News Article | May 18, 2017
Worldwide, diabetes affects around 415 million adults, a number estimated to rise to 642 million by 2040 (1 in 10 adults), with 50% of deaths in people with T2D caused by cardiovascular disease. Specifically, people with type-2 diabetes (T2D) face a much higher risk of heart failure and death than those without diabetes. The prognosis for patients with diabetes that develop heart failure is especially ominous. However, research led by Mikhail Kosiborod, M.D. at Saint Luke’s Mid America Heart Institute, in coordination with the CVD-REAL Executive Scientific Committee, and published today in the American Heart Association’s flagship journal, Circulation, revealed that patients treated with sodium-glucose co-transporter-2 inhibitor (SGLT-2i) medicines experienced a significantly lower risk of hospitalizations for heart failure and death when compared with T2D patients treated with other glucose lowering drugs (oGLDs). The CVD-REAL study assessed data from more than 300,000 patients across six countries, 87% of whom did not have a known history of cardiovascular disease. The data showed that across this broad population of patients with T2D, treatment with SGLT-2i medicines - canagliflozin, dapagliflozin and empagliflozin - was associated with a 39% lower risk of hospitalization for heart failure (HR 0.61; 95% CI 0.51-0.73; p<0.001) and 51% lower risk of death from any cause (HR 0.49; 95% CI 0.41-0.57; p<0.001), compared with other T2D medicines. For the composite endpoint of hospitalization for heart failure or death from any cause, treatment with SGLT-2i versus other drugs was associated with a 46% lower risk (HR 0.54; 95% CI 0.48-0.60; p<0.001). “T2D remains a major risk factor for cardiovascular disease and overall mortality despite advances in treatment,” said Saint Luke’s cardiologist Mikhail Kosiborod, M.D., the lead author of the study. “There is a substantial need to develop treatments that not only lower blood glucose levels, but also reduce the risk of cardiovascular complications, including heart failure. The CVD-REAL study results suggest that SGLT-2i medicines may have a significant impact on reducing those risks and may improve overall outcomes in a much broader population of patients with T2D than previously thought.” The hospitalizations for heart failure analysis was conducted using anonymized patient data from Denmark, Norway, Sweden, United Kingdom, Germany and the United States. Of the data reviewed, 53% were on canagliflozin, 42% on dapagliflozin, and 5% on empagliflozin. The analysis of death from any cause was conducted using anonymized patient data from Denmark, Norway, Sweden, United Kingdom and the United States. Of the data reviewed, 42% of patients were on canagliflozin, 51% on dapagliflozin and 7% on empagliflozin. Among patients treated with SGLT-2i, the majority in the US received canagliflozin, and the majority in Europe received dapagliflozin; lower risks of hospitalization for heart failure and death associated with SGLT-2i use were seen both in the US and Europe, suggesting that these potential benefits may represent a class effect. This is the first of several comparative analyses of CVD-REAL. The study is ongoing and future analyses will be conducted using this dataset as well as data from additional countries. The data for this study were obtained from real-world sources including medical records, claims databases and national registers, and were not independently adjudicated or verified against source documents. The CVD-REAL study is sponsored by AstraZeneca. This study was validated by the independent academic statistical group at St. Luke’s Mid America Heart Institute, Kansas City, US. While CVD-REAL is a large study with a robust propensity-matching technique, given its observational nature the possibility of residual, unmeasured confounding factors cannot be definitively excluded. Saint Luke’s Mid America Heart Institute is a member of Saint Luke’s Health System, which consists of 10 area hospitals and several primary and specialty care practices, and provides a range of inpatient, outpatient, and home care services. Founded as a faith-based, not-for-profit organization, our mission includes a commitment to the highest levels of excellence in health care and the advancement of medical research and education. The health system is an aligned organization in which the physicians and hospitals assume responsibility for enhancing the physical, mental, and spiritual health of people in the metropolitan Kansas City area and the surrounding region.
