Angioplasty safer in community hospitals when team has more experience
An intra cellular pathway not previously linked to breast cancer is driving a sub-type of the disease that is highly lethal and disproportionately over-represented in African American women. The pathway regulates how cells identify and destroy proteins and represents a class of genes called proteasome targeting complexes. The work shows that basal cancer cells degrade
Full Post: Scientists find intra cellular pathway driving a deadly sub-type of breast cancer
Heart experts at Johns Hopkins have evidence that life-saving coronary angioplasty at community hospitals is safer when physicians and hospital staff have more experience with the procedure.
In a report to be presented Nov. 12 at the American Heart Association’s annual Scientific Sessions in New Orleans, researchers found that among 5,737 men and women who had emergency, so-called primary angioplasty for treatment of sudden heart attack, all at community hospitals with no on-site cardiac surgery backup, hospitals performing 83 or more procedures per year had the lowest death rates at the time of hospital discharge, at 2.2 percent.
Angioplasty consists of threading a thin tube into the main blood vessels near the heart, and using it to inflate a tiny balloon to widen an artery blocked or narrowed from the buildup of cholesterol-laden plaque. A metal cylinder stent is often deployed to keep the blood vessel open.
Researchers say their findings, collected over seven years from a diverse group of 31 hospitals across the country, none of which have elective angioplasty programs, suggest that patient safety and survival rates for primary angioplasty could be improved by easing restrictions on the use of elective angioplasty so that such hospitals can get more experience.
Under present guidelines from the American Heart Association and the American College of Cardiology, community hospitals are limited to offering angioplasty only in emergency situations, such as during a heart attack. In all other nonemergency or elective surgical cases, patients must be transferred to another hospital that has on-site, specialized heart surgery backup.
“The results reinforce what we have known for a long time with many other technical procedures, such as organ transplantation or specialized heart surgery: From an institutional and physician perspective, the more procedures performed, the better the outcomes for the patient,” says senior study investigator and interventional cardiologist Thomas Aversano, M.D.
According to the American Heart Association, in 2005 an estimated 1,265,000 angioplasty procedures were performed on 640,000 Americans. This amounts to a 324 percent increase in volume since 1987.
In this study, one of a number being conducted by the Cardiovascular Patient Outcomes Research Team (or C-PORT), all participants had primary angioplasty in response to a heart attack caused by a blocked artery. Mortality rates were adjusted to account for factors that heighten risk, such as age, ability to tolerate clot-busting drugs, diabetes and the extent of blockages in coronary blood vessels.
The research is part of several C-PORT projects investigating the safety of performing angioplasty in hospitals without heart-surgery backup, all led by Aversano, an associate professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute.
He notes that even in lower volume hospitals, at no more than 46 procedures per year, the death rate is 4 percent. Previous research by Aversano, published in the Journal of the American Medical Association in 2002, showed that heart attack patients who were treated with a clot-busting drug to open up the artery, the alternative to primary angioplasty, had a 6.7 percent death rate.
“Even in low-volume community hospitals, survival rates are better for primary angioplasty than thrombolytic therapy,” says Aversano.
“Our results serve as one potential motivation for expanding elective angioplasty to community hospitals without on-site cardiac surgery so that institutional volume is not restricted to emergency cases,” he says.
For the last two decades, surgical backup has been required for nonemergency angioplasty because, in rare instances, the procedure leads to a tear in a vessel or closing of an artery rather than opening it. The risk that angioplasty patients will need emergency heart bypass surgery is less than 1 to 2 in every 1,000 cases.
But Aversano and other researchers say medical advances have led to nonsurgical means of treating many of these complications, including the use of stents to keep arteries open, thus minimizing the need for on-site cardiac surgery backup.
Hispanic patients were 57 percent less likely than Caucasian patients to undergo coronary artery bypass surgery (CABG) one year after successful angioplasty, a type of percutaneous coronary intervention (PCI) to open blockages in the coronary arteries. Hispanics also had a trend toward lower rates of overall repeat revascularization procedures including stenting and bypass surgery, according
Full Post: Hispanics less likely to have repeat revascularizations 1 year after angioplasty
Ventricular assist devices, or VADs - surgically-placed mechanical pumps that can support failing hearts or buy time to transplant - are associated with high hospital costs and high rates of early death among Medicare recipients, say researchers at Duke University Medical Center. Their study, appearing in the November 26 issue of the Journal of the
Full Post: Study looks at ventricular assist device outcomes
Men and women have about the same in-hospital death rate for heart attack - but women are twice as likely to die if hospitalized for a more severe type of heart attack, according to a report in Circulation: Journal of the American Heart Association. Among patients with ST elevation myocardial infarction (STEMI) in a recent
Full Post: Gender disparity gap in heart attack care still present
There is strong evidence that getting to the hospital quickly during a heart attack is critical, since early treatment saves both lives and heart muscle. And if the responsible coronary artery is completely blocked, it should be opened as soon as possible. What about patients with incomplete blockages, who have ACS or acute coronary
Full Post: Timing is everything for some heart attack patients
Despite substantial progress in the diagnosis and treatment of heart attack patients, prevention of recurrent heart attacks continues to be a major clinical challenge. A new study showed that patients who suffered a non-fatal heart attack within the first three months of hospitalization for chest pain had a significantly higher risk for dying or having
Full Post: Heart attack prevention within three months after hospitalization significantly averted future attacks