Following a systematic review and meta-analysis, enoxaparin seems to be superior to unfractionated heparin in reducing mortality and bleeding outcomes during percutaneous coronary intervention and particularly in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction.
Twenty three trials representing 30,966 patients were identified.
Read more in the BMJ.
Researchers report that, for rates of revascularisation at one year, drug-eluting stents (DES) appear to be superior to bare metal stents (BMS) in saphenous vein graft lesions.
The results of the ISAR-CABG (Efficacy Study of Drug-eluting and Bare Metal Stents in Bypass Graft Lesions) study were presented recently at the ACC.
“Out to 12 months, the need of revascularisation was reduced by about half with drug-eluting stents compared to bare metal stents, and, for safety parameters, drug-eluting stents were comparable to bare metal stents for stent thrombosis, death or myocardial infarction,” said presenter and investigator Julinda Mehilli, director of clinical research and data coordinating in the Intracoronary Stenting and Antithrombosis Research Centre (ISAR) at the German Heart Centre in Munich, Germany.
The multi-centre, randomised study was the largest to-date comparing DES to BMS in the saphenous vein.
Read more.
The novel reversible antiplatelet agent ticagrelor was associated with lower mortality from coronary artery bypass graft surgery (CABG) compared with standard clopidogrel (Plavix), according to a subanalysis of the pivotal PLATO trial.
Compared with clopidogrel, ticagrelor cut total mortality by a relative 51% (4.7% versus 9.7%, P<0.01) and cardiovascular mortality by 48% (4.1% versus 7.9%, P<0.01), according to Claes Held et al, Sweden. The mortality advantage came with no excess bleeding risk, the researchers reported online in the Journal of the American College of Cardiology.
Read more.
A measure of the ability of HDL to remove cholesterol from macrophages predicted the likelihood that an individual undergoing cardiac catheterisation had coronary artery disease, a cross-sectional study showed.
As cholesterol efflux capacity increased, the odds of coronary disease dropped, an effect independent of HDL cholesterol (P=0.002), according to Daniel Rader, MD, of the University of Pennsylvania in Philadelphia, and colleagues.
Compared with patients with the lowest efflux capacity, those with the highest had a 52% reduced likelihood of having coronary disease after adjustment for cardiovascular risk factors and HDL cholesterol level (OR 0.48, 95% CI 0.30 to 0.78), the researchers reported in the New England Journal of Medicine.
Read more.
Systolic heart failure patients treated with candesartan had better one-year survival than those taking losartan regardless of dose, comorbidities, or background heart failure treatments, registry data showed.
Survival rate at one year for the 2,639 patients taking candesaratan was 90% compared with 82% for the 2,500 treated with losartan. The difference was significant at P=0.001, said Maria Eklind-Cervenka, MD, of the Karolinska Institute in Stockholm. The one-year survival for the 357 patients taking valsartan (Diovan) was 88%, which was not significantly different from the candesartan survival, Eklind-Cervenka reported at the Heart Failure Congress in Berlin.
Read more.
A six-month outpatient prevention programme conducted by nurses has resulted in significant and sustained improvements in the control of cardiovascular risk factors, including high cholesterol or high blood pressure, in patients hospitalised for a heart attack or impending heart attack.
The programme, applied in addition to standard medical care, led to the improved adherence to current guidelines on prevention, including lifestyle and compliance with drug treatment. The nurses were able to increase the proportion of patients with good control of risk factors by 40% (defined as at least seven out of nine risk factors on target) and to reduce the calculated risk of dying in the next 10 years by about 17%.
Read more.
Cardiovascular disease in all its forms is the biggest cause of death across Europe. Although there is little doubt that better focus on prevention can lessen its impact, we are left with a series of fundamental questions: to what extent can the impact be reduced, and at what cost? And are the health benefits of prevention worth the investment?
The EUROASPIRE III health economics study aims to find out.
Read more.
Men treated with a statin to lower cholesterol achieved a 30% reduction in prostate cancer recurrence after surgery compared with men who do not take a statin, according to a study published recently in Cancer.
The authors also reported that higher statin dosing was associated with lower risk of recurrence.
“The findings add another layer of evidence suggesting that statins may have an important role in slowing the growth and progression of prostate cancer,” said senior author Stephen Freedland, MD, Duke Prostate Center, Durham Veterans Affairs Medical Center, Durham, North Carolina. “Previous studies have shown that statins have anti-cancer properties, but it’s not entirely clear when it’s best to use them - or even how they work.”
Read more.
Smoking cessation markedly improves survival for patients with MI and residual left ventricular dysfunction.
When smokers with left ventricular systolic dysfunction following MI quit, six months later, they had a propensity score-adjusted hazard ratio for all-cause death of 0.57 (95% CI 0.31 to 0.91) compared with similar patients who continued to smoke, according to Amil Shah, MD, of Brigham and Women’s Hospital in Boston, and colleagues.
