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2016 MAR 26 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Researchers detail new data in Cardiology. According to news reporting originating from [...]

2016 FEB 27 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Investigators publish new report on Cardiology. According to news reporting originating in [...]

2016 FEB 20 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Fresh data on Cardiology are presented in a new report. According to [...]

2016 FEB 13 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- A new study on Cardiology is now available. According to news reporting [...]

2016 FEB 6 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- TORONTO, The number of people living in high-rise buildings in rising, but [...]

2016 JAN 23 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- WASHINGTON --Although survival rates for people who suffer cardiac arrest outside a [...]

2016 JAN 16 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Research findings on Cardiology are discussed in a new report. According to [...]

2015 DEC 5 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Current study results on Cardiology have been published. According to news reporting [...]

Background: Counseling patients about the risks and benefits of in-hospital cardiopulmonary resuscitation (CPR) can potentially reduce patient suffering and hospital costs. However, there is currently much disagreement regarding the overall rate of in-hospital CPR survival and characteristics that identify patients more or less likely to survive CPR. Methods: The charts of all adults who were pulseless and received basic CPR at a 720-bed university hospital during 1990 and 1991 were reviewed. Patients were excluded if cardiac arrest occurred outside the hospital or in the emergency department, operating room, recovery room, or cardiac catheterization laboratory. Each patient's chart was reviewed to determine the presence of explicitly defined clinical characteristics. Results: Overall, 50 (16.0%) of 313 patients survived to discharge. Before arrest, only impaired functional capacity and sepsis identified patients unlikely to survive CPR. Of adults suffering cardiac arrest during the study period, only 22% underwent CPR, including 13.0% of those with cancer and 18.1% of those 70 years or older. Conclusions: The use of do-not-resuscitate orders to exclude patients who were inappropriate candidates for CPR may explain why the survival rate reported here is higher than similar reports and why more clinical characteristics were not found to predict CPR survival. Investigators of in-hospital CPR should use explicit criteria to describe the conditions studied and report survival for patients who receive basic CPR. The impact of do-not-resuscitate orders on survival rates must be considered. Functional capacity deserves further investigation as a predictor of CPR survival. (Arch Intern Med. 1994;154:2426-2432)

Background: Survival rates from out-of-hospital cardiac arrests due to ventricular fibrillation or pulseless ventricular tachycardia vary greatly. The majority of published reports indicate a survival range from 11% to 33%, depending on the area of observation. Two recent series from major metropolitan centers describe markedly less favorable outcomes and have led to speculation that dense urbanization may contribute to worse outcomes. Methods: Examination of a consecutive series of out-of-hospital cardiac arrests in New Haven, Conn, a city of 127 000 people and 55 [km.sup.2] with a two-tiered emergency response system. All cases of nontraumatic cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia occurring outside of a hospital between January 1988 and June 1989 were considered. That city's emergency medical system employs emergency medical technicians and paramedics. Standard resuscitation techniques were employed: high-dose epinephrine and interposed abdominal counterpulsations were not routine interventions. The main outcome measure was survival to hospital discharge. Results: Three (4.0%) of 75 patients survived cardiac arrest and were discharged alive from the hospital. Two (5.3%) of 38 witnessed arrests resulted in hospital discharges. Patient demographics were typical of those reported from other cities that have published outcomes data. Few patients (16%) received bystander-initiated cardiopulmonary resuscitation. Conclusion: There is increasing evidence that previously recognized standards for resuscitation success may not be present in certain types of municipalities, including this northeastern city. A registry of outcomes from out-of-hospital cardiac arrests would help to clarify the true national experience. (Arch Intern Med. 1993;153:1218-1221)