News Article | March 17, 2017
A primitive tribe in the Amazon rainforest may have the best heart health in the world. Researchers of a new study think that simple living provides them with extraordinary protection against cardiovascular disease. Members of the tribe live in thatched huts in the Bolivian jungle. The Tsimane people thrive on subsistence farming harvesting rice, corn, and plantains from small farm plots and foraging nuts and wild fruits in the Amazon rainforest. They also live an active life hunting monkeys and wild pigs for their meals as well as catching catfish and piranha in the local rivers. Study researcher Gregory Thomas, from the Memorial Care Heart & Vascular Institute in California, and colleagues learned about this people through anthropologists led by Hillard Kaplan, from the University of New Mexico, who have been studying members of the tribe and rarely observed heart disease in them. To conduct their study, which was published in The Lancet on March 17, Thomas and colleagues had over 700 Tsimane travel from the Amazon rainforest to Trinidad city in Bolivia, to undergo CT scan. The results of the CT scan revealed that hardened arteries are five times less common among members of the Tsimane tribe compared with adults in the United States. Researchers also found that the Tsimane have lower blood pressure, heart rates, and blood sugar level than the rest of the world. The researchers found that almost nine in every 10 Tsimane had no heart disease risk because of the absence of arterial plaques. About 13 percent of those who were scanned also had low risk while only 3 percent had moderate and high risk. The risk for cardiovascular problem among the Tsimane is significantly lower when compared to that of Americans. In a study funded by the U.S. National Institutes of Health, researchers revealed that only 14 percent of people in the United States who had CT scans had no heart disease. Based on the findings, the researchers said that the Tsimane measured far healthier than other populations in the world which include people from Europe, the United States, and Japan. "If you think of the calcium plaque as a reasonable measure of arterial age, their arteries are 28 to 30 years younger than ours," said study researcher Randall Thompson, from St. Luke's Mid America Heart Institute. "Obviously the Tsimane are achieving something that we are not." The primitive people's diet may seem unique, but it is their active lifestyle and their overall diet that may help explain why most of them have arteries that were not clogged by cholesterol plaques that raise risk for stroke and heart attack. Because of their way of living as subsistence farmers and hunters, men of the tribe are physically active between six and seven hours a day averaging 17,000 steps daily. The women are physically active between four and six hours daily averaging about 16,000 steps per day. The Tsimane also consume low-fat diet and fresh food by eating only what they can grow and catch. Almost three-fourth of what they eat are non-processed carbohydrates and their protein come from fish and lean wild game. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.
News Article | May 7, 2017
Vienna, Austria - 7 May 2017: A large nuclear cardiology laboratory has slashed its average radiation dose by 60% in eight years, according to new research presented today at ICNC 2017 and published in JACC: Cardiovascular Imaging.1,2 The study in over 18 000 patients shows dose reductions were achieved despite a large number of obese patients. "There has been concern amongst the medical community and the public that the radiation from medical diagnostic tests could increase the risk of cancer," said Professor Randall Thompson, a cardiologist at the Mid America Heart Institute, Kansas City, Missouri, US. He continued: "Although the risk of harm from an individual nuclear cardiology test is very low - even very conservative estimates suggest only one in 1 000 extra patients would develop cancer 20 years later - the cumulative dose from multiple medical diagnostic tests may be a concern." Medical societies advocate getting radiation doses as low as is reasonably achievable. There are ways to do this but surveys show that adoption of new technologies, which cost money, and new testing algorithms, which take more physician time, has been slow. This study assessed the impact on radiation dose of modifying protocols and introducing new hardware (cameras) and post processing software in a large nuclear cardiology laboratory network in Kansas City. The study included the 18 162 single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) studies performed at all four of the Saint Luke's Mid America Heart Institute nuclear cardiology laboratories from 1 January 2009 to 30 September 2016. SPECT MPI shows how well blood flows through the muscle of the heart and is primarily performed to diagnose the cause of chest pain or to help manage patients with known coronary artery disease.. Protocols were modified by performing stress-only tests where possible, which saves the radiotracer dose from the rest scan. Stress and