American College of Cardiology, March 16-18
The annual meeting of the American College of Cardiology was held from March 16 to 18 in New Orleans and attracted more than 20,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in cardiology. The conference highlighted recent advances in the treatment, management, and prevention of cardiovascular diseases with presentations focusing on novel drugs and surgical approaches to improve quality of care for patients.
In one study, Serena Day, M.D., of The Ohio State University in Columbus, and colleagues reported a 436 percent increase in hospital admissions at one medical center between 2012 and 2017 for infective endocarditis related to intravenous drug use.
"Intravenous drug use has other serious clinical implications besides overdose. It is a highly morbid condition with a nearly 25 percent mortality rate in our study population. These patients are often young and on Medicare or Medicaid, making this condition particularly impactful on societal and health care resources," Day said. "This condition needs to be managed with a holistic approach and should include comprehensive drug abuse treatment. These patients show high rates of recidivism, with significant resource utilization, and until the root cause is addressed, we continue to see high rates of relapse and rehospitalizations."
In another study, Matthew Kronish, M.D., of the Columbia University Medical Center in New York City, and colleagues found that patients who suffered a heart attack or unstable angina and underwent screening for depression and were referred to treatment when appropriate did not demonstrate a significant improvement in quality of life compared with those who did not receive depression screening.
The investigators enrolled 1,500 patients who were randomly assigned to (1) depression screening, with those who had positive screens having their treating providers notified and being provided depression care throughout the study (screen, notify, and treat); (2) depression screening, with those who had positive screens having their treating providers notified but not being provided with depression treatment throughout the study; or (3) no depression screening.
"The primary outcome of the trial was change in quality-adjusted life years from baseline to 18 months of follow-up, not just for the screened depressed patients, but for the entire screened sample. This is what was so distinct about our trial. Prior studies typically limited themselves to assessing outcomes in those who screen positive for depression and agree to enroll in a treatment trial. Other outcomes of importance were depressive symptoms, harms attributable to antidepressant medications, and mortality," Kronish said. "We identified somewhat fewer depressed patients than expected -- 7 percent screened positive for depression. Prior studies suggest that 10 percent have major depression and 20 percent have elevated depressive symptoms, although these prevalences vary widely between studies, in part due to differences in the screening instruments used and the timing of assessments. Symptoms are often higher in the hospital, but at least 50 percent spontaneously remit in the weeks after hospitalization, which is why we waited two months until we conducted depression screening."
The investigators note that excluding patients with a history of depression from the study also likely contributed to a low rate of positive depression screens.
"There were no differences, not even a hint of difference, for any of our outcomes in the screened versus not screened groups. Even the group that was provided with enhanced depression care, comprised of patient-preference (patients could choose problem solving therapy delivered by telephone or antidepressants or both) and stepped care (with careful monitoring of depressive symptoms and titrations of treatments accordingly) did not show a signal for net benefit versus usual care. So basically, depression screening did not appear to lead to a population-level benefit in key patient outcomes," Kronish said. "We certainly do not want clinicians or patients to walk away from our study thinking that identifying and treating depression is not important. Multiple studies have convincingly shown that depression is a risk factor for cardiovascular disease and that depression also has a detrimental impact on a patient's adherence to cardiovascular treatment and quality of life. So, clinicians should continue to be on the lookout for depression in their practice."
Robert Avram, M.D., of the University of California in San Francisco, and colleagues demonstrated that a smartphone application that measures heart rate using a phone's camera may help detect vascular changes tied to diabetes.
"Our study is the first proof-of-concept demonstrating that we can use smartphone-derived photoplethysmography (PPG) signals and deep learning to detect prevalent diabetes," Avram explained.
The investigators found that the model correctly identified people suffering from diabetes in more than 72 percent of the cases (sensitivity) using the PPG signal alone.
"The test had a strong negative predictive value of 97 percent, meaning that out of every 100 participants who were predicted as not having diabetes, 97 truly did not have the disease," Avram said. "When combining the diabetes score with other commonly accessible risk factors for diabetes, such as age, gender, body mass index, and race/ethnicity, the ability to appropriately classify someone as having diabetes improved further, jumping to 81 percent."
These findings were derived using the participant "self-report" of diabetes. The investigators will be validating their findings in a prospective, in-clinic cohort, using glycated hemoglobin levels as an objective measure of effectiveness.