Imbalances in autonomic nervous system function have been posed as a possible mechanism that produces ventricular fibrillation and sudden cardiac arrest in patients with cardiovascular disease. Heart rate (HR) variability is described in survivors and nonsurvivors of sudden cardiac arrest within 48 hours after resuscitation using time and frequency domain analytic approaches. HR data were collected using 24-hour ambulatory electrocardiograms in 16 survivors and 5 nonsurvivors of sudden cardiac arrest, and 5 control subjects. Survivors of sudden cardiac arrest were followed for 1 year, with recurrent cardiac events occurring in 4 patients who died within that year. Analysis of 24-hour electrocardiograms demonstrated that control subjects had the highest HR variability (standard deviation of all RR intervals = 155.2 [+ or -]54 ms), with nonsurvivors demonstrating the lowest HR variability (standard deviation of all RR intervals = 52.3 [+ or -] 6.1 ms) and survivors of sudden cardiac arrest falling between the other 2 groups (standard deviation of all RR intervals = 78 [+ or -] 25.5 ms, p [is less than or equal to]0.0000). Two other indexes of HR variability (mean number of beat to beat differences in RR intervals >50 ms/hour and root-mean-square of successive differences in RR intervals) did not demonstrate the expected pattern in this sample, indicating that perhaps patterns of HR variability differ between groups of patients with cardiovascular disorders. Spectral analytic methods demonstrated that survivors of sudden cardiac arrest had reduced low- and high-frequency spectral power, whereas nonsurvivors demonstrated a loss of both low- and high-frequency spectral power. Left ventricular ejection fraction was significantly correlated with standard deviation of all RR intervals and standard deviation of the mean of RR intervals for 5-minute segments. One-year mortality in the survivor group of cardiac arrest was inversely related to several variables including age, standard deviation of all RR intervals, and low frequency power. (Am J Cardiol 1992;70:441-448)

* Objectives: To determine whether a gender bias exists in referral for coronary bypass graft surgery among patients with catheterization-documented coronary artery disease. * Design: Historical cohort study (1969 to 1984). * Setting: A referral medical center. * Patients: A total of 5795 patients with catheterization-documented coronary artery disease. * Measurements: Surgical referral patterns of men and women grouped by risk for cardiac death and by treatment effectiveness. Time trends were evaluated for three periods: 1969 to 1974, 1975 to 1979, and 1980 to 1984. * Results: Overall, when no adjustments was made for baseline risk for cardiac death, no statistical difference was found between men and women regarding referral for surgery (46% compared with 44%, respectively). When an adjustment was made for such risk, the male-to-female odds ratio for surgical referral was 1.28 (95% CI, 1.05 to 1.58) among patients with a low risk for cardiac death. his effect was most evident in the 1980 to 1984 period (odds ratio, 1.73;CI, 1.29 to 2.31). In the high-risk group, the odds ratio was 0.84 (CI, 0.68 to 1.04), with little to be referred for surgery when surgery were more likely to be referred for surgery when surgery offered the least survival benefit relative to medical therapy most pronounced in the 1980 to 1984 period (odds was most pronounced in the 1980 to 198 period (odds ratio, 1.63;CI, 1.27 to 2.19). * Conclusions: Women are less likely than men to be referred for coronary bypass graft surgery among patients with a low risk for cardiac death, in whom surgery offers little or no survival benefit over medical treatment. Women are at least as likely as men to be referred for bypass surgery among more symptomatic and more severely diseased patients, in whom surgery offers the greatest survival benefits. These trends were most prominent in the recent years of the study. Based. on surgical survival benefits, these referral patterns may represent more appropriate treatment referral for women than men.