rest scans are still required in some patients since shadowing from body parts can look like a lack of blood flow and two scans can clarify the findings. Technetium tracers are now used instead of thallium 100% of the time at one-third of the radiation dose. Small field of view cameras which have advanced post processing, and a new generation of camera systems which are more sensitive and need less radiotracer injected into the body, have both been introduced. These camera systems are equipped with advanced processing which enhances the nuclear pictures and need less radiation or shorter image acquisition times. Professor Thompson's laboratory focussed primarily on reducing the radiation dose. The average radiation dose fell from 17.9 mSv in 2009 to 7.2 mSv in 2016 and the median dose (the 50th percentile) dropped from 10.2 mSv to 2.5 mSv. Professor Thompson said: "There was a dramatic lowering of the radiation dose with all of these concerted efforts. The average dose fell by 60% and the median dropped by 75%." "The average dose had fallen to 5.4 mSv in 2012 but crept up as we've had more obese patients referred in whom we have to use the higher dose protocols," he added. "But more than half of patients now are tested with a low-dose, stress-only test using the new technology, which is why the median dose of radiation has fallen so dramatically." The average background dose for people living in Europe and North America from radon underground and cosmic background sources is about 3 mSv a year. Medical societies consider higher and lower dose tests to be above 10 mSv and below 3 mSv, respectively. In 2010 the American Society of Nuclear Cardiology set a target of 9 mSv or less for the majority of tests.3 Professor Thompson said: "The majority of studies were in the high dose range back in 2009 and now most tests have a radiation dose that is about a third of the target. This is despite being referred a larger number of obese patients. In the last 2.5 years, 17% of patients have needed the large field of view camera as their average body mass index was 46 kg/m2 and they were simply too big for the small cameras." He concluded: "By adopting contemporary protocols and technologies it is feasible to substantially lower radiation doses in nuclear cardiology in very large numbers of patients in real world clinical practice."
News Article | March 20, 2017
Diabetes affects more than 400 million people worldwide, out of which type 2 diabetes covers 90 percent. AstraZeneca, a research-based biopharmaceutical company, presented a study on March 19 which reveals that some SGLT2 based type 2 diabetes drugs reportedly reduced deaths. The study shares that the drugs decreased deaths related to any cause by 51 percent and heart failure hospitalization by 39 percent. Also called SGLT2 inhibitors, the drugs basically work by eliminating the blood sugar through the urine. These drugs include the company's Farxiga, Johnson & Johnson's Invokana, and Jardiance from Eli Lilly and Boehringer Ingelheim. A real-world study dubbed CVD Real, which was sponsored by AstraZeneca, was conducted to examine the role played by SGLT2 in reducing heart-related deaths, as well as hospitalization. During the study, the researchers scrutinized reports of over 300,000 patients from six different countries. It was observed that the SGLT2 drugs reduced heart-related deaths and hospitalization cases significantly, when compared to other types of treatments. This research's findings affirm those from the Empa-Reg Outcome study, which revealed that the administration of Jardiance reduced heart-related hospitalizations by 35 percent. Since 2015's report of Jardiance reducing heart-related deaths and hospitalization, it was considered as one of the best to treat cardiac complications. The Empa-Reg Outcome reflected that Jardiance reduced cardiovascular deaths by 38 percent. It also led to a 35 percent decrease in hospitalization due to heart failure . Jardiance includes a variety of other diabetes treatments such as metformin, as well as DPP-4 inhibitors like Janvia from Merck & Co, and insulin. The latest study revealed that most patients in America were consuming Invokana, whereas those in Europe were partial to Farxiga when compared to Jardiance. The study revealed that most patients used Farxiga or Invokana and less than 10 percent took Jardiance. "The fact that the results are remarkably consistent from country to country regardless of which compound predominates, that certainly seems to suggest that it's a class effect," shared Dr. Mikhail Kosiborod, a cardiologist from the Saint Luke's Mid America Heart Institute in Kansas City. There is an increased demand for AstraZeneca's Farxiga drug, which resulted in a spike in sales by 70 percent in 2016.The product has been declared one of the best medicines for curing diabetes. AstraZeneca is expected to hold its own clinical trials to assess the effects of Farxiga in reducing heart ailments. The result is expected to be announced in 2019. The study was presented at the American College of Cardiology conference. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.
