TAG: "Heart"

Implantable heart devices provide similar survival benefits to diverse groups


Study is among the largest to compare survival benefits of these devices by race, ethnicity.

Gregg Fonarow, UCLA

Racial and ethnic minorities who receive implantable devices to treat heart failure derive the same substantial survival benefit from these therapies as white patients, new UCLA-led research shows.

While the American College of Cardiology and American Heart Association jointly recommend the use of implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices for all eligible patients, minorities have not been well represented in clinical trials of the devices, and previous studies had shown that African American and Hispanic patients are less likely to receive these recommended therapies.

The current study — among the largest to compare the survival benefits of these devices by race and ethnicity — involved more than 15,000 patients at 167 cardiology and multi-specialty practices across the U.S. The research was coordinated by 10 academic medical centers, including UCLA

The findings are published in the current issue of the Journal of the American College of Cardiology.

Drawing on data from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF), the researchers monitored 15,177 heart failure patients over two years to measure the benefits of implantable device therapy on survival in community practice settings.

They found that ICD device therapy reduced the likelihood of death during the two-year period by 36 percent, with no significant differences by race or ethnicity. They also found a 45 percent reduction in mortality with CRT therapy, again without any significant differences in device benefit by race or ethnicity.

“This is among the largest studies to address the question of race- and ethnicity-specific benefits with ICD or CRT therapies in real-world practice,” said senior author Dr. Gregg C. Fonarow, who holds the Eliot Corday Chair in Cardiovascular Medicine and Science and directs the Ahmanson–UCLA Cardiomyopathy Center at the David Geffen School of Medicine at UCLA. “Our results are a reminder to physicians and patients that this proven life-extending therapy should be offered to all eligible heart failure patients without regard for race or ethnicity.”

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Excessive exercise may be harmful to heart attack survivors


Surprising results from Berkeley Lab research.

(Photo by Roy Kaltschmidt, Berkeley Lab)

Heart attack survivors who exceed 30 miles of running per week may lose the health benefits accrued by running less, according to new research by the Department of Energy’s Lawrence Berkeley National Laboratory life sciences researcher Paul T. Williams. His work appears in an upcoming issue of the Mayo Clinic Proceedings. Similar results were found for walkers who expended 46 miles per week, the energy equivalent of running 30 miles. The study was co-authored by Paul D. Thompson, cardiologist at Hartford Hospital in Connecticut.

The study included 2,377 subjects who reported having had a prior heart attack when they enrolled in the National Runners’ and Walkers’ Health Study. During the average 10.4 years of follow-up there were 376 deaths due to cardiovascular disease. The risk of dying from a cardiovascular disease decreased progressively through about 30 miles run or 46 miles walked per week. Those achieving this level were at 70 percent lower risk than those who neither walked nor ran.  But at higher exercise levels, the risk of a cardiovascular death was about 2.6-times greater.  This wiped out all of the risk reduction accrued below 30 miles run or 46 miles walked, so much so that cardiovascular disease mortality in these patients was similar to those that hardly exercised.

“The results are surprising,” said Williams. “Our previous research has shown that heart disease risk factors and the risk for nonfatal heart attacks improved with greater running distance through at least 40 miles per week, with no indication that things got worst at higher mileages. Like other medical treatments, there appears to be a level that can be excessive.” Williams cautions that his findings were specific to heart attack survivors.

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Researchers ID gene mutation for heart disease in Newfoundland dogs


Information could help gradually eliminate the disease from the breed.

Newfoundlands — those massive, furry, black dogs — have captured many a heart with their hallmark size, sweet nature and loyalty. Unfortunately these gentle giants’ own hearts are all too often afflicted with a potentially lethal congenital disease called subvalvular aortic stenosis, or SAS, which also affects children and other dog breeds including the golden retriever.

A team of researchers led by UC Davis veterinary cardiologist Joshua Stern has for the first time identified a gene mutation responsible for canine SAS, the most common inherited heart disease in dogs. The study appears online in the journal Human Genetics: www.ncbi.nlm.nih.gov/pubmed/24898977.

“Our hope now is that breeders will be able to make informed breeding decisions and avoid breeding dogs that harbor this mutation, thus gradually eliminating the disease from the Newfoundland breed,” Stern said. “In addition, now that we know one gene responsible for SAS and more about which proteins are involved, we can move forward to consider novel therapies that may help treat this devastating condition.”

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Coalition teams to help reduce heart attacks, strokes in San Diego County


UC San Diego part of regional project awarded $5.8M Health Care Innovation grant.