This report examines whether in the Cardiac Arrhythmia Suppression Trial death and cardiac arrest from encainide, flecainide and moricizine during the titration phase and from encainide and flecainide during the follow-up phase were related to presence (Q-wave acute myocardial infarction [Q-AMI]) or absence (non-Q-AMI) of pathologic Q waves. In all, 2,371 patients (70% with Q-AMI, 26% with non-Q-AMI, and 4% unknown) entered the titration phase, starting 117 [+ or -]163 days after index AMI and lasting for an average of 21 days. For the titration phase, no significant differences existed between Q-AMI and non-Q-AMI patients for death and cardiac arrest rate, ventricular premature complex suppression rate, and nonrandomization rate. A total of 1,498 patients entered the follow-up phase of an average of 10 months (starting 129 [+ or -] 158 days after the index AMI), and were randomized to encainide or flecainide, or their matching placebos. In the placebo group, non-Q-AMI patients had a significantly lower rate of death and cardiac arrest than Q-AMI patients (1.0 and 4.6%, respectively; p = 0.04). Encainide and flecainide significantly elevated death and cardiac arrest rate in both non-Q-AMI patients (8.7%, p

The results of a retrospective study of the treatment of 209 patients with coronary artery disease raise serious questions about the use of empiric therapy against arrhythmias in patients resuscitated after out-of-hospital heart attacks. The risk of a second heart attack is very high among heart attack victims, and it has been supposed that antiarrhythmic drugs should have a beneficial effect. However, in the present study, patients treated with quinidine and procainamide had a two-year survival rate of 61 and 57 percent, respectively, while untreated patients had a survival of 71 percent. In addition, patients treated with digoxin, which strengthens the muscular contractions of the heart, had a worse overall survival rate. Since this study did not randomize which patients received which treatment, it is not possible to attribute the differences in survival to the drug treatment itself. Nevertheless, it is suggested that some thought be given to the appropriate use of antiarrhythmic drugs in a high-risk population. (Consumer Summary produced by Reliance Medical Information, Inc.)

Elevated heart rate (HR) during hospitalization and after discharge has been predictive of death in patients with acute myocardial infarction (AMI), but whether this association is primarily due to associated cardiac failure is unknown. The major purpose of this study was to characterize in 1,807 patients with AMI admitted into a multicenter study the relation of HR to in-hospital, after discharge and total mortality from day 2 to 1 year in patients with and without heart failure. HR was examined on admission at maximum level in the coronary care unit, and at hospital discharge. Both inhospital and postdischarge mortality increased with increasing admission HR, and total mortality (day 2 to 1 year) was 15% for patients with an admission HR between 50 and 60 beats/min, 41% for HR >90 beats/min and 48% for HR [greater than or equal to] 110 beats/min. Mortality from hospital discharge to 1 year was similarly related to maximal HR in the coronary care unit and to HR at discharge. in patients with severe heart failure (grade 3 or 4 pulmonary congestion on chest x-ray, or shock), cumulative mortality was high regardless of the level of admission HR (range 61 to 68%). However, in patients with pulmonary venous congestion of grade 2, cumulative mortality for patients with admission HR [greater than or equal to]90 beats/min was over twice as high as that in patients with admission HR (Am J Cardiol 1990;65:547-553), Elevated heart rate (HR) following heart attack (myocardial infarction, MI) has been thought to be related to dysfunction of the left ventricle, the major pump of the heart muscle, and is also thought to be predictive of subsequent death. The relationship between HR, mortality, and degree of heart failure was studied in 1,807 patients admitted to the hospital with MI. Patients with admission HR greater than 90 beats per minute (bpm) were slightly older, were more likely to have a history of risk factors (angina, congestive heart failure, and lung disease), were treated more often with digitalis and less often with beta-blockers, and had a higher incidence of arrhythmias (abnormal heart beat). Eighty percent of patients with HR less than 90 bpm had absent to mild heart failure (HF) and 5 to 7 percent had severe HF, while 58 percent of patients with HR over 90 bpm had absent to mild HF and 24 percent had severe HF. Total mortality (from day two to one year after admission) was 15 percent for patients with admission HR between 50 and 60 bpm, and increased to 41 percent at HR over 90 bpm and to 48 percent at HR over 110 bpm. Occurrence of fatal repeat MI was associated with HR over 90 bpm, but nonfatal repeat MI was not. Patients with severe heart failure did not differ on mortality rate based on HR, while mortality rates in patients with mild or moderate HF did increase with increasing HR. The study shows that HR during hospitalization is a significant and independent predictor of mortality following MI. (Consumer Summary produced by Reliance Medical Information, Inc.)

