Cath Lab Digest - October 2007 - (Page 58)

58 CLINICAL AND INDUSTRY NEWS OCTOBER 2007 Hospital discharge cont. multiple opportunities to stress to them the Get With The Guidelines prevention measures,” said Hiratzka, chair of the American Heart Association’s Council of Cardiovascular Surgery and Anesthesia and medical director of cardiac surgery, TriHealth, Inc., Cincinnati, Ohio. “Some PCI patients tend to be in the hospital for less than 24 hours; even then, healthcare providers have opportunities before and after the procedure to meet with patients and their families to review these topics.” Get With The Guidelines performance measures include: prescribing angiotensin-converting enzyme (ACE) inhibitors, when appropriate; recommending that patients take aspirin; prescribing appropriate beta blockers for blood pressure and heart rate control; giving smoking cessation advice if patients are smokers; and prescribing statins and other kinds of cholesterol-lowering medications. The study found these measures were provided as follows for patients without exclusions or contraindications for each group: • ACE (angiotensin-converting enzyme) inhibitors - PCI patients – 74 percent - CABG patients – 57.3 percent - No intervention patients – 66.3 percent • Aspirin therapy - PCI patients – 99.4 percent - CABG patients – 97.1 percent - No intervention patients – 94.5 percent • Beta blockers - PCI patients – 91 percent - CABG patients – 90.8 percent - No intervention patients – 88.2 percent • Smoking cessation counseling - PCI patients – 84.8 percent - CABG patients – 82.4 percent - No intervention patients – 73.9 percent • Lipid drugs - PCI patients – 89.2 percent - CABG patients – 77.4 percent - No intervention patients – 72.3 percent Those patients who did receive all of the recommended performance measures were more often PCI patients — 71.5 percent of those patients received all the measures, while 65.1 percent of all CABG patients received all of the measures and 62.1 percent of the no-intervention group of patients received all the measures. “Even though these numbers are better than they have been, they are not as good as they could be in any of the groups — in particular the group at highest risk, the surgical patients,” said Hiratzka. “Though there were limitations to this study, it suggests that we need to improve our systems of care so that they are better geared to making sure that all heart disease patients are getting the information, guidance and treatment they need to prevent future cardiac events.” Note: Get With The Guidelines (GWTG) is the American Heart Association and American Stroke Association’s evidenced-based quality improvement program that helps hospitals align their care for coronary artery disease, stroke and heart failure patients with the latest scientific guidelines. For more information, visit www.americanheart.org/ getwiththeguidelines. ■ Severe Heart Attack Damage Limited By Hydrogen Sulfide, Study Shows A dministering hydrogen sulfide (H2S) directly into the heart during a simulated heart attack significantly reduces the tissue and cell damage often seen in oxygen-starved organs, according to a new study from researchers at the University of Alabama at Birmingham. H2S boosts post-heart-attack function by helping to minimize reperfusion injury, an unwanted side effect of restoring blood flow swiftly to hearts suffering from low oxygen, the study authors said. In testing on mice, the H2S injection led to a 72 percent reduction in the amount of severe heart-tissue death after restoring normal oxygen and blood flow to mice hearts. The 72 percent reduction compares to a much larger average amount of tissue death in untreated mice hearts after the same 30 minutes of oxygen deprivation. Findings on the protective qualities of H2S have broad implications for improving human survival after cardiac arrest, heart transplant and trauma in general, said David Kraus, PhD, a UAB associate professor in the Departments of Environmental Health Sciences and Biology and co-author on the new study. “One of the most damaging biological stresses on the heart and other organs from trauma or transplantation is the rapid change in oxygen levels,” Kraus said. “First there’s a drop, which elicits a dramatic cellular adjustment to survive low oxygen, and then a rapid rise caused by resuscitation. “H2S as an internal bodily signal appears to serve as an important protective mechanism during the stress of low oxygen availability,” he said. The UAB researchers worked with a team led by David Lefer, PhD from the Albert Einstein College of Medicine in Bronx, NY. The tests were done by injecting H2S directly into the hearts of mice who had been anesthetized for surgery, and whose left ventricular artery had been clamped for 30 minutes to simulate a heart attack. In addition to a decrease in hearttissue death, H2S-treated mice hearts showed a 35 percent drop in bloodprotein levels that signal myocardial damage, and a 26 percent drop in hearttissue markers of inflammation when compared to un-treated mice hearts. Furthermore, by isolating mitochondria from the H2S-treated mice, the authors confirmed that heart-cell functional integrity had been preserved. Recent reports from other researchers demonstrate that inhaled H2S can induce a fully reversible “suspended animation” state in animals. Kraus said it follows that H2S could be used to place organs into "suspended animation" before surgery or during medical transport until normal oxygen and blood flow is restored. Also, by augmenting internal H2S production in the body, perhaps through diet, people may reduce their risks of cardiovascular disease, chronic oxidative cell damage and other illnesses, Kraus said. H2S is normally considered a toxic, flammable gas that is responsible for the foul odor of rotten eggs. But in the UAB study it was carefully formulated into a low concentration saline-type solution. The study was published Sept. 18 in the online Early Edition of the journal Proceedings of the National Academy of Sciences.■ We Invite You to Write for Cath Lab Digest! All topics are welcome, but we are especially seeking articles for brand-new, inexperienced staff. Gain increased respect from your peers — submit an article to Cath Lab Digest. For more information and a copy of CLD author guidelines, email managing editor Rebecca Kapur at rkapur@hmpcommunications.com http://www.americanheart.org/getwiththeguidelines http://www.americanheart.org/getwiththeguidelines

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

Saints Medical Center Fibromuscular Dysplasia in Children and Adolescents Cerebral Vascular Accident Following a Pulmonary Embolism: Search for the Hidden Patent Foramen Ovale Contents Clinical Editor’s Corner Meetings Calendar CEU Education Center Radiation Tracking in the Cardiac Catheterization Lab Letter to the Editor Carotid Stenting: An update Release from Stent-jail: Beneficial Snow-Plowing? Patient Management Guidelines Searching for a Cardiovascular Position? Tips for Creating a ‘Stand-Out’ Resume Long-Term Implications of Short-Term Closure Decisions – The Evolution to Vascular Access Management and the Boomerang Catalyst System The Ten-Minute Interview with… Angie Bowles, RN, CCRN CMS Issues Final FY 2008 IPPS Rule ACVP• Membership Page Experience with a New Workhorse Guidewire Ask the Clinical Instructor: Q&A for Those New to Cath Lab A Glimpse of the Future of Clinical Education: Boston Scientific’s SimSuite Bus Visits Carnegie Institute 2007 Educational Fair Held at the Washington Hospital Center Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology What Do You Think? A Virtual Cath Lab Viewer (VCL): The Development of an Online 3D C-arm Simulator and Coronary Anatomy Viewer Clinical & Industry News Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization

Cath Lab Digest - October 2007

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