EP Lab Digest - December 2007 - (Page 32)

32 NEWS DECEMBER 2007 In-Clinic Treatment Protocol Improves Care for Patients at Risk of Sudden Cardiac Arrest Data Shows Higher Recognition Rate of At-Risk Patients oster data was presented at Scientific Sessions 2007, the annual congress of the American Heart Association, which shows that the application of clinical practice modifications combined with advanced electronic technologies can improve the care of patients at risk for sudden cardiac arrest (SCA). In fact, recognition of at-risk patients improved from a baseline of 24 percent to 70 percent at regional clinics not using the process, and to 93 percent at the main clinic applying this process and technology. The objectives of this prospective, single-center study, sponsored by Medtronic, Inc., were to compare the effect of specific clinical practice processes and tools on the ability of clinicians to recognize patients at risk for SCA, and apply the appropriate treatment guidelines for those patients. Clinic staff was trained to use a new process to better identify at-risk patients, which included: • A patent-pending clinical decision support tool for Electronic Medical Record (EMR) systems that automatically identified patients at risk and continued tracking of those patients who did not immediately qualify for implantable cardioverterdefibrillator (ICD) therapy, • A standardized patient education process and education video, and • Broad operational and workflow changes. The clinical practice process included optimal medical treatment prior to an ICD, Continued from page 1 P temporary and absolute exclusions for ICD therapy, and is based on current AHA/American College of Cardiology (ACC) and the Centers for Medicare and Medicaid Services (CMS) guidelines with practice-specific requirements.An independent review of medical charts for all patients visiting the main clinic (the group utilizing the new process) and regional clinics (those that did not use the process) was conducted over a two-month period; patients were followed for six months. “A recent report shows that it takes 10 to 15 years for new advances in medicine to be adopted into clinical practice,” said William Daniel, MD, clinical director at Cardiovascular Consultants, P.C., and medical director of Quality and medical director of Inpatient Services at Mid America Heart Institute in Kansas City, Missouri. “Recognizing this time lag, and the fact that there are thousands of pages of guidelines for caring for our cardiac patients, this study illustrated that the use of our electronic solution and process changes helped give physicians the right information at the right time, and allowed them to use their judgment and be extremely accurate in making appropriate treatment decisions. Further, every patient, regardless of age, gender or race, receives the same high quality of care, since the process reduces variability and physician reliance on memory.” He continued, “Implementing true quality processes allows us to deliver evidencebased, guideline-driven care. Quality care should not be an option – we owe that much to our patients, ourselves and the profession of cardiology.” St. Jude Medical Announces Results from RethinQ Clinical Trial Data Provide Further Information about Indications for Cardiac Resynchronization Therapy t. Jude Medical, Inc. announced that the Resynchronization Therapy In Normal QRS (RethinQ) Trial, which studied a subgroup of heart failure patients, most of whom are currently not indicated for cardiac resynchronization therapy (CRT), did not reach its primary effectiveness endpoint of improved oxygen consumption at peak exercise (peak VO2). While there was a statistically significant improvement in NYHA class, a secondary endpoint, there was no improvement in quality-of-life, six-minute walk or echocardiographic measures in the patients who received CRT. Data were presented during a late-breaking clinical trial session at the American Heart Association Scientific Sessions 2007 in Orlando, by Principal Investigator John F. Beshai, MD, director, Pacemaker and Defibrillator Services, and assistant professor of medicine at the University of Chicago School of Medicine. The RethinQ study, which followed 172 patients for six months, was designed to determine whether CRT can help heart failure patients with a narrow QRS complex and left ventricular mechanical dyssynchrony. Patients with a wide QRS already are indicated for CRT therapy. In the RethinQ study, narrow QRS was defined as 130 milliseconds or less (120 milliseconds or less is considered normal). S Notably, the subgroup of patients with QRS duration between 120 and 130 milliseconds showed a statistically-significant benefit from CRT, as measured by the primary endpoint of exercise duration.This patient subgroup already is indicated for CRT, and this finding supports previous research on this patient subgroup. Previous studies have suggested, but not proven, that patients with a narrow QRS and with evidence of mechanical dyssynchrony may benefit from CRT.“While there may be patients with a narrow QRS who can benefit from CRT therapy, the measures of dyssynchrony used in the RethinQ study did not identify them,” said Dr. Beshai.“These new data are helpful for all heart failure physicians as we continue to determine the best criteria for assessing who will most benefit from CRT therapy.” “Heart failure remains one of the leading causes of death in the U.S., underscoring the significant need for more information about potential treatment options,” said Mark D. Carlson, MD, chief medical officer and senior vice president of clinical affairs in St. Jude Medical’s Cardiac Rhythm Management Division.“RethinQ will help guide future studies to identify patients who may benefit from ICD and CRT therapy, and adds valuable information to enhance our ability to improve patient outcomes.”

Table of Contents Feed for the Digital Edition of EP Lab Digest - December 2007

EP Lab Digest - December 2007 Improved Anatomical Orientation During AF Catheter Ablation: Experience from Leipzig Heart Center One EP Lab’s Solution to the Administration of Deep Sedation Contents Letter from the Editor Spotlight Interview: Northeast Georgia Medical Center Emerging Technologies for the Electrophysiology Lab The Western Atrial Fibrillation Symposium About the PRECEDE-HF Trial: Interview with William T. Abraham, MD, FACP, FACC, FAHA Overview on Shire and the Discontinuation of Ethmozine®: After the Heart Rhythm Society Intervenes, the Company Changes its Decision Minimizing the Risk of Infection at Children’s Sibley Heart Center: Interview with Nicole Jarrell, RNC, MSN, and J. Renee Watson, RN, CIC Is There a Link Between Gasoline Vapors and Brugada Syndrome? Interview with Darko Kranjcec, MD and Hugues Abriel, MD, PhD New Feature! Pacemaker/ICD Puzzle Email Discussion Group Events Calendar Industry News and Products

EP Lab Digest - December 2007

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