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#OnThisDay 25 years ago Trial of Outpatient vs. Inpatient Cardiac Catheterization

#OnThisDay 25 years ago Trial of Outpatient vs. Inpatient Cardiac Catheterization | Heart and Vascular Health | Scoop.it

To evaluate the safety and cost of outpatient cardiac catheterization, we conducted a randomized trial at three hospitals of outpatient (n = 192) as compared with inpatient (n = 189) cardiac catheterization in low-risk patients.

There were no significant differences between the two groups in whether they resumed normal activities or in the rates of rehospitalization within one week of the procedure. Total catheterization-related charges per patient were $679 lower for outpatients, with total savings in hospital charges of $885 per patient.

We conclude that elective cardiac catheterization as an outpatient procedure for selected patients is feasible and safe. Given the small size of our sample, however, we urge caution in interpreting these findings, since they do not exclude a small increase in complication rates with outpatient cardiac catheterization.

Seth Bilazarian, MD's insight:

25 years ago this paper helped pave the way for outpatient catheterization.  Coronary angiography (pictures of the heart arteries) was done at the time only as an inpatient with an overnight stay.  In the last few years, hospitals have just begun taking the next step, allowing outpatient same day discharge after coronary angioplasty (PCI) and stenting.  These changes are welcomed by patients (more comfort at home), hospitals and insurance payers (lower cost), but have been adopted slowly by physicians.

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10 years ago the first drug eluting stent data published: Sirolimus-Eluting Cypher Stent in Sirius Trial

10 years ago the first drug eluting stent data published: Sirolimus-Eluting Cypher Stent in Sirius Trial | Heart and Vascular Health | Scoop.it

Randomized, double-blind trial comparing a sirolimus-eluting stent with a standard stent in 1058 patients at 53 centers in the United States who had a newly diagnosed lesion in a native coronary artery. The coronary disease in these patients was complex because of the frequent presence of diabetes (in 26 percent of patients), the high percentage of patients with longer lesions (mean, 14.4 mm), and small vessels (mean, 2.80 mm). The primary end point was failure of the target vessel (a composite of death from cardiac causes, myocardial infarction, and repeated percutaneous or surgical revascularization of the target vessel) within 270 days.

Results The rate of failure of the target vessel was reduced from 21.0 percent with a standard stent to 8.6 percent with a sirolimus-eluting stent (P<0.001) — a reduction that was driven largely by a decrease in the frequency of the need for revascularization of the target lesion (16.6 percent in the standard-stent group vs. 4.1 percent in the sirolimus-stent group, P<0.001). The frequency of neointimal hyperplasia within the stent was also decreased in the group that received sirolimus-eluting stents, as assessed by both angiography and intravascular ultrasonography. Subgroup analyses revealed a reduction in the rates of angiographic restenosis and target-lesion revascularization in all subgroups examined.

Conclusions

In this randomized clinical trial involving patients with complex coronary lesions, the use of a sirolimus-eluting stent had a consistent treatment effect, reducing the rates of restenosis and associated clinical events in all subgroups analyzed.

Seth Bilazarian, MD's insight:

10 years ago the coronary interventional world was revolutionized with the publication and availability of the first drug eluting stent (DES) for coronary artery disease treated with angioplasty. We have several newer versions since and this first version is no longer available and the company that manufactured it ($JNJ) has exited the business.
This innovation has made the minimally invasive treatment of coronary artery disease more durable since the chance of re-narrowing at the site of the stent is less than 10%..

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#OnThisDay 150 years ago: 1st presentation on low carbohydrate diet by William Banting

#OnThisDay 150 years ago: 1st presentation on low carbohydrate diet by William Banting | Heart and Vascular Health | Scoop.it

In 1863, William Banting wrote a booklet called Letter on Corpulence, Addressed to the Public which contained the particular plan for the diet he followed. It was written in the form of an open letter in the form of a personal testimonial. Banting accounted all of his unsuccessful fasts, diets, spa and exercise regimes in his past, then described the dietary change which finally had worked for him, following the advice of a physician. His own diet was four meals per day, consisting of meat, greens, fruits, and dry wine. The emphasis was on avoiding sugar, saccharine matter, starch, beer, milk and butter. Banting’s pamphlet was popular for years to come, and would be used as a model for modern diets. Initially, he published the booklet at his personal expense. The self-published edition was so popular that he determined to sell it to the general public. The third and later editions were published (see the archived comoplete booklet at he link on teh image) The pamphlet's popularity was such that the question "do you bant?" referred to his method.