Approximately 84 million people in the United States suffer from some form of cardiovascular disease, and about 720,000 Americans have a heart attack every year, which works out to one every 44 seconds. To address these alarming statistics, the Be There San Diego Initiative has been awarded a $5.8 million Health Care Innovation grant for a coalition project to help reduce heart attacks and strokes in San Diego County.

The initiative’s program, San Diego: A Heart Attack and Stroke Free Zone, is a regional collaboration of health care organizations and stakeholders to improve health care delivery and patient outcomes.

The goal during the three year project is to enroll 4,000 high-risk patients and lower their blood pressure and cholesterol levels through evidence-based practices and a better understanding of the importance of treatment adherence. The project will also promote heart attack and stroke prevention measures, test novel, cost-effective technology solutions and provide educational opportunities both for patients and within the physician community.

Partners in the Be There Initiative include UC San Diego Health System, Arch Health Partners, Scripps Health, Sharp HealthCare, Kaiser Permanente, Palomar Medical Center, Naval Medical Center, Veterans Administration, the San Diego County Medical Society Foundation, the County of San Diego Health and Human Services Agency, community clinics and others. UC San Diego Health System serves as the fiscal agent for the project.

“Health organizations that are competitive in the market will be working together for the benefit of San Diego patients,” said Anthony DeMaria, M.D., principal investigator of the Heart Attack and Stroke Free Zone program and cardiologist at UC San Diego Health System. “This approach will decrease our community’s risk for cardiovascular disease and could result in saving millions in the county by preventing half of the heart attacks and strokes that would have otherwise occurred in the participating patient population.”

Patients will be educated about the program, consented and enrolled through their physician’s office beginning later this year. Participants will also receive blood pressure cuffs to monitor levels at home and work closely with a health care coach.

“Because it’s a silent condition, we find that many patients are unaware of having hypertension, and only about 40 percent of patients diagnosed with high blood pressure take their medication, which can directly lead to cardiovascular disease. We hope through the Heart Attack and Stroke Free Zone program, we can increase this to 80 percent,” said Katherine Bailey, executive director of the Be There Initiative.

The Health Care Innovation grant supporting the project is made possible by the Centers for Medicare and Medicaid Services (CMS) through the Affordable Care Act and is part of an ongoing effort to advance innovative solutions in delivering and improving patient care across the nation.

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Earlier intervention for most common heart attacks linked to improved survival rates


Study suggests room for improvement in how guidelines applied among patient groups.

Changes in the treatment of the most common form of heart attack over the past decade have been associated with higher survival rates for men and women regardless of age, race and ethnicity, according to a UCLA-led analysis.

But the study also suggests that there is room for improvement in how current treatment guidelines are applied among specific patient groups.

The researchers reviewed records for 6.5 million people who were treated for heart attacks between 2002 and 2011. The analysis was among the first and largest national studies to assess the impact of the trend toward more aggressive care for patients who experience the type of heart attack known as non-ST elevation myocardial infarction, or NSTEMI.

Their findings are reported in the peer-reviewed Journal of the American Heart Association.

“The substantial reductions in in-hospital mortality observed for NSTEMI patients nationwide over the last decade reflect greater adherence to evidence-based, guideline-directed therapies,” said Dr. Gregg C. Fonarow, the study’s senior author and UCLA’s Eliot Corday Professor of Cardiovascular Medicine and Science.

“Nevertheless, there may be further opportunities to improve care and outcomes for patients with NSTEMI, who represent the greater proportion of patients presenting with myocardial infarction,” said Fonarow, who also is director of the Ahmanson–UCLA Cardiomyopathy Center at the David Geffen School of Medicine at UCLA.

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New approach to remove blood clots


Catheter-based system removes clots without open heart surgery.

Victor Pretorius (left) and Mitul Patel, UC San Diego

When a large blood clot was discovered attached to the end of a catheter inside the right atrial chamber of a patient’s heart, doctors faced a daunting challenge. If the clot came loose, the consequences would likely be catastrophic for the patient, who suffered from pulmonary hypertension – a dangerous narrowing of blood vessels connecting the heart and lungs.

But experts at the UC San Diego Sulpizio Cardiovascular Center (SCVC) are now able to save patients like this one from potentially fatal outcomes by using a new technology capable of removing blood clots, infected masses or foreign bodies from major cardiac blood vessels without performing open-heart surgery.

