Cath Lab Digest - September 2007 - (Page 53)

53 Blood Flow cont. flow in one arm by inflating a blood pressure cuff that acted like a tourniquet. Between each cycle, the cuff was deflated. Before and after surgery, the researchers measured the blood levels of troponin T in all patients. They found that levels of the protein were reduced by 43 percent among patients who had undergone preconditioning, compared with those who hadn’t. “If you can have a noninvasive technique that can reduce by 43 percent the amount of injury sustained by the heart during bypass surgery, then you can improve the morbidity and mortality of patients,” Hausenloy said. More study is needed to see if the technique actually improves clinical outcomes, Hausenloy said. “If this can be shown, it may warrant a change in clinical practice in all patients undergoing bypass surgery,” he added. Another heart expert agrees that if this concept is workable, it could represent a major advance in heartbypass surgery. “Revascularization with angioplasty or bypass surgery carries risk of heart muscle damage, measured in the study by troponin release,” said Dr. Henry Purcell, of the Royal Brompton Hospital in London, and co-author of an accompanying editorial in the journal. “We need to minimize these risks in cardiac and non-cardiac surgery.” “We clearly need more data, and the current team is designing outcome studies to see if this protection translates into clinical benefits,” Purcell said. ■ National Quality Improvement Program Reaches Million-patient Milestone T he American Heart Association’s Get With The GuidelinesSM quality improvement program touches the lives of hundreds of thousands of patients hospitalized for heart disease and stroke, in a nationwide effort to reduce risk from these diseases. Launched in 2000, Get With The Guidelines (GWTG) is designed to help hospitals treat patients with evidenced-based medicine known to improve health outcomes. August marked the entry of more than one million patient records into the program’s database. More than 1,400 hospitals across the country now participate in at least one of the program’s three modules — coronary artery disease (CAD), heart failure (HF) and stroke. Each module addresses specific clinical practices and lifestyle changes that can help patients reduce their risk of having another heart attack or stroke, or from suffering heart failure. “Get With The Guidelines helps hospitals provide the best possible treatment to heart disease and stroke patients. We compile extensive research, convert it into treatment guidelines, and help hospitals adhere to those guidelines,” said Gregg Fonarow, MD, chair of the American Heart Association’s Get With The Guidelines steering committee. “The program was originally designed to empower healthcare providers to save lives and reduce healthcare costs. An upshot to the program has been how empowering it has become for patients to take responsibility for their own health. They get information they need to lead healthier lives and work with their providers as a team to take action to save their own lives.” GWTG uses the time soon after a patient has had a heart attack or stroke as a teachable moment, when they are most likely to listen to and follow their healthcare provider’s advice. Studies show that patients who are taught while they are still in the hospital can reduce their risk of another acute event. Upon admission and while they are in the hospital, the patients are treated according to recommended guidelines. When they are discharged, they are given easyto-understand instructions for medicines they need to take or lifestyle changes they need to make. There are many examples of how patient care has improved since the program started. Data at the end of 2006 show that more than 94 percent of GWTG-CAD patients are now being counseled on smoking cessation, compared with only 58.7 percent when the program began. For stroke patients that number has increased from 38.8 percent to 83.8 percent and for heart failure patients it has improved from 74.3 percent to 91.4 percent. More than 94 percent of heart attack patients are now receiving aspirin upon admission, compared to 76.4 percent at baseline. Stroke patients arriving at the hospital less than two hours after symptom onset are now receiving tPA more than 63 percent of the time, much improved from the 23.5 percent at baseline. There is also significant improvement in the percentage of patients getting treatment to improve their cholesterol, as well as those getting beta blockers and other medications known to improve their health outcomes. “Despite these improvements, we know there is room for us to do even more,” Fonarow said. “Evidence shows us these interventions work, they can save lives. Ideally every patient should get every treatment that is right for them every time. We need to continue to work with hospitals to ensure that appropriate treatments are being given 100 percent of the time.” ■ FDA Advisory Panel to Review Medtronic’s Endeavor Drug-Eluting Stent in October M edtronic, Inc. has been informed by the U.S. Food and Drug Administration (FDA) that an Advisory Panel will review the Premarket Approval (PMA) application for the Endeavor® DrugEluting Coronary Stent in October. The FDA will announce the date and the complete agenda four to six weeks prior to the meeting in accordance with their normal communications regarding public panel meetings. Medtronic’s PMA submission includes safety and efficacy data on more than 4,100 patients who have been treated with Endeavor in clinical trials that include follow up for as long as four years. The Endeavor PMA sets a new standard for clinical data submitted to the FDA, with data from the largest, most wide-ranging patient population and for patients with the longest followup ever submitted to support the safety and efficacy of a new drug-eluting stent (DES). Patient follow-up in the Endeavor clinical trials has been extensive. The number of patients included in the Endeavor PMA is nearly double the number of the two commercially available drug-eluting stents combined at the time of their submission. The Endeavor PMA includes safety and efficacy data from the following major clinical trials or registries: • The ENDEAVOR I first-in-man study • The ENDEAVOR II randomized, controlled trial comparing the performance of the Endeavor drugeluting stent to the Medtronic Driver® bare metal stent • The ENDEAVOR II Continued Access study • The ENDEAVOR III and ENDEAVOR IV randomized, controlled trials comparing Endeavor against both of the DES products commercially available in the United States • The E-Five post-market registry conducted outside the United States Caution: The Endeavor® Drug Eluting Coronary Stent is an investigational device. The device is limited by federal (or United States) law to investigational use only. ■

Table of Contents Feed for the Digital Edition of Cath Lab Digest - September 2007

St. Dominic Hospital The Genous Bio-engineered R Stent Percutaneous Treatment of Peripheral Arterial Chronic Total Occlusions: Device Options and Clinical Outcomes Contents Clinical Editor’s Corner Percutaneous Revascularization of Peripheral Chronic Total Occlusion — Which Patients, Why, and How? Myocardial Infarction and Syncope: A Manifestation of the “Raynaud-Prinzmetal Syndrome”? Essential Technical Components of the Transradial Approach If You Build It, Will They Come? Evidence-Based Medicine with Drug-Eluting Stents Back to School: The Value of Education in Cardiovascular Services The ACVP Standards and Competencies: Are You Using Them Effectively? What Do You Think? My Experience with Fibromuscular Dysplasia and Stroke A Brief Review of Fibromuscular Dysplasia Letter to the Editor A Look at On-the-Job Training: Perceptions, Reality and Our Profession Doing the Wave: Inventory Management with RFID The Ten-Minute Interview with… Paul Pinsker, RCIS CLD’s Annual Salary Survey Harrisburg Area Community College Volunteer Survey CEU Education Center SICP* Section Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Clinical & Industry News

Cath Lab Digest - September 2007

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