The European Cardiology Arena - In Brief A Round-up of Trends, Statistics and Clinical Research

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Seven-point System Predicts Heart Failure Survival in Elderly

A simple yet 'truly predictiveÔÇÖ system for establishing the seriousness of heart failure in the elderly has been developed. The study, conducted at Washington University School, St. Louis, has resulted in a seven-point system. Based on basic lab tests and routine medical history, the system is designed to establish the likely survival period of elderly patients. Physicians can then better match treatment options to the patientÔÇÖs condition.

The system, which can predict the likelihood of death within six, 12 or 60 months, was based on a study of 282 elderly heart failure patients over periods of up to 14 years. The better the condition of the patient, more invasive treatment options may be considered, such as implanted defibrillators or pacemakers, as the patientÔÇÖs ability to withstand the treatment increases. For patients with low predicted survival time, palliative or hospice care may be prescribed as a more beneficial option.

The seven factors identified by researchers are thought to be particularly relevant to predicting survival periods. Among the seven relevant factors are low sodium in the blood, a history of dementia and peripheral vascular disease, all of which have been shown by previous studies to predict patient mortality. Other possible risk factors such body mass index (BMI) have been excluded, as they fail to predict survival periods. For patients with only one applicable risk factor, their survival period is likely to be five years or more, while patients with four or more are unlikely to live beyond six months. The development of such a system is particularly important in an aging population, where increasing numbers of elderly people are being hospitalised by heart failure. Ôûá

Heart Transplants No Longer the Only Option

In the future, mechanical hearts may eventually be able to restore severely damaged hearts to their normal function. A study by Imperial College London and the Royal Brompton and Harefield NHS Trust has shown that artificial hearts, aided by a combination of drugs, may help hearts to regenerate themselves, so that patients may achieve a 'nearly normalÔÇÖ quality of life.

The mechanical hearts are already in use as an interim solution for patients awaiting heart transplants. The hearts, called left ventricular assist devices (LCADs), work by moving oxygen rich blood from the left ventricle via a mechanical pump to the aorta. Along with the artificial heart, the combination of drugs used encourages reverse modelling of the heart and prevents atrophy and the shrinking of the heart beyond an acceptable size. This regenerative therapy enables the patientÔÇÖs own heart to continue working healthily after the LCAD is removed, with ÔÇ£dramatic, sustained improvementÔÇØ.

In the study, 11 out of 15 patients with severe heart failure who were given the full combination therapy had no reoccurrence of illness within five years. This points to a future in which heart transplantation is no longer the only option for patients with 'end-stageÔÇÖ heart failure. Ôûá

Surgery a Better Option than Stents for Some Patients

Surgery is a safer and more effective treatment than stents for patients who are symptomatic for stroke, according to a French trial. In fact, results were so conclusive that researchers were forced to prematurely end the trial, which involved 527 patients. Results showed that mortality and stroke rates were twice as high for patients fitted with stents, compared with patients who underwent surgery.

The study showed that patients with stents are 11.7% more likely to die or suffer a stroke six months after the procedure compared with 6.1% for those who received endarterectomy surgery.

The results are not applicable to all patient categories, however, since those who are at risk of complications from carotid surgery were excluded from the trial. These include patients with severe heart disease, for whom surgery could trigger a heart attack. A similar US study named SAPPHIRE (Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy) concluded that diabetic patients are also likely to benefit more from stents than surgery, due to the risk of surgery induced heart attack. Ôûá

Grape Seeds Fight Cholesterol

Older women may be protected against the hardening and narrowing of the arteries by taking grape derivatives. Red wine is already widely thought to be beneficial to the cardiovascular system. However, Russian researchers have found that particular grape components can lower cholesterol at the cellular level and ultimately prevent the accumulation of cholesterol.

Six female volunteers were given a variety of grape derivatives obtained in the process of wine production, including ground grape seeds, fermented grape pedicles and dried husks of grapes. The most effective form was dry ethanolic extract from grape seeds, which was found to reduce the cholesterol content of cells by up to 70% within just two hours. Researchers emphasise that grape seeds alone will not produce this effect, so eating whole grapes, with seeds, will have no effect.

This is a promising development, especially for women, for whom the risk of cardiovascular disease increases with age due to falling estrogen levels. Existing hormone replacement therapies are unable to prevent the degeneration of arteries, and have potentially serious side effects. The grape extracts work in a similar way to oestrogens, without the harmful side effects, and have powerful antioxidant properties. Ôûá

Exercise Helps Patients with Severe Pulmonary Hypertension

Moderate exercise, rather than being dangerous, may be beneficial to patients with severe chronic pulmonary hypertension (PH). Researchers at University Heidelberg, Germany, devised a daily training programme which, over the course of 15 weeks, can increase the walking distance of patients by an average 96 metres. The discovery may be especially important since current medications for the management of PH have negative side effects.

The daily exercise programme, which includes bicycle training, walking, dumbbell-training and respiratory training such as yoga, is carried out under hospital supervision for the first three weeks. The patient can then train at home using the specially devised home-training programme, which is supervised by telephone every two weeks.

It was widely believed that exercise increases the risk of heart failure by inflicting excess pressure on the pulmonary arteries. However, this study was able to demonstrate the positive effects of exercise, such as better absorption of oxygen, which promotes both physical and mental well-being. Ôûá

Immediate Results for ItalyÔÇÖs Public Smoking Ban

The number of people being admitted to hospital for heart attacks has fallen dramatically in the five months following ItalyÔÇÖs introduction of a ban on smoking in public spaces. Researchers from the University of Turin, Italy, recorded admission rates between January 2005, when the ban was introduced, and June 2005. The results showed an almost 11% decrease from the same period the previous year.

The study, which covered the Piedmont region of Italy, shows that a ban on public smoking can have immediate results. The results are especially striking as the admission rate for heart attacks had been gradually increasing between 2001 and 2004.

The results, which are only applicable to under 60s, have been directly linked to the decrease in passive smoking, in public spaces, rather than a decrease in active smoking. It is believed that younger people are affected more by passive smoking as they spend more time in smoke-filled spaces such as bars. Although sales and consumption of tobacco did decrease marginally following the ban, the main effect can be seen in a 90% fall in nicotine vapour phase concentration in pubs and discos. Ôûá