was present in nearly 31 percent of off-pump patients and 33.6 percent of heart-lung patients, a negligible difference, the researchers said. The editorial noted that elderly people in general are prone to mental decline after major surgery, and not just after heart bypass operations.