Previous studies of the value of electrophysiologic studies in patients with nonsustained ventricular tachycardia (VT) have been hampered by the inclusion of a small number of patients with various types of heart disease. This retrospective study was designed to assess the value of programmed stimulation in 205 asymptomatic patients who had had an acute myocardial infarction > 1 month before study. inclusion was based on 24-hour Holter monitoring during which patients had to manifest >3 consecutive ventricular beats at a rate >135 beats/min. Forty-seven (23%) patients had normal, 70 (34%) mildly impaired and 88 (43%) severely impaired left ventricular function. Programmed stimulation, using up to 3 extrastimuli, was used in each. Seventy-five patients (36%) were noninducible, 59 (29%) had nonsustained VT ( (Am J Cardiol 1990;65:594-598), Nonsustained ventricular tachycardia (NVT) is a common cardiac dysfunction in which the ventricles, the major pumps of the heart, beat abnormally rapidly, but in a non-sustained fashion. NVT has been difficult to study, as patients at risk for NVT are not easily identified. The effects of treatment of NVT with antiarrhythmic drugs has been equivocal. The records from 205 patients found to have NVT who were studied by electrophysiology were reviewed. During electrophysiological studies, hearts were stimulated with a programmed series of electrical stimuli. Stimulation caused no arrhythmia in 36 percent of patients. NVT was found in 29 percent of patients, while sustained VT was induced in 33 percent of patients. Left ventricular dysfunction was only slightly associated with sustained VT. Of the 205 patients, 82 were left untreated, 66 were treated with medication on the basis of the electrophysiological tests, and 57 were treated with medications but not on the basis of the electrophysiological tests. The type of treatment did not alter morbidity (illness) and mortality risk from 1 to 36 months later among groups with nonsustained, sustained, or no VT, except that of three patients with sustained VT who were not treated, only one remained alive and without illness. Left ventricular function was the only important predictor of outcome. The study suggests that invasive electrophysiological testing is not predictive of further arrhythmias. The benefits of antiarrhythmic drug therapy were not apparent in this study, except possibly for sustained VT. The retrospective design (using records of past patients) limits the usefulness of conclusions, and a prospective randomized trial is needed to provide more appropriate evaluation of this condition. (Consumer Summary produced by Reliance Medical Information, Inc.)

The basis for the excess mortality with age after acute myocardial infarction (AMI) is not clear, nor is it known whether the mode of death is altered with age. Age-related factors predictive of mortality and age-related mechanisms of the 333 deaths were examined in 2,466 patients who were enrolled in a placebo-controlled trial to determine the effect of diltiazem on mortality and reinfarction after AMI. There were 3 age groups with increasing mortality rates: ages 25 to 49 (n = 499), 50 to 64 (n = 1,228) and 6S to 75 years (n = 739). There was a significant age-related increase in the proportion of patients with baseline risk factors. These baseline characteristics did not differ by treatment (placebo vs diltiazem). However, multivariate survivorship analysis still identified age as an independent risk factor for cardiac death. The proportion of arrhythmic and myocardial failure deaths did not differ by treatment or age group. (Am J Cardiol 1990;65:559-566), The likelihood of death after a heart attack (myocardial infarction, MI) is associated with advanced age, but the basis for this increased mortality risk is not known. Some identifiable factors such as impaired function of the left ventricle (the major pump of the heart muscle) are more prevalent in the elderly than in younger patients after MI, but this does not adequately explain the increased risk. Factors predictive of mortality were examined during a study which was evaluating the effects of diltiazem on 2,466 survivors of acute MI during a one- to five-year period. Prognosis, risk predictors, mechanism of death, and presence of ischemia (deficient blood supply) before death were studied. There was a similar incidence of arrhythmias (abnormal heart rhythms) and ischemia preceding death in younger and older age groups. The older group of patients had more risk factors, including previous MI, advanced New York Heart Association Classification, and decreased ventricular function or abnormal heart beat. Nevertheless, age still predicted mortality risk independently of these other factors. Possibly, older patients may have had more coronary vessel obstructions, but there was a similar incidence of MI recurrence in younger and older patients. Much of the current knowledge about MI relates to a younger population, but the US population is rapidly aging. Further studies are needed to broaden the understanding of heart physiology following MI in the elderly, so as to improve the survival rate in these patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