Spertus J.A.,Mid America Heart Institute |
Spertus J.A.,University of Missouri - Kansas City |
Jones P.G.,Mid America Heart Institute
Circulation: Cardiovascular Quality and Outcomes | Year: 2015
Background-There is a growing demand to collect patients' experiences of their health status (their symptoms, function, and quality of life) in clinical trials, quality assessment initiatives, and in routine clinical care. In heart failure, the 23-item, disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ) has been shown to be valid, reliable, sensitive to clinical change, and prognostic of both clinical events and costs. However, its use has been limited, in part, by its length. We sought to develop a shortened version of the instrument that maintains the psychometric properties of the full KCCQ. Methods and Results-Using data from 3 clinical studies incorporating 4168 patients, we derived and validated a 12-item KCCQ, the KCCQ-12, to capture symptom frequency, physical and social limitations, and quality of life impairment as a result of heart failure, as well as an overall summary score. The KCCQ-12 scores had high correlations with the original scales (>0.93 for all scales in all clinical settings), high test-retest reliability (>0.76 for all domains), high responsiveness (16-31 point improvements after discharge from hospitalization; standardized response mean =0.61-1.12), and comparable prognostic significance and interpretation of clinically important differences as compared with the full KCCQ. Conclusions-The KCCQ-12 is a shorter version of the original 23-item instrument that should be more feasible to implement while preserving the psychometric properties of the full instrument. © 2015 American Heart Association, Inc.
Chan P.S.,Mid America Heart Institute |
Nallamothu B.K.,University of Michigan |
Krumholz H.M.,Yale University |
Krumholz H.M.,Yale New Haven Hospital |
And 4 more authors.
New England Journal of Medicine | Year: 2013
BACKGROUND: Little is known about the long-term outcomes in elderly survivors of in-hospital cardiac arrest. We determined rates of long-term survival and readmission among survivors of in-hospital cardiac arrest and examined whether these outcomes differed according to demographic characteristics and neurologic status at discharge. METHODS: We linked data from a national registry of inpatient cardiac arrests with Medicare files and identified 6972 adults, 65 years of age or older, who were discharged from the hospital after surviving an in-hospital cardiac arrest between 2000 and 2008. Predictors of 1-year survival and of readmission to the hospital were examined. RESULTS: One year after hospital discharge, 58.5% of the patients were alive, and 34.4% had not been readmitted to the hospital. The risk-adjusted rate of 1-year survival was lower among older patients than among younger patients (63.7%, 58.6%, and 49.7% among patients 65 to 74, 75 to 84, and ≥85 years of age, respectively; P<0.001), among men than among women (58.6% vs. 60.9%, P = 0.03), and among black patients than among white patients (52.5% vs. 60.4%, P = 0.001). The risk-adjusted rate of 1-year survival was 72.8% among patients with mild or no neurologic disability at discharge, as compared with 61.1% among patients with moderate neurologic disability, 42.2% among those with severe neurologic disability, and 10.2% among those in a coma or vegetative state (P<0.001 for all comparisons). Moreover, 1-year readmission rates were higher among patients who were black, those who were women, and those who had substantial neurologic disability (P<0.05 for all comparisons). These differences in survival and readmission rates persisted at 2 years. At 3 years, the rate of survival among survivors of in-hospital cardiac arrest was similar to that of patients who had been hospitalized with heart failure and were discharged alive (43.5% and 44.9%, respectively; risk ratio, 0.98; 95% confidence interval, 0.95 to 1.02; P = 0.35). CONCLUSIONS: Among elderly survivors of in-hospital cardiac arrest, nearly 60% were alive at 1 year, and the rate of 3-year survival was similar to that among patients with heart failure. Survival and readmission rates differed according to the demographic characteristics of the patients and neurologic status at discharge. (Funded by the American Heart Association and the National Heart, Lung, and Blood Institute). Copyright © 2013 Massachusetts Medical Society.
