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A study was conducted to evaluate the efficacy of cardiac-resynchronization therapy (CRT) in reducing the risk of mortality or heart-failure events in the case of patients with mild cardiac symptoms. Results indicated that CRT with implantable cardioverter-defibrillator (ICD) greatly reduced the risk of mortality or heart-failure events.

Patients who have had a heart attack and develop heart failure should receive an implantable defibrillator, according to a study of 1,232 patients. An implantable defibrillator can detect an abnormal heart rhythm and sends an electric shock to correct it. Otherwise, the arrhythmia could cause cardiac arrest.

Genetic mutations in genes related to potassium channels in the heart may increase the risk of fatal cardiac events in patients with long-QT syndrome. Long-QT syndrome is a disorder of heart rhythm that increases the risk of fainting, ventricular tachycardia, and sudden death. Researchers examined the genetic profile of 541 people with the disorder, and found that particular genetic mutations were present in 246 people. Those with the mutations were 4-20% more likely to suffer a fatal heart disturbance than people without the mutations.

An implantable defibrillator may be more effective than anti-arrhythmic drugs in preventing life-threatening arrhythmias in patients who have had a heart attack. Researchers randomly assigned 196 patients with severe heart disease and a history of heart attack to receive either an implantable defibrillator or anti-arrhythmic drugs. All of the patients had a high risk of arrhythmia documented by the fact that doctors were able to induce an arrythmia under carefully controlled conditions. After an average of 27 months, those with the defibrillator had half the death rate of those taking anti-arrhythmic drugs.

Objectives. Hospitalization of nursing home residents is a growing, poorly defined problem. The purposes of this study were to define rates, patterns, costs, and outcomes of hospitalizations from nursing homes and to consider implications for reducing this problem as part of health care reform. Methods. Communitywide nursing home utilization review and hospital discharge data were used to define retrospectively a cohort of 2120 patients newly admitted to nursing homes; these patients were followed for 2 years to identify all hospitalizations. Resident characteristics were analyzed for predictors of hospitalization. Charges and outcomes were compared with hospitalization of community-dwelling elders. Results. Hospitalization rates were strikingly higher for intermediate vs skilled levels of care (566 and 346 per 1000 resident years, respectively). Approximately 40% of all hospitalizations occurred within 3 months of admission. No strong predictors were identified. Length of stay, charges, and mortality rates were higher than for hospitalizations from the community. Conclusions. Hospitalizations from nursing homes are not easily predicted but may in large part be prevented through health care reforms that integrate acute and long-term care. (Am J Public Health. 1994;84:1615-1620), The movement of nursing home residents to hospitals to receive acute care may be prevented by combining acute and long-term care within the nursing home. A study of utilization and discharge data for the 892 hospitalizations of 2,120 nursing home residents in Monroe County (Rochester), NY, revealed that those in intermediate care facilities were hospitalized at higher rates than those in skilled care facilities. One reason for the different rates may be that there was less medical supervision for patients with less serious chronic ailments. These patients would need to be moved to a hospital if they acquired a serious illness. Patients in skilled care need more medical supervision due to their more serious chronic illnesses, and they may have asked for life-saving interventions, such as hospitalization, to be withheld. Moving nursing home residents to hospitals may be stressful to the patients as well as costly, and may be preventable through reforms of nursing home care.

Detection of myocardial ischemia with or without symptoms of angina after heart attack does not appear to be a useful predictor of future heart attacks. Myocardial ischemia refers to a deficiency of blood to the heart caused by the blocking or narrowing of arteries. Using rest electrocardiogram, exercise electrocardiogram and scintigraphy imaging, 936 patients who had been hospitalized for either heart attack or unstable angina in the previous six months were tested for myocardial ischemia. Of all the test results, only ST depression during the rest electrocardiogram was associated with an increased risk of recurrent heart attack. Exercise-induced ST depression in combination with reduced exercise capacity was significantly associated with an increased risk of heart attack, however. Myocardial ischemia was not associated with an increased risk nor was its presence or absence useful in determining prognosis., Objective.--To determine the clinical significance of silent and symptomatic myocardial ischemia detected by noninvasive testing in stable postcoronary patients. Design.--Cohort study with a mean 23-month follow-up. Setting.--Ambulatory outpatients after recent hospitalization for an acute coronary event. Patients.--Nine hundred thirty-six patients (76% male; mean age, 58 years) who were clinically stable 1 to 6 months after hospitalization for acute myocardial intarction or unstable angina. Interventions.--Noninvasive testing involved rest, ambulatory, and exercise electrocardiograms and stress thallium-201 scintigraphy. Main Outcome Measures.---Cox regression analysis was used to evaluate the risk (hazard ratio) of first recurrent priman] events (cardiac death, nonfatal infarction, or unstable angina) or restricted events (cardiac death or nonfatal infarction) associated with ischemic noninvasive test results. Results.--ST segment depression on the rest electrocardiogram was the only noninvasive test variable that identified a significantly increased risk (P=.05) for first recurrent priman] events (hazard ratio; 95% confidence limits): rest electrocardiogram ST depression (1.5; 1.00, 2.25); ambulatory electrocardiogram ST depression (0.86; 0.49, 1.51 ); exercise electrocardiogram ST depression (1.13; 0.82, 1.56); and stress thallium-201 reversible defects (1.3; 0.96, 1.74). Test results were similar for first recurrent restricted events, and in patients with and without angina. Significantly increased risk (P Conclusion.--Detection of silent or symptomatic myocardial ischemia by noninvasive testing in stable patients 1 to 6 months after an acute coronan] event is not useful in identifying patients at increased risk for subsequent coronan] events. (JAMA. 1993;269:2379-2385)