The SCVC is the first in San Diego County to use the AngioVac system developed by AngioDynamics. The AngioVac is a catheter-based device in which thin tubes are inserted into two major veins in the body through the neck or groin area. Under X-ray guidance, the flexible tubes are advanced to the proximal veins, right-sided heart chambers and/or lung arteries. Each is equipped with an expandable, balloon-shaped funnel tip that, when attached to a bypass circuit, vacuums the targeted material, such as a blood, clot out of the body.

“In some cases, medications can be used to dissolve blood clots, but this treatment option does not work for all patients, especially those who are in a life-threatening situation,” said Mitul Patel, M.D., FACC, interventional cardiologist at UC San Diego Health System. “This new device allows our team to safely extract material, preventing the patient from having to undergo invasive, high-risk surgery.”

Open-heart surgery takes much longer to perform and often requires the surgeon to divide the breastbone lengthwise down the middle and spread the halves apart to access the heart. After the heart is repaired, surgeons use wires to hold the breastbone and ribs in place as they heal.

“Removing a blood clot through open-heart surgery results in longer hospitalization, recovery and rehabilitation times compared to the minimally invasive approach provided by this new device,” said Victor Pretorius, M.B.Ch.B., cardiothoracic surgeon at UC San Diego Health System.

The AngioDynamics device does not eliminate the need for a surgery called pulmonary thromboendarterectomy (PTE) to remove chronic blood clots in the lung arteries, a surgery that cardiothoracic surgeons at UC San Diego Health System have special expertise in performing.

Nearly 100,000 Americans die each year when a clot breaks away from a blood vessel wall and lodges in the lungs or heart. Several factors can cause a blood clot, including certain medications (oral contraceptives and hormone therapy drugs), deep vein thrombosis, family history, heart arrhythmias, obesity, surgery, prolonged sitting or bed rest, and smoking.

The new procedure is performed by a multidisciplinary team comprised of anesthesiologists, cardiothoracic surgeons and interventional cardiologists. Six patients at UC San Diego Health System have undergone the procedure so far, which can be completed in as little as one hour with patients typically able to walk and leave the hospital the following day.

“The success of this new device would not be possible without the collaboration of our colleagues dedicated to helping patients with a vast array of cardiovascular issues,” said Patel. “As the only academic hospital in San Diego County, we are excited about this new technology and what it offers as a new treatment option for our patients at SCVC.”

To learn more about treatment options at UC San Diego Sulpizio Cardiovascular Center, click here.

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Minimally invasive heart stents prove safer


The safety of the procedure also appears to be improving over time.

Researchers at the UC San Diego School of Medicine have documented the safety benefits of aortic stent grafts inserted during minimally invasive surgery to repair abdominal aortic aneurysms – weaknesses in the body’s largest artery that can rupture, causing potentially lethal internal bleeding.

The study, published today (July 9) in JAMA Surgery, shows that patients who received the minimally invasive aortic repair procedure had a 42 percent reduction in preventable post-operative complications and a 72 percent reduction in mortality, compared with those who had undergone open repair surgery.

The safety of the endovascular “inside blood vessel” procedure also appears to be improving over time, as researchers documented a 37 percent reduction in the likelihood of an avoidable complication between 2003 and 2010.

The statistics are based on an analysis of 70,946 cases of abdominal aortic aneurysm repair performed over the seven-year period, culled from a nationwide hospital database maintained by the Healthcare Cost and Utilization Project.

“All this is good news for patients because endovascular repair has become the most common treatment for abdominal aortic aneurysms,” said senior author John Lane, M.D., director of endovascular surgery at UC San Diego Health System and associate professor at the UC San Diego School of Medicine.

The lead author is John Rose, M.D., a resident physician at UC San Diego School of Medicine.

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Catheter ablation a first-line treatment for atrial flutter


UCSF researchers find procedure also reduces hospital visits, lowers atrial fibrillation risk.

Use of catheter ablation is not only beneficial for treating atrial flutter but also can significantly reduce hospital visits – both inpatient and emergency – and lower the risk for atrial fibrillation, according to research by UC San Francisco.

The study is in the July issue of PLOS ONE and available online.

“We’ve seen firsthand in our clinical experience that atrial flutter is difficult to control with drugs, even more than atrial fibrillation,” said senior author Gregory Marcus, M.D., director of clinical research in the UCSF Division of Cardiology. “Based on our study findings, physicians and patients need to be educated that atrial flutter can be readily cured through catheter ablation, and the procedure may reduce the risk for atrial fibrillation.”