From wikipedia http://en.wikipedia.org/wiki/William_Banting

 

Seth Bilazarian, MD's insight:

As a cardiologist, practicing for 20 years I am complicit in the incorrect counsel of patients earlier in my career that was part of government and professional medical societies that recommended eating a low fat and high carbohydrate diet.  This approach has clearly contributed to the obesity and diet issues we face as a society.  The lower carbohydrate, very low sugar diet advocated first 150 years ago is "new again".  For those interested in a well done documentary on the topic, check out he documentary Perfect Human Diet at http://www.perfecthumandiet.us 

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Alexis Dickerson's comment, September 22, 2013 9:39 AM
very cool document!
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10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes

10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes | Heart and Vascular Health | Scoop.it

During the United Kingdom Prospective Diabetes Study (UKPDS), patients with type 2 diabetes mellitus who received intensive glucose therapy had a lower risk of microvascular complications than did those receiving conventional dietary therapy. We conducted post-trial monitoring to determine whether this improved glucose control persisted and whether such therapy had a long-term effect on macrovascular outcomes.

Results Between-group differences in glycated hemoglobin levels were lost after the first year. In the sulfonylurea–insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%, P=0.04) and microvascular disease (24%, P=0.001), and risk reductions for myocardial infarction (15%, P=0.01) and death from any cause (13%, P=0.007) emerged over time, as more events occurred. In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), myocardial infarction (33%, P=0.005), and death from any cause (27%, P=0.002).

Conclusions

Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients. (UKPDS 80; Current Controlled Trials number.

Seth Bilazarian, MD's insight:

Amazing! Twenty five years ago the UKPDS published the follow-up of metformin in diabetes showing a benefit on heart attack and death even years after patients came off the drug.  Despite years of basic science and clinical research and billions of dollars spent on development of new therapies we still don't have a single other diabetes drug that reduces heart attack risk. Many drugs have been developed for blood sugar control but all have shown no benefit over placebo for reduction of heart attack risk for diabetics.  Only metformin.

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First Subcutaneous Implantable Defibrillator approved one year ago

First Subcutaneous Implantable Defibrillator approved one year ago | Heart and Vascular Health | Scoop.it

One year ago the first Subcutaneous Implantable Defibrillator (S-ICD) System was approved by the FDA.  A defibrillator provides an electric shock to the heart (defibrillation) for the treatment of an abnormally rapid heartbeat that originates from the lower chambers of the heart (ventricular tachyarrhythmias)

Seth Bilazarian, MD's insight:

There was great enthusiasm that this simpler to implant system might find significant adoption for patients that need implanted defibrillators.  Some patient groups, such as young patients with hypertrophic cardiomyopathy were considered to be good candidates for the features and benefits of this less invasive approach.  But, to date, in my practice, referring to several different arrhythmia specialists in eastern Massachusetts I have not seen one of these devices implanted.  The adoption is slow for a variety of reasons, but unfamiliarity and uncertainty about long term results are likely the biggest contributors to this slow commercial uptake.

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kleenbottom's comment, September 28, 2013 6:45 AM
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If you are using toilet paper to clean after doing your business, you are not getting very clean. Toilet paper leaves behind fecal material with hundreds of thousands of bacteria, viruses, and fungi. This can cause recurring infections, and worsen any medical condition you may have down there (vaginal itch or odor, hemorrhoids, pruritus ani, fungus itch) This is why health professionals agree that using water is the best way to clean. The best way to do this is by using a modern bidet"
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#OnThisDay 36 years ago - First ever balloon angioplasty in 1977

#OnThisDay 36 years ago - First ever balloon angioplasty in 1977 | Heart and Vascular Health | Scoop.it

Andreas Roland Grüntzig was born in Dresden, Germany, in 1939 and died in a plane crash in the United States in 1985. In his short life he invented a number of medical techniques and changed cardiology for ever with one. Percutaneous transluminal coronary angioplasty (PTCA), or percutaneous coronary intervention (PCI) as it is called today, was not the first catheter-based invasive treatment in cardiology. Yet it is the one that created the discipline called interventional cardiology, meaning catheter-based therapy for coronary or structural heart disease. Electrophysiology should be but is not subsumed under this heading. On September 16, 1977 Dölf Bachmann, a 38-year-old salesman, was the world’s first patient to undergo PCI. He had a single discrete stenosis in the proximal left anterior descending coronary artery and unstable angina. Andreas Grüntzig had been looking for a straightforward case like that for almost 3 years. Coronary angiography at that time period was only done in patients with advanced and drug refractory symptoms and almost invariably multivessel disease with impaired left ventricular function was found. The procedure went well and neither an abrupt closure (later occurring in 7% of balloon angioplasties) nor a restenosis (problem in about 35% of balloon angioplasties) occurred. The patient, an age-mate of Grüntzig is celebrating his 72nd birthday in 2011 and enjoys excellent health. He needed one additional PCI in another place in 2000.

Seth Bilazarian, MD's insight:

The field has evolved and is now mature with routine use of drug coated stents.  Increasingly, patients are being discharged the same day after the procedure.  The radial artery in the wrist is being used with greater frequency in the last several years in American catheterization laboratories, but it all started in 1977.  In 1993 the catheterization laboratory I began my fellowship at, had a foot pedal for balloon inflation still labelled "schnelle und langsame" from the Swiss-German manufacturers.

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