Jain R.,University of Michigan |
Nallamothu B.K.,University of Michigan |
Chan P.S.,Mid America Heart Institute
Circulation: Cardiovascular Quality and Outcomes | Year: 2010
Background: The quality and effectiveness of resuscitation processes may be influenced by the patient's body mass index (BMI); however, the relationship between BMI and survival after in-hospital cardiac arrest has not been previously studied. Methods and Results: We evaluated 21 237 adult patients with an in-hospital cardiac arrest within the National Registry for Cardiopulmonary Resuscitation (NRCPR). We examined the association between BMI (classified as underweight [<18.5 kg/m2], normal [18.5 to 24.9 kg/m2], overweight [25.0 to 29.9 kg/m2], obese [30.0 to 34.9 kg/m 2], and very obese [>35.0 kg/m2]) and survival to hospital discharge using multivariable logistic regression, after stratifying arrests by rhythm type and adjusting for patient characteristics. Of 4499 patients with ventricular fibrillation or pulseless ventricular tachycardia as initial rhythm, 1825 (40.6%) survived to discharge. After multivariable adjustment, compared with overweight patients, underweight (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.003), normal weight (OR, 0.75; 95% CI, 0.63 to 0.89; P<0.001), and very obese (OR, 0.78; 95% CI, 0.63 to 0.96; P=0.02) had lower rates of survival, whereas obese patients had similar rates of survival (OR, 0.87; 95% CI, 0.72 to 1.06; P=0.17). In contrast, of 16 738 patients with arrests caused by asystole or pulseless electric activity, only 2501 (14.9%) survived. After multivariable adjustment, all BMI groups had similar rates of survival except underweight patients (OR, 0.67; 95% CI, 0.54 to 0.82; P<0.001). Conclusions: For cardiac arrest caused by shockable rhythms, underweight, normal weight, and very obese patients had lower rates of survival to discharge. In contrast, for cardiac arrest caused by nonshockable rhythms, survival to discharge was similar across BMI groups except for underweight patients. Future studies are needed to clarify the extent to which BMI affects the quality and effectiveness of resuscitation measures. © 2010 American Heart Association, Inc.
Sasson C.,Aurora University |
Magid D.J.,Kaiser Permanente |
Chan P.,Mid America Heart Institute |
Root E.D.,University of Colorado at Boulder |
And 3 more authors.
New England Journal of Medicine | Year: 2012
BACKGROUND: For persons who have an out-of-hospital cardiac arrest, the probability of receiving bystander-initiated cardiopulmonary resuscitation (CPR) may be influenced by neighborhood characteristics. METHODS: We analyzed surveillance data prospectively submitted from 29 U.S. sites to the Cardiac Arrest Registry to Enhance Survival between October 1, 2005, and December 31, 2009. The neighborhood in which each cardiac arrest occurred was determined from census-tract data. We classified neighborhoods as high-income or lowincome on the basis of a median household income threshold of $40,000 and as white or black if more than 80% of the census tract was predominantly of one race. Neighborhoods without a predominant racial composition were classified as integrated. We analyzed the relationship between the median income and racial composition of a neighborhood and the performance of bystander-initiated CPR. RESULTS: Among 14,225 patients with cardiac arrest, bystander-initiated CPR was provided to 4068 (28.6%). As compared with patients who had a cardiac arrest in high-income white neighborhoods, those in low-income black neighborhoods were less likely to receive bystander-initiated CPR (odds ratio, 0.49; 95% confidence interval [CI], 0.41 to 0.58). The same was true of patients with cardiac arrest in neighborhoods characterized as low-income white (odds ratio, 0.65; 95% CI, 0.51 to 0.82), low-income integrated (odds ratio, 0.62; 95% CI, 0.56 to 0.70), and high-income black (odds ratio, 0.77; 95% CI, 0.68 to 0.86). The odds ratio for bystander-initiated CPR in highincome integrated neighborhoods (1.03; 95% CI, 0.64 to 1.65) was similar to that for high-income white neighborhoods. CONCLUSIONS: In a large cohort study, we found that patients who had an out-of-hospital cardiac arrest in low-income black neighborhoods were less likely to receive bystander-initiated CPR than those in high-income white neighborhoods. Copyright © 2012 Massachusetts Medical Society. All rights reserved.
