News in brief from the world of cardiology
EVINCI study completed
The prevalence of “significant” coronary artery disease in patients with chest pain symptoms is lower than expected in Europe, according to preliminary findings from the The EValuation of INtegrated Cardiac Imaging (EVINCI) study.
Once the final analysis is completed, the EVINCI study is expected to demonstrate that performing adequate non-invasive imaging screening of patients with suspected coronary artery disease could safely avoid invasive procedures in 75 out of 100 patients. The study will have sufficient power to answer the question of which is the most cost-effective non-invasive imaging strategy for the job, authors claim.
Prescribing restrictions hinder best practice for CVD
Local prescribing restrictions are being placed on cholesterol-lowering medications, despite government calls to stop commissioners blacklisting the use of certain guideline approved medicines, according to a survey of over 450 UK GPs, which was sponsored by MSD. Key survey findings include:
93% have been told to switch a patient’s dyslipidaemia medication to a cheaper alternative
68% of GPs feel frustrated by restrictions on their prescribing autonomy and 60% think cost is restricting best medical practice
Of the 63% of GPs who have exception coded patients not reaching cardiovascular disease (CVD) targets with statins alone, 42% cited this as due to local prescribing restrictions or pressure from local authorities
Of the reasons given for exception reporting CVD patients not reaching CVD targets, GPs commonly cite patient intolerance to statins despite alternative types of cholesterol-reducing medication being available
Eplerenone accepted for use in Scotland
Eplerenone (Inspra®, Pfizer) has recently been accepted by the Scottish Medicines Consortium (SMC) for use in adult patients with chronic heart failure NYHA class II, in combination with standard optimal therapy. This follows evidence to support its effectiveness in reducing the risk of hospitalisation and death.
The SMC’s advice on eplerenone is in line with the recent update from the European Society of Cardiology in their guidelines for chronic heart failure, and follows approval in the UK of a new therapeutic indication. Eplerenone is also indicated to treat patients with heart failure and left ventricular ejection fraction ≤40%, after recent myocardial infarction, again alongside standard therapy.
Short-term antiarrhythmic treatment efficacy
Short-term antiarrhythmic drug treatment after cardioversion is nearly as effective in preventing recurrences of atrial fibrillation (AF) as long-term treatment, according to the Flec-SL trial conducted by the German Competence Network on Atrial Fibrillation (AFNET).
More than 600 patients were enrolled in the study, treated with flecainide for either four weeks or six months. At the end of the study, short-term therapy reached about 80% of the effect of long-term therapy.
AF relapses occurred in 120 of 261 patients receiving short-term treatment and only in 103 of 263 patients receiving
Reduced CVD risk for renal patients with combination tablet
An ezetimibe/simvastatin combination tablet (Inegy®, MSD) reduces risk of cardiovascular disease in patients with chronic kidney disease (CKD), according to an updated Summary of Product Characteristics (SPC) from the European Medicines Agency (EMA).
Results from the SHARP study, comparing ezetimibe/simvastatin in combination to placebo in 9,270 patients, demonstrated a 17% relative risk reduction of major atherosclerotic events in hard-to-treat CKD patients. In addition, the EMA also added data from SHARP showing that the product was well tolerated and there was no increase in cancer risk, compared to placebo.
Lower LDL cholesterol with phytosterols
Evidence on the cholesterol-lowering benefits of phytosterols has been positively received by the panel that reviews Disease Risk Reduction Claims (DRRC) for foods in the European Union.
EFSA’s panel concluded that: “plant sterols and stanol esters at a daily intake of 3 g (range 2.6–3.4 g) in matrices approved by Regulation (EC) No 376/2010 (yellow fat spreads, dairy products, mayonnaise and salad dressings) lower LDL-cholesterol by 11.3% (95% CI: 10.0–12.5)”.
The opinion has not yet been ratified by the European Commission, EU Member States and European Parliament.
NCEPOD report on acute care
The importance of early consultant review of patients admitted acutely to hospital has been highlighted by Time to Intervene, a report on in-hospital cardiopulmonary resuscitation (CPR) from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD).