Similar risk reductions were seen for composites of death and recurrent MI (adjusted HR 0.68, 95% CI 0.47 to 0.99) and death and heart failure hospitalisation (adjusted HR 0.65, 95% CI 0.46 to 0.92), the researchers reported online in the American Journal of Cardiology.
Ten health charities have produced a report calling on the NHS to take a long term view of spending on care for people with chronic conditions such as heart disease and cancer.
The report claims that too much money is wasted by focusing on short term savings rather than long term strategies, and it is vital that the needs of people with more than one chronic condition are met by the healthcare system.
The charities’ report, called How to deliver high quality, patient centred, cost effective care, identifies five key areas for improvement. They are:
1. Better co-ordinated care, which automatically includes long-term care planning with regular review. Too many people are currently admitted to hospital for conditions that could be effectively managed in the community.
2. Prevention, early diagnosis and intervention, which saves money as preventing or treating illness earlier means less need for more expensive intervention later.
3. Emotional, psychological and practical support. Long-term conditions can put people under severe psychological and emotional strain. Supporting people’s psychological health can help them manage their own condition and return to work.
4. Patients must be actively involved in decisions about their care. A major survey showed that this was what mattered most to patients about their care. It can improve the management of conditions and improve services.
5. Supported self-management. Patients should be treated more as able adults who are taught to manage their own conditions, rather than helpless patients who are forced to rely on healthcare professionals. They need to be given the tools to help themselves.
The charities behind the report are the British Heart Foundation, Age UK, Asthma UK, Breakthrough Breast Cancer, British Lung Foundation, Diabetes UK, Macmillan Cancer Support, Neurological Alliance, Rethink and the Stroke Association. They were helped by the King’s Fund.
They believe achieving these changes will require a policy and regulatory framework that is designed to support the delivery of patient-centred care. It will also require commitment, innovation and leadership from clinicians, managers and commissioners across the system. And it will require partnership in many forms; between patients and clinicians, and between different professions, organisations and sectors in health, social care, public health, wider public services, and the voluntary and private sectors.
It claims four specific recommendations are particularly important:
1. Greater accountability and rewards for patient-centred care.
2. Partnership between the public and voluntary sectors to spread best practice and innovation.
3. Commissioning that is informed by patients’ voices and insights.
4. Focus on co-ordinated care in commissioning and workforce planning.
The NHS, public health services and social care sectors need to be held properly accountable (and be rewarded) for providing services that meet these priorities, the report claims. To do this, accountability, standard-setting and payment systems such as the Outcomes Framework, the NICE quality standards and the tariff need to be structured around ensuring patient-centred care.
This, it suggests, can begin to be achieved by incorporating performance measures of the quality and cost of whole pathways of care that cross organisational boundaries, measuring care transitions, shared decision-making, access to information and self-management support, and reflecting the experiences, satisfaction and needs of patients with multiple conditions. If we continue to measure and reward organisations and services only in isolation from each other, and on the basis of limited dimensions of performance, it will remain very difficult to achieve the improvements in quality and value for money that we need.
Disseminating innovation is challenging in all industries, including health and social care. However, sharing evidence, information and examples of innovative, effective services and embedding innovation in the working culture of the NHS and social care is essential if we are to achieve change at pace and deliver consistently high-quality, cost-effective services across the country, the report claims.
Working with organisations such as NICE and NHS Evidence, and with the NHS Institute for Innovation and Improvement and its successors, the charities would like to help to share information about innovative services widely, to encourage and support NHS and social care leaders to adopt the ways of working and service models that they know work.
The decisions of commissioning boards, at the local, regional and national level, must be informed by patients’ experiences of care. The charities claim to have a wealth of intelligence on patients’ needs and experiences and are willing to offer advice and support to commissioners on all aspects of service design. Furthermore, if the government is to realise its commitment that there should be ‘no decision about me, without me’, the charities believe that all commissioning boards at national and regional level must have a significant, not tokenistic, number of members drawn from those representing patients, carers and voluntary organisations, and that all GP commissioning consortia must demonstrate significant patient involvement and input.
All patients with long-term conditions must have a right to choose a care-coordinator to oversee their care and act as a single contact point for the patient, the report asserts. This is an essential part of a health and social care service geared to deal with the burden of chronic disease in a way that is truly patient-centred and realises the cost and quality benefits of self-management. The charities say they are committed to supporting the relevant statutory authorities and professional bodies to ensure that these community-based roles and skills are developed. And they will also support commissioners to ensure that local needs assessments identify where failings in care co-ordination exist and provide advice to aid the commissioning of services that promote care co-ordination as part of programmes of care for patients.
Read the full report.