News Article | November 1, 2016
WASHINGTON - November 1, 2016 - Patients with severe aortic stenosis (AS) at intermediate surgical risk, and who are treated with transcatheter aortic valve replacement (TAVR) had improved health status at one month compared with surgical aortic valve replacement (SAVR) but two-year quality of life outcomes were similar. Prior studies have shown that TAVR results in an early quality of life (QoL) benefit in patients at high surgical risk; however, the effect of TAVR versus. SAVR on QoL in intermediate risk patients was unknown prior to this study. Findings from the PARTNER II QUALITY OF LIFE study were reported today at the 28th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium. Sponsored by the Cardiovascular Research Foundation (CRF), TCT is the world's premier educational meeting specializing in interventional cardiovascular medicine. Between 2011 and 2013, 2,032 intermediate risk patients with severe AS were randomized to TAVR with the SAPIEN XT valve (n=1,011) or SAVR (n=1,021) in the PARTNER II Trial. Quality of life was assessed on all patients at baseline, one, 12 and 24 months using the Kansas City Cardiomyopathy Questionnaire (KCCQ), SF-36 and EQ-5D. The study found that at two year follow-up, both TAVR and SAVR were associated with clinically and statistically significant improvements in disease-specific and generic QoL measures as compared with baseline. The two year change in KCCQ Overall Summary Score was 19.2 points with TAVR compared with 18.3 points for SAVR. Similarly, the two year change in the SF-36 Physical Component Summary Score was 3.0 points with TAVR versus 2.7 points with SAVR. In contrast, at one month, TAVR was associated with significantly better QoL than SAVR, but this difference was restricted to patients who were treated via transfemoral (TF) access and was not seen in patients that were treated via alternative (transapical or transaortic) access (p "This study shows that among intermediate risk patients with severe AS, quality of life improved significantly and to a similar extent with TAVR and SAVR through two years. However, transfemoral (but not transthoracic) TAVR was associated with a substantial and clinically important early health status benefit compared with SAVR.," said lead investigator David J. Cohen, MD, MSc Director of Cardiovascular Research at Saint Luke's Mid America Heart Institute in Kansas City, MO. "We believe that these early differences in quality of life may be important to many patients who are suitable candidates for both procedures. Longer term follow up is needed to assess the durability of quality of life improvement with TAVR versus SAVR in this intermediate risk population." The PARTNER II trial was funded by Edwards Lifesciences. Dr. Cohen reports research grant support from Edwards Lifesciences, Medtronic, Abbott Vascular, and Boston Scientific, and consulting income from Medtronic and Abbott Vascular. The results of the PARTNER II QUALITY OF LIFE trial will be presented on Tuesday, November 1 at 9:20 AM ET in the Main Arena (Ballroom, Level 3) of the Walter E. Washington Convention Center. The Cardiovascular Research Foundation (CRF) is a nonprofit research and educational organization dedicated to helping doctors improve survival and quality of life for people suffering from heart and vascular disease. For over 25 years, CRF has helped pioneer innovations in interventional cardiology and has educated doctors on the latest treatments for heart disease. Transcatheter Cardiovascular Therapeutics (TCT) is the annual scientific symposium of CRF and the world's premier educational meeting specializing in interventional cardiovascular medicine. Now in its 28th year, TCT features major medical research breakthroughs and gathers leading researchers and clinicians from around the world to present and discuss the latest evidence-based research in the field. For more information, visit http://www. and http://www. .