The rate of sudden cardiac death increases with age, but the reason for this is not known. Three hundred and eighty-one patients over the age of 30 who experienced cardiac arrest (sudden stoppage of the heart) and who were not in a hospital at the time were studied. Based on forms filled out by paramedics at the time of the cardiac arrest, information of several kinds was analyzed, including the history of heart disease, the symptoms just before the paramedics were called, disturbances in heart rhythm that had been noted before the arrest, and the rhythm initially recorded by the paramedics. Thirty-six percent of the patients were successfully resuscitated and hospitalized, and 17 survived. More younger (under 70 years) patients survived hospitalization than older (over 70 years). In addition to age, cardiac rhythm at the time of the arrest was an important predictor of survival: considerably more patients with ventricular fibrillation (erratic contraction of the left ventricle, the chamber which pumps blood to the body) survived than those with other rhythms. Also, people who complained of chest pain had a better survival rate than those with shortness of breath (dyspnea). These findings suggest that resuscitation is equally successful in people regardless of age, but the probability of survival during subsequent hospitalization is greater for people under 70. Both the initial rhythm disturbance and the patient's symptoms proved better predictors of survival than age alone. Implications of possible relevant differences between older and younger patients with respect to diagnosis and use of medication to treat heart disease are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Few if any prearrest or intraarrest variables have been identified as highly predictive of inhospital mortality following cardiopulmonary arrest. A total of 310 consecutive patients requiring advanced cardiac life support [...]

A ventricular arrhythmia is a life-threatening event often occurring after a heart attack that is characterized by an abnormal beating of the lower chambers of the heart called the ventricles. Patients with a recent history of heart attack frequently develop a type of arrhythmia called ventricular fibrillation which may lead to sudden cardiac death (cardiac arrest). In fact, seventy-five percent of patients with a cardiac arrest have ventricular fibrillation. Sudden cardiac death is a major health problem in the United States affecting 200,000 to 600,000 persons annually with major resources being allocated to identify the causes and possible treatments of this affliction. Methods used to treat cardiac arrest include cardiopulmonary resuscitation in which a paramedic or other person physically compresses the patient's chest causing the heart to beat while intermittently breathing into the patient's mouth, and defibrillation in which the normal beat of the ventricle is restored through chemical or electrical means. The implementation of these techniques prevents the onset of brain damage and death. A recent study reported the survival rate and factors influencing this rate in 447 cardiac arrest patients from Seattle. The initial resuscitation rate was 60 percent, but only 26 percent survived in the long-run. Risk factors associated with the development of cardiac arrest include: poor function of the left ventricle; the presence of congestive heart failure; a prior history of cardiac arrest, heart attack, or smoking; disease of the blood vessels supplying the heart; advanced age; low blood pressure; and being of the male gender. In order to assess the effectiveness of therapy, cardiac deaths should be classified as either arrhythmic or non-arrhythmic in nature. Persons who died a non-arrhythmic cardiac death most likely had effective treatment of their ventricular fibrillation. It is suggested that an easier way to gauge the effectiveness of antiarrhythmic therapy is to measure the total amount of cardiac deaths. (Consumer Summary produced by Reliance Medical Information, Inc.)