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Montreal, Canada

Cardiovascular disease (CVD) is the most highly prevalent disease in the United States and remains the leading cause of death among adults aged ≥18 years despite advancements in treatment and prevention in recent decades. Each year, approximately 800,000 persons die from CVD, which includes coronary heart disease (CHD); the majority of those persons who die from CVD had underlying atherosclerosis. Approximately 7.9 million U.S. adults have a history of heart attack, approximately 7 million U.S. adults have a history of stroke, and, approximately 16 million U.S. adults have received a diagnosis of CHD. CVD and CHD cause a substantial economic burden in the United States. In 2010, the estimated annual cost (direct and indirect) of CVD in the United States was approximately $450 billion, including $109 billion for CHD and $54 billion for stroke alone.

Inglis S.C.,Heart Health
Cochrane database of systematic reviews (Online) | Year: 2010

BACKGROUND: Specialised disease management programmes for chronic heart failure (CHF) improve survival, quality of life and reduce healthcare utilisation. The overall efficacy of structured telephone support or telemonitoring as an individual component of a CHF disease management strategy remains inconclusive. OBJECTIVES: To review randomised controlled trials (RCTs) of structured telephone support or telemonitoring compared to standard practice for patients with CHF in order to quantify the effects of these interventions over and above usual care for these patients. SEARCH STRATEGY: Databases (the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment Database (HTA) on The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED and Science Citation Index Expanded and Conference Citation Index on ISI Web of Knowledge) and various search engines were searched from 2006 to November 2008 to update a previously published non-Cochrane review. Bibliographies of relevant studies and systematic reviews and abstract conference proceedings were handsearched. No language limits were applied. SELECTION CRITERIA: Only peer reviewed, published RCTs comparing structured telephone support or telemonitoring to usual care of CHF patients were included. Unpublished abstract data was included in sensitivity analyses. The intervention or usual care could not include a home visit or more than the usual (four to six weeks) clinic follow-up. DATA COLLECTION AND ANALYSIS: Data were presented as risk ratio (RR) with 95% confidence intervals (CI). Primary outcomes included all-cause mortality, all-cause and CHF-related hospitalisations which were meta-analysed using fixed effects models. Other outcomes included length of stay, quality of life, acceptability and cost and these were described and tabulated. MAIN RESULTS: Twenty-five studies and five published abstracts were included. Of the 25 full peer-reviewed studies meta-analysed, 16 evaluated structured telephone support (5613 participants), 11 evaluated telemonitoring (2710 participants), and two tested both interventions (included in counts). Telemonitoring reduced all-cause mortality (RR 0.66, 95% CI 0.54 to 0.81, P < 0.0001) with structured telephone support demonstrating a non-significant positive effect (RR 0.88, 95% CI 0.76 to 1.01, P = 0.08). Both structured telephone support (RR 0.77, 95% CI 0.68 to 0.87, P < 0.0001) and telemonitoring (RR 0.79, 95% CI 0.67 to 0.94, P = 0.008) reduced CHF-related hospitalisations. For both interventions, several studies improved quality of life, reduced healthcare costs and were acceptable to patients. Improvements in prescribing, patient knowledge and self-care, and New York Heart Association (NYHA) functional class were observed. AUTHORS' CONCLUSIONS: Structured telephone support and telemonitoring are effective in reducing the risk of all-cause mortality and CHF-related hospitalisations in patients with CHF; they improve quality of life, reduce costs, and evidence-based prescribing.

Mack M.J.,Heart Health
Current Cardiology Reports | Year: 2011

Risk scoring tools have been developed from clinical databases to predict expected patient mortality from cardiac surgical procedures. The risk algorithms have been developed and validated from variables that have been demonstrated to be predictive of mortality. At least six risk models have been developed from different databases measuring outcomes of cardiac surgery. These algorithms have then been used to select very high risk patients for conventional aortic valve replacement (AVR) who would be appropriate candidates for transcatheter aortic valve implantation (TAVI). The two most common risk models used for TAVI selection are the logistic EuroSCORE (LES) and the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) algorithms. Although both models are accurate in predicting mortality in low-risk patients, the LES has been clearly demonstrated to overpredict expected mortality by a factor of three in high-risk candidates for AVR. Various factors that also impact mortality but are not included in either algorithm include liver disease, frailty, porcelain aorta, and previous radiation. Despite these shortcomings, risk algorithms are effective models for predicting risk, with the STS-PROM being more accurate in high-risk patients. Ultimately, a new risk algorithm specific for TAVI will need to be developed once sufficient databases are developed. © Springer Science+Business Media, LLC 2011.

Strauss B.H.,Heart Health
Journal of the American College of Cardiology | Year: 2013

Diabetic patients have long been identified to be at high risk of restenosis and reintervention with bare-metal stents (BMS) (1). Drug-eluting stents (DES) have been shown in multiple clinical trials to decrease restenosis compared with BMS, including in diabetic patients, and remain the treatment of choice for diabetic percutaneous revascularization. © 2013 American College of Cardiology Foundation.

The report of the so-called Berlin patient cured of HIV with hematopoietic stem cell transplantation and a few other studies raised tremendous hope, excitement, and curiosity in the field. The National Heart, Lung and Blood Institute of the National Institutes of Health convened a Working Group to address emerging heart, lung, and blood research priorities related to HIV infection. Hematopoietic cells could contribute to HIV cure through allogeneic or autologous transplantation of naturally occurring or engineered cells with anti-HIV moieties. Protection of central memory T cells from HIV infection could be a critical determinant of achieving a functional cure. HIV cure can only be achieved if the virus is eradicated from reservoirs in resting T cells and possibly other hematopoietic cells. The Working Group recommended multidisciplinary efforts leveraging HIV and cell therapy expertise to answer the critical need to support research toward an HIV cure.

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