News Article | October 27, 2016
Only 92 gold-standard studies in 20 years for heart emergency that happens 535,000 times a year in US ANN ARBOR, Mich. -- Hundreds of thousands of times a year in this country, a heart stops suddenly, when the electrical signals that keep it beating go tragically haywire. It's called a cardiac arrest, and only one in 10 people survive it, whether it happens on a city street, a golf course or a hospital floor. But despite the fact that cardiac arrest kills ten times more people than breast cancer, new research shows a huge lack of studies aimed at improving care and survival. Over the last 20 years, a University of Michigan-led team found, only 92 gold-standard clinical trials have been done on the immediate treatment of cardiac arrest. They report their results, which are based on an exhaustive review of the medical literature, in a paper published online in Circulation: Cardiovascular Quality and Outcomes. The randomized clinical trials that have been done on cardiac arrest involved just over 64,000 patients. Less than five studies a year have published their results. And most tested drugs and devices rather than ways to improve the system of caring for cardiac arrest, from bystanders to ambulance crews to hospitals. "What we found in a nutshell was a striking paucity of randomized clinical trials relative to the burden of cardiac arrest in this country," says Shashank S. Sinha, M.D., M.Sc., a cardiovascular medicine fellow at the U-M Medical School. "We estimate that only 2.5 such trials have been done for every 10,000 out-of-hospital cardiac arrests, and the number is even lower for in-hospital cardiac arrests." By comparison, he says, each year there are 25 to 86 times more clinical trials published for heart failure, heart attack and stroke than for cardiac arrest. Sinha performed the study with U-M co-authors who include Brahmajee K. Nallamothu, M.D., M.P.H., a member of an Institute of Medicine panel that called for action on cardiac arrest, and Robert W. Neumar, M.D., Ph.D., the chair of the American Heart Association's emergency heart care committee who helped create new cardiac arrest treatment guidelines. A colleague from the Mid America Heart Institute, Paul S. Chan, M.D., M.Sc., also contributed. Chan is also Chair of Science for the American Heart Association's Get With The Guidelines-Resuscitation registry for in-hospital cardiac arrest. The review did find that the pace of trials on cardiac arrest has picked up in the last five years, a hopeful sign that more can be done. The researchers evaluated more than 5,000 published medical journal articles and abstracts, but most did not meet the standard needed to draw specific conclusions about the effectiveness of treatment options. "Cardiac arrests remain a significant public health need worldwide, and the limited progress in improving poor survival in the U.S. and globally may be due to inadequate research," says Sinha. "We need to move the needle." He notes that the recent IOM report, and the AHA's recent update to guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care, appear to be building momentum for further action on cardiac arrest. The new paper spotlights areas where research on cardiac arrest is most lacking, including protocols for emergency care, post-arrest care, and studies of long-term survival and functional outcomes. Many of the trials highlighted only followed patients through the return of spontaneous circulation, or the restarting of normal heart rhythm. Some studied whether the patients survived long enough to be discharged from the hospital. But what happens to survivors after that, for the days, months and years that follow, is largely unstudied. Another potential area for research to improve cardiac arrest care is standardizing how researchers measure the outcomes of care, including patient-centered things like returning to work or having a reasonable quality of life. Sinha notes that most of the best studies on cardiac arrest have been done outside the U.S. - suggesting a major opportunity for funding agencies and organizations to support new trials. While new drugs and automated CPR devices used while a cardiac arrest is under way should be studied, he says, there's a "compelling opportunity" to study immediate post-arrest care. Better research on processes of care, which could lead to standardization and even accreditation of hospital care, is sorely needed, he says. Perhaps one day, cardiac arrest care could reach the place that heart attack care already has. The new review did not include studies of public-health interventions such as installation of automated external defibrillators or AEDs. It also excluded studies on infants and children. In addition to Sinha, Nallamothu, Neumar and Chan, the paper's authors are Devraj Sukul, M.D., John J. Lazarus, M.D., Ph.D., and Vivek Polavarapu, B.S. All except Chan and Neumar are members of the Frankel Cardiovascular Center and Department of Internal Medicine's Division of Cardiology. Neumar is chair of the U-M Department of Emergency Medicine. Sinha and Nallamothu are members of the U-M Institute for Healthcare Policy and Innovation, and Sinha, Neumar and Nallamothu are members of the Michigan Center for Integrative Research in Critical Care. Nallamothu is also affiliate with the VA Ann Arbor Healthcare System. The research was supported by the National Institutes of Health (HL007853, HL123980, HL091606, HL123227), the VA Health Services Research and Development Program and the American Heart Association.