Atrial flutter (AFL) is a common abnormal heart rhythm similar to atrial fibrillation (AF). In AF, electrical impulses are triggered from many areas in and around the upper chambers (atria) of the heart instead of just one area. This activity is chaotic, and the atrial walls quiver rather than contract normally in moving blood to the lower chambers (ventricles). In AFL, the electrical activity is more coordinated into one rapid circuit, but the atria contract very rapidly.

“The use of catheter ablation for AFL is very effective and can significantly reduce hospital visits and demand on health care services,” Marcus said. “It’s a safe procedure we frequently perform, even on people in their 90s.”

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Forbes, Buffett honor UCSF donor


Chuck Feeney recognized after decades of stealth philanthropy.

Chuck Feeney, after decades of anonymous and stealth philanthropy, has been caught in the spotlight by earning a Forbes 400 Lifetime Achievement Award.

In presenting the award, billionaire Warren Buffett referred to Feeney as his hero, and Bill Gates’ hero as well. “He should be everybody’s hero,” Buffett remarked.

Feeney, through his philanthropic arm The Atlantic Philanthropies, is UC San Francisco’s single greatest benefactor, giving more than a quarter of a billion dollars over the years. Proof of his epic generosity is visible most prominently at Mission Bay, where he has provided indispensable support to state-of-the-art buildings and created the environment for the remarkable science that goes on within them.

“Chuck’s approach to giving is based on backing great people in achieving demonstrable outcomes. As he has noted, ‘you should think of your philanthropic efforts as a business – out to achieve a demonstrable result,’” said Feeney’s business partner, Steve Denning, who accepted the honor on his behalf.

Feeney’s deep and wide investment in UCSF is evidence of his confidence in UCSF’s ability to deliver on its promise as a world-class bioscience center.

His most recent gift to UCSF has been to Global Health Sciences, enabling UCSF to build Mission Hall, which will house its global health researchers, scientists, and students under the same roof for the first time. The building opens this fall.

Feeney also has given generously to the building of the Smith Cardiovascular Research Building, Helen Diller Family Cancer Research Building, and the UCSF Medical Center at Mission Bay, which opens its doors in 2015.

“Chuck Feeney is an extraordinary human being – a visionary, a humanitarian, and a pragmatist,” said Interim Chancellor Sam Hawgood, M.B.B.S. “These traits have made him an indispensable partner in our evolution as a global health science hub. We are thrilled that he is being recognized for the magnitude of his remarkable generosity around the world.”

Committed to “giving while living,” Feeney transferred nearly all his and his family’s assets to The Atlantic Philanthropies with the intent to give it all away during his lifetime. For the first 15 years, Feeney swore The Atlantic Philanthropies staff to secrecy and gave anonymously, until he was outed by Forbes Magazine. By 2016, Atlantic Philanthropies will close its books, having emptied its $7.5 billion coffers into the promising causes Feeney has carefully chosen over the years.

“Chuck Feeney has changed the face of philanthropy,” said Hawgood. “Giving while living substantially increases the value of a gift both emotionally and financially. The working relationship we have with Chuck has been a source of inspiration for us all, personally and professionally.”

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Heart muscle can regenerate itself in very limited amounts


UCLA researchers are first to directly measure division of cardiomyocytes.

Reza Ardehali, UCLA

Researchers from UCLA’s Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research are the first to directly measure the division of heart muscle cells, proving that while such division is very rare, it does occur.

The study, conducted by assistant professor of cardiology Dr. Reza Ardehali and colleagues, resolves a recent controversy over whether the heart muscle has the power to regenerate itself. The findings are also important for future research that could lead to the regeneration of heart tissue to repair damage caused by disease or heart attack.

The findings were published May 29 in Proceedings of the National Academy of Sciences.

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UC Davis Medical Center receives echocardiography accreditation


Accreditation a ‘seal of approval’ for patients.

UC Davis Medical Center has been granted a three-year term of accreditation in echocardiography in three areas by the Intersocietal Accreditation Commission (IAC).

The three areas for which the IAC granted accreditation are adult stress, adult transesophageal and adult transthoracic.

Accreditation by the IAC signifies that the medical center has undergone a thorough review of its operational and technical components by a panel of experts. The IAC grants accreditation only to those facilities that are found to be providing quality patient care, in compliance with national standards through a comprehensive application process including detailed case study review.

