Model Refines Sudden Death Risk in Women With CAD
A risk model that goes beyond left ventricular ejection fraction proved better at predicting sudden cardiac death (SCD) among postmenopausal women with coronary artery disease, researchers found.
Combined with left ventricular ejection fraction (LVEF), the following clinical risk factors were better predictors of SCD than LVEF alone: myocardial infarction, heart failure, reduced kidney function, atrial fibrillation, physical inactivity, and diabetes, according to the study published online July 25 in the Archives of Internal Medicine .
In a linear fashion, the incidences of SCD increased with each additional risk factor at baseline, reported Rajat Deo, MD, from the University of Pennsylvania in Philadelphia, and colleagues: No risk factors: 0.3% per year One risk factor: 0.5% per year Two risk factors: 1.2% per year Three risk factors: 2.9% per year
The SCD risk increased almost 10-fold across the four groups, the authors pointed out.
In an invited commentary, Christine M. Albert, MD, MPH, from Brigham and Women's Hospital in Boston, put the incremental risk into perspective.
"The SCD risk rate in the highest category of the risk score [2.9%] is comparable to the annual SCD rate observed in the placebo arm of the Sudden Cardiac Death in Heart Failure Trial, in which implantable cardioverter defibrillators reduced overall mortality by 24%," she wrote.
Albert added that the rate in the lowest category (0.34%) is comparable to estimates for the general population.
"These risk categories, if confirmed in validation populations, may have potential clinical utility," she wrote.
Deo's group performed a C-index analysis, a measure of discrimination, in a subset of women (66%) who had echocardiograms available. The C-index was higher for the clinical risk score alone (0.66) or in combination with LVEF (0.68) than with the LVEF alone (0.60).
Albert noted the lack of a "formal statistical test comparing the differences in the C- index," making it uncertain whether the "the clinical risk score significantly improved discrimination."
However, she noted an improvement in net classification when the clinical risk score was added to LVEF, "mostly because of the reclassification of 24% of women into a higher-risk category [ P <0.001]."
A limitation, Albert reported, is that most of these women had LVEFs greater than 35%, leaving uncertainty about whether these risk factors would add clinical discrimination in patients with worse LVEFs.
Congestive Heart Failure In Women - News
However, compared with those who died from non-cardiac causes (246), those who died from cardiac causes (sudden or non-sudden) had a higher prevalence of congestive heart failure and diabetes, a higher body mass index, and a lower LDL level,
Among this set, 1378 has experienced congestive heart failure or myocardial infarction. 22.6% of them were administered supplemental external beam radiation therapy and 42.9% were given 4 months of androgen deprivation therapy to decrease testosterone
Therefore, in hypothyroidism, the body slows down and gets sluggish, leading to low energy, weight gain, cold intolerance, hair loss, constipation and, in extreme cases, congestive heart failure. The opposite is true with hyperthyroidism.
For this study, they looked at 2008-09 data on patients with heart attack, congestive heart failure, and pneumonia. Care in accordance with Hospital Quality Alliance process measures was provided to: 91 percent of heart attack patients in CAHs and 97.8
"No one in the health care system is coordinated -- it's a nightmare," says Rozanne Weissman, a marketing communications consultant in Washington, DC who made medical decisions on behalf of her mother before her death from congestive heart failure in
Cardiovascular Center: Innovative Trials and Screening for ...
Directed by Kenneth L. Baughman, MD, the Advanced Heart Disease Program – part of the Cardiovascular Center – is comprised of a multidisciplinary team of leading specialists dedicated to the care of patients with congestive heart failure and other severe cardiac conditions. New clinical trials at the Program include:
Jarvik 2000 Heart Assist System – Gregory S. Couper, MD, and James Fang, MD, are directing this trial assessing a new ventricular assist device (VAD) that is quieter, smaller, and more durable compared with older generation VADs. Patients with end-stage congestive heart failure who are failing medical therapy and considered appropriate candidates for cardiac transplantation may qualify for this clinical trial. (For more information, please call Gregory S. Couper, MD, at 617-732- 7678 or email eborde@partners.org .) OPCAT – For patients with diastolic heart failure, this National Heart, Lung, and Blood Institute (NHLBI)-sponsored, international multicenter trial is testing the efficacy of an aldosterone antagonist in the treatment of heart failure patients with preserved ejection fraction. Patients 50 years of age or younger with a left ventricular ejection fraction of less than or equal to 45 percent and signs and symptoms of heart failure with either a heart failure hospitalization in the past 12 months or elevated brain natriuretic peptide levels are eligible for the study. TOPCAT is led internationally by Brigham and Women’s Hospital senior cardiologist Marc A. Pfeffer, MD, PhD, and locally at Brigham and Women’s Hospital by Dr. Fang, along with Eldrin F. Lewis, MD, MPH, Scott D. Solomon, MD, and Akshay S. Desai, MD. This trial is only the second major trial that has offered a medical therapeutic option for patients with diastolic heart failure. (For more information, please contact Eldrin F. Lewis, MD, MPH, at 617-525-7057 or eflewis@partners.org , or James Fang, MD, at 617-732-7367 or jfang@partners.org .) HF-ACTION (Heart Failure – A Controlled Trial Investigating Outcomes of Exercise Training) – Sponsored by the NHLBI, this randomized, controlled, multicenter trial is designed to evaluate the impact of exercise on advanced heart disease, including its effects on mortality, morbidity, hospitalizations, and over- (continued on page 6) all quality-of-life.Congestive Heart Failure In Women - Bookshelf
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