Cardiovascular Business - September/October 2008 - (Page 18) Clinical Study Digest › By Justine Cadet and C.P. K aiseR - CRT underused, especially in blacks - Go directly to cath lab, forsake the ER - How heavy is too heavy for your cath lab? JAMA: Ankle brachial index improves accuracy of Framingham score Including the ankle brachial index (ABI) in cardiovascular risk stratification using the Framingham risk score (FRS) results in reclassification of risk category in a significant number of cases (J Am Med Ass 2008;300:197-208). Researchers from Scotland searched MEDLINE from 1950 to February 2008 and EMBASE from 1980 to February 2008 for studies in which participants were derived from a general population. ABI was measured at baseline, and individuals were followed up to detect total and cardiovascular mortality. They included 16 population cohort studies fulfilling the inclusion criteria. The ABI in conjunction with the FRS would have resulted in reclassification of the risk category and modification of treatment recommendations in approximately 19 percent of men and 36 percent of women, the authors found. repeated hospitalization and lower the risk of untimely death. Researchers also found that blacks were less likely than whites to receive CRT—even though blacks are twice as likely to suffer from heart failure as whites. “Our findings parallel previous studies evaluating adoption of new medical technology in that they show racial disparity in who is receiving the newest therapies,” said Piccini. The study appeared online August 12 in Circulation. AJR: Model predicts CTA saves money in low-risk patients Researchers at Harvard, using a microsimulatin model, found that coronary CT angiography (CCTA) is cost-effective in lowrisk patients with chest pain compared to either discharge, stress tests or invasive angiography (Am J Roent 2008;191:455-463). Using CCTA to triage 55-year-old men with acute chest pain increased emergency department and hospital costs by $110 and raised total healthcare costs by $200. In 55-yearold women, however, ED and hospital costs decreased by $410, and total healthcare costs decreased by $380. Ladapo et al noted that CCTA raised overall costs in men primarily because it was more likely to identify patients with CAD, and the patients incurred costs related to a lifetime of cardiovascular treatment. “However, they also gained risk reductions because of this treatment,” they added. Circulation: CRT underused in hospitals, race plays role Researchers from Duke University found that the use of cardiac resynchronization therapy (CRT) varies significantly from hospital to hospital. Some hospitals didn’t use it at all, while others delivered the treatment to only 23 percent of eligible patients. Additionally, in about 10 percent of cases, physicians were prescribing CRT for patients who had ejection fractions above 35 percent, the cutoff point in clinical guidelines. AHJ: Direct emergency Jonathan Piccini, MD, and colleagues admission to cath lab noted that their findings reveal a trouspeeds intervention Coronary Cta-based triage is cost-effective in bling picture. It has been estimated that Direct admission of patients with low-risk patients. source: Ge Healthcare anywhere from a third to a half of all suspected STEMI from ambulance to patients hospitalized with heart failure could benefit from CRT. the cath lab significantly reduces time to treatment in primaPrevious studies have shown that when CRT is used with optiry PCI, allowing the 90-minute door-to-balloon time target mal medical treatment, it can dramatically reduce the need for to be reliably achieved (Am Heart J 2008;155[6]:1054-1058). 18 Cardiovascular Business September/October 2008
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