In the study, of the 200 patients who survived the immediate CPR attempt, only 85 survived to hospital discharge. The survival rate to discharge was much lower – 8% – in cardiac arrests secondary to non-cardiac disease.
Consultant physicians should be at the forefront of delivering high quality care to acutely unwell patients seven days a week, said the Royal College of Physicians (RCP) in a statement welcoming the report. Consultants should be involved in decisions to escalate treatment or transfer care to the intensive care unit for those patients who fail to respond to initial treatment or deteriorate, they said.
In July, the RCP launched a National Early Warning Score, which will alert doctors and nurses of when a patient is deteriorating and trigger a consistent approach to the escalation of their care, including the involvement of senior doctors.
Read the full report at http://www.ncepod.org.uk/2012cap.htm
New indication for single pill hypertension treatment
A pill combining olmesartan medoxomil, amlodipine, and hydrochlorothiazide (Sevikar HCT,® Daiichi Sankyo) has been granted an additional license indication. It is now indicated for the treatment of hypertensive adults whose blood pressure remains uncontrolled on a combination of olmesartan medoxomil and amlodipine.
The safety of the triple combination was investigated in clinical trials in 7,826 patients receiving olmesartan medoxomil in combination with amlodipine and hydrochlorothiazide. The most commonly reported adverse reactions during treatment were peripheral oedema, headache and dizziness.
Public alerted to sudden cardiac arrest
An online campaign has recently been launched which aims to inform the general public about the dangers of sudden cardiac arrest, at www.SaveLives.net (Royal Philips Electronics).
The site aims to educate people on the importance of acting quickly when someone suffers from a sudden cardiac arrest. It includes advice on the use of automated external defibrillators (AED), and their correct use with cardiopulmonary resuscitation (CPR). It features real life survivor stories, and an interactive walkthrough on defibrillation and CPR.
‘Bad’ dieting increases cardiovascular risk
The increasing popularity of a low carbohydrate diet was paralleled by an increase in cholesterol levels, according to a 25 year study in Northern Sweden published recently in BioMed Central’s open access Nutrition Journal.
After 2005 the amount of complex carbohydrates eaten was found to have decreased, while the levels of total and saturated fat intake began to increase, the timing of which matched the promotion of low glycaemic index diets in the media. Consequently cholesterol levels began to increase, despite the introduction of cholesterol lowering medication.
Lead author Professor Ingegerd Johansson commented: “The association between nutrition and health is complex…While low carbohydrate/high fat diets may help short term weight loss, the results of this Swedish study demonstrate that long-term weight loss is not maintained and that this diet increases blood cholesterol which has a major impact on risk of cardiovascular disease”.
Cardiac damage in obese teens without CVD
Obese adolescents with no symptoms
of cardiovascular disease (CVD) already have cardiac damage, according to findings presented at the Heart Failure Congress 2012, held recently in Belgrade, Serbia.
The study investigated the relationship between body mass index (BMI) and cardiac function in 97 healthy adolescents, categorised as lean, overweight and obese. Obese adolescents with no symptoms of heart disease were found to have damaged hearts with thicker walls. The systolic and diastolic function of their hearts was also impaired. Both structural and functional measures correlated with BMI.
“Education on healthy food and exercise is needed in schools to prevent obesity and early CVD in adolescents,” says lead author Professor Gani Bajraktari (University of Pristina, Kosovo). “This is an important step in preventing obesity and cardiovascular disease in adults”.
NICE announces new 2013/14 QOF menu
NICE has recently published a set of new proposed indicators for the 2013/14 Quality and Outcomes Framework (QOF).
There are four new indicators on rheumatoid arthritis (RA) which cover practices producing a register of all patients aged 16 years and over with RA, and patients with RA being assessed for cardiovascular risk and fracture risk. There are also indicators on offering patients with heart failure and chronic obstructive pulmonary disease (COPD) rehabilitation programmes, and further proposed indicators on hypertension.
Final QOF indicators will be published later this winter. The Committee’s recommendations on these topics, as well as the proposed 2013/14 menu of indicators, are available at: www.nice.org.uk/aboutnice/qof/Recommendationsindicatorretirement.jsp