"We hope to put this technology in the hands of consumers as soon as the in-clinic validation is conducted," Avram said. "Our goal is to provide a low-cost and easily accessible screening test for diabetes that would refer participants to a physician if a 'diabetes signal' is found for diagnostic confirmation."
ACC: Photoplethysmography Signal Can Detect Diabetes
FRIDAY, March 8, 2019 -- An application using the photoplethysmography signal, which is readily obtained from smartphones and wearable devices, can detect diabetes, according to a study presented at the annual meeting of the American College of Cardiology, held from March 16 to 18 in New Orleans.
ACC: Robust Evidence Lacking for Many Cardiovascular Guidelines
THURSDAY, March 21, 2019 -- Only a small proportion of recommendations in major cardiovascular society guidelines are supported by evidence from multiple randomized controlled trials (RCTs) or a single large RCT, according to a study published in the March 19 issue of the Journal of the American Medical Association. This cardiovascular medicine theme issue was released early to coincide with the annual meeting of the American College of Cardiology, held from March 16 to 18 in New Orleans.
ACC: Catheter Ablation Does Not Cut Mortality, Stroke in A-Fib
WEDNESDAY, March 20, 2019 -- For patients with atrial fibrillation, catheter ablation does not significantly reduce the risk for death, disabling stroke, serious bleeding, or cardiac arrest, but it does improve quality of life versus medical therapy, according to two studies published online March 15 in the Journal of the American Medical Association. The research was published to coincide with the annual meeting of the American College of Cardiology, held from March 16 to 18 in New Orleans.
ACC: Icosapent Ethyl Beneficial for Statin-Treated Patients
TUESDAY, March 19, 2019 -- For statin-treated patients with elevated triglycerides and established cardiovascular disease or diabetes, icosapent ethyl is associated with a reduced rate of total primary end point events, according to a study published online March 18 in the Journal of the American College of Cardiology. The research was published to coincide with the annual meeting of the American College of Cardiology, held from March 16 to 18 in New Orleans.
ACC: Adherence to Statins Low Among Patients With ASCVD
MONDAY, March 18, 2019 -- Few patients are optimally adherent to statins, although adherence is associated with a reduced risk for major adverse cardiovascular events, according to a study presented at the annual meeting of the American College of Cardiology, held from March 16 to 18 in New Orleans.
ACC: Antibacterial Envelope Can Reduce CIED Infections
MONDAY, March 18, 2019 -- An antibacterial envelope can reduce the incidence of major cardiac implantable electronic device infections, according to a study published online March 17 in the New England Journal of Medicine to coincide with the annual meeting of the American College of Cardiology, held from March 16 to 18 in New Orleans.
ACC: Dietary Cholesterol Ups Cardiovascular Disease Risk
MONDAY, March 18, 2019 -- Higher consumption of dietary cholesterol, including eggs, is significantly associated with a higher risk for incident cardiovascular disease and all-cause mortality, according to a study published in the March 19 issue of the Journal of the American Medical Association. This cardiovascular medicine theme issue was released early to coincide with the annual meeting of the American College of Cardiology, held from March 16 to 18 in New Orleans.
ACC: Long-Term Outcomes for MI Similar at ≤40, 40 to 50
THURSDAY, March 7, 2019 -- Patients with myocardial infarction at age 40 years or younger have similar long-term all-cause and cardiovascular death rates as patients aged older than 40 years, according to a study presented at the annual meeting of the American College of Cardiology, held from March 16 to 18 in New Orleans.
ACC: Ultrasound Surgery May Help Control Blood Pressure
FRIDAY, March 22, 2019 -- The benefits of reduced blood pressure following renal denervation surgery are maintained for at least six months, according to a study published online March 17 in Circulation to coincide with the annual meeting of the American College of Cardiology, held from March 16 to 18 in New Orleans.
ACC: New Guidelines Issued for Primary Prevention of CVD
FRIDAY, March 22, 2019 -- Recommendations have been developed for primary prevention of atherosclerotic cardiovascular disease; the American College of Cardiology/American Heart Association guideline was published online March 17 in Circulation to coincide with presentation at the annual meeting of the American College of Cardiology, held from March 16 to 18 in New Orleans.
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Posted: March 2019