IAC accreditation is a “seal of approval” that patients can rely on as an indication that the facility has been carefully critiqued on all aspects of its operations considered relevant by medical experts in the field of echocardiography. When scheduled for an echocardiography procedure, patients are encouraged to ask about the accreditation status of the facility where their examination will be performed, and can learn more by visiting www.intersocietal.org/echo/main/patients.htm.

IAC accreditation is widely respected within the medical community, as illustrated by the support of the national medical societies related to echocardiography, which include physicians and sonographers. Echocardiography accreditation is required in some states and regions by the Centers for Medicare and Medicaid Services (CMS) and by some private insurers. However, patients should remain vigilant in making sure that their echocardiography procedures are performed within accredited facilities, because for many facilities accreditation remains a voluntary process.

Cardiovascular diseases are the No. 1 cause of death in the United States. On average, one American dies every 39 seconds of cardiovascular disease — disorders of the heart and blood vessels. The American Heart Association estimates that the direct and indirect cost for cardiovascular disease in the U.S. for 2010 was $503.2 billion.

Early detection of life threatening heart disorders and other diseases is possible through the use of echocardiography procedures performed within hospitals, outpatient centers and physicians’ offices. While these tests are helpful, there are many facets that contribute to an accurate diagnosis based on echocardiography testing. The skill of the echocardiography sonographer performing the examination, the type of equipment used, the background and knowledge of the interpreting physician and quality assurance measures are each critical to quality patient testing.

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Possible source of Kawasaki disease found


Deadly childhood condition may be triggered by aerosols from northeast China.

Jane Burns, UC San Diego

An international team of scientists, including researchers at the UC San Diego School of Medicine and Scripps Institution of Oceanography, report that the likely cause of Kawasaki disease in Japan is a windborne agent originating from northeast China, a region characterized by dense cereal croplands.

Kawasaki disease (KD) is the most common cause of acquired heart disease in children, most notably in Japan, though incidence rates are also rising in the United States and Western Europe. For decades, it has stubbornly resisted scientific explanation. The disease is difficult to diagnose and, without treatment, 25 percent of children with the condition develop coronary artery aneurysms – balloon-like bulges of heart vessels – that may eventually result in heart attacks, congestive heart failure or sudden death. Prevalence rates of KD are rising among children in Asia, the United States and Western Europe. Predictive models estimate that by 2020 one in every 1,600 adults in the U.S. will be affected by the disease.

First described in Japan in 1967 and named after its discoverer, Dr. Tomisaku Kawasaki, the cause of KD has eluded two generations of researchers. Dr. Jane C. Burns, professor and director of the Kawasaki Disease Research Center at the UC San Diego School of Medicine and Rady Children’s Hospital-San Diego, assembled an international team to help decipher the distinct seasonality of this devastating childhood illness.

Noting that the timing of KD outbreaks in Japan coincides with certain wind patterns from Asia, climate scientist Xavier Rodó and colleagues at the Catalan Institution for Research and Advanced Studies and the Catalan Institute of Climate Sciences, both in Barcelona, used computer models to simulate air currents and airborne particle transport for all days since 1977 with high numbers of KD cases in Japan, based on data compiled by Dr. Yoshikazu Nakamura and colleagues at Jichi Medical University in Japan. The modeling indicated that KD cases in many Japanese locations, both in and out of epidemic years, peaked only when winds originated from a densely-cultivated region in northeastern China characterized by vast cereal croplands.

In 2011, the Barcelona researchers equipped an aircraft based in Japan with a newly designed large-volume air-filtering device to collect aerosol samples. With help from Hiroshi Tanimoto and colleagues at the National Institute of Environmental Science in Tsukuba, Japan, the plane sampled at altitudes between two and three kilometers above Japan to avoid surface contaminants, and on days during the KD season when air currents originated only from northeastern China. Detailed microbiome analyses of the samples by Brent Williams and Dr. Ian Lipkinat Columbia University in New York City identified Candida species as the dominant airborne fungus, a finding not previously reported from other aerosol sampling campaigns in other regions of the globe. Candida is a genus of yeasts and the most common cause of diverse human fungal infections worldwide.

In their new PNAS paper, the multidisciplinary team of Rodó; Burns; Dan Cayan, a climate researcher at UC San Diego’s Scripps Institution of Oceanography; and co-authors in New York, Barcelona and Japan, say the new evidence suggests that the most likely cause of KD is a “preformed toxin or molecule” originating from northeastern China, possibly related to Candida, which has been linked to Kawasaki-like coronary artery vasculitis in mouse models.

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