Pauline Anderson

A device that stimulates the median nerve and a D1 receptor antagonist are among the promising new treatment approaches for patients with Tourette syndrome (TS), according to an overview of new therapies presented at the XXVI World Congress of Neurology.

One recent study by University of Nottingham researchers showed a wrist-worn stimulating device significantly reduces the frequency and severity of tics – repetitive movements or vocalizations that can occur several times a day.

“Wearable nerve stimulation holds great promise because it will be good across the age spectrum; adults can wear it to work, and children can go to school with it to help them concentrate on their schoolwork, and then they take it off at night,” Eileen Joyce, PhD, MB BChir, professor of neuropsychiatry at the Institute of Neurology, University College London, told this news organization.

Dr. Joyce, who was not part of the study, discussed this and other new advances in tic therapy at the meeting.

About 24% of children will suffer from tics at some point. The prevalence of Tourette syndrome among males is about four times that of females, Dr. Joyce told delegates. She added the typical age of onset is about 7 years with peak severity at about 12 years.

Predictors of tics persisting into adulthood include comorbid attention deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder, and autism spectrum disorder, said Dr. Joyce, who also discussed the “highly heritable” nature of the syndrome and the numerous related genes identified to date.
 

Current and emerging treatments

Current treatments include psychological therapy, Botox for focal tics, and medications such as antipsychotics. Emerging therapies included deep brain stimulation and the new median nerve stimulation approach.

A study published  earlier this year included 135 patients with moderate to severe tic disorder who were randomly assigned to receive the investigational neuromodulation treatment, a sham treatment, or a wait-list treatment group.

The intervention involves rhythmic pulse trains of median nerve stimulation delivered via a device worn at the wrist. The device was programmed to deliver rhythmic (10 Hz) trains of low-intensity (1-19 mA) electrical stimulation to the median nerve at home once daily, 5 days a week for 4 weeks.

At 4 weeks, tic severity, as measured by the Yale Global Tic Severity Scale-Total Tic Severity Score (YGTSS-TTSS), was reduced by 7.1 points (35% reduction) in the active stimulation group compared to 2.13 points in the sham and 2.11 points in wait-list control groups.

The reduction for active stimulation was substantially larger, clinically meaningful (effect size, 0.5), and statistically significant (P = .02) compared to both the sham stimulation and wait-list control groups, which did not differ from one another.

Tic frequency (tics per minute or TPM) was reduced more in the active than sham stimulation groups (−15.6 TPM vs. −7.7 TPM; P < .03) and the reduction in tic frequency was clinically meaningful (>25% reduction; effect-size, 0.3).

When the active stimulator was turned off, the tics worsened, noted Dr. Joyce.

“The study showed that if you stimulate the median nerve at the wrist, you can train brain oscillations that are linked to the suppression of movement,” Dr. Joyce said. “So based on physiological knowledge, they have developed a median nerve stimulator to entrain cortical rhythms.”
 

Simple and exciting

The new device is “really exciting”, she added. “It’s not invasive and is quite simple to use and could help a lot of people with Tourette syndrome.”

Asked to comment, Alan Carson, MD, consultant neuropsychiatrist and honorary professor of neuropsychiatry, University of Edinburgh, who co-chaired the neuropsychiatry session featuring this presentation, called the device “promising.”

“Deep brain stimulation appears to be very effective but it’s a major procedure, so a simple wearable device seems highly desirable,” Dr. Carson said.

Dr. Joyce also discussed a study on the efficacy of cannabis (nabiximols; Sativex) as an intervention for tic management in males, those with severe tics, and those with comorbid ADHD.

And a new oral medication, ecopipam, a highly selective D1 receptor antagonist, is also raising hopes, said Dr. Joyce, with results from a randomized controlled trial  showing the drug significantly improved tics and had few adverse effects.

Dr. Joyce and Dr. Carson report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

A device that stimulates the median nerve and a D1 receptor antagonist are among the promising new treatment approaches for patients with Tourette syndrome (TS), according to an overview of new therapies presented at the XXVI World Congress of Neurology.

One recent study by University of Nottingham researchers showed a wrist-worn stimulating device significantly reduces the frequency and severity of tics – repetitive movements or vocalizations that can occur several times a day.

“Wearable nerve stimulation holds great promise because it will be good across the age spectrum; adults can wear it to work, and children can go to school with it to help them concentrate on their schoolwork, and then they take it off at night,” Eileen Joyce, PhD, MB BChir, professor of neuropsychiatry at the Institute of Neurology, University College London, told this news organization.

Dr. Joyce, who was not part of the study, discussed this and other new advances in tic therapy at the meeting.

About 24% of children will suffer from tics at some point. The prevalence of Tourette syndrome among males is about four times that of females, Dr. Joyce told delegates. She added the typical age of onset is about 7 years with peak severity at about 12 years.

Predictors of tics persisting into adulthood include comorbid attention deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder, and autism spectrum disorder, said Dr. Joyce, who also discussed the “highly heritable” nature of the syndrome and the numerous related genes identified to date.
 

Current and emerging treatments

Current treatments include psychological therapy, Botox for focal tics, and medications such as antipsychotics. Emerging therapies included deep brain stimulation and the new median nerve stimulation approach.

A study published  earlier this year included 135 patients with moderate to severe tic disorder who were randomly assigned to receive the investigational neuromodulation treatment, a sham treatment, or a wait-list treatment group.

The intervention involves rhythmic pulse trains of median nerve stimulation delivered via a device worn at the wrist. The device was programmed to deliver rhythmic (10 Hz) trains of low-intensity (1-19 mA) electrical stimulation to the median nerve at home once daily, 5 days a week for 4 weeks.

At 4 weeks, tic severity, as measured by the Yale Global Tic Severity Scale-Total Tic Severity Score (YGTSS-TTSS), was reduced by 7.1 points (35% reduction) in the active stimulation group compared to 2.13 points in the sham and 2.11 points in wait-list control groups.

The reduction for active stimulation was substantially larger, clinically meaningful (effect size, 0.5), and statistically significant (P = .02) compared to both the sham stimulation and wait-list control groups, which did not differ from one another.

Tic frequency (tics per minute or TPM) was reduced more in the active than sham stimulation groups (−15.6 TPM vs. −7.7 TPM; P < .03) and the reduction in tic frequency was clinically meaningful (>25% reduction; effect-size, 0.3).

When the active stimulator was turned off, the tics worsened, noted Dr. Joyce.

“The study showed that if you stimulate the median nerve at the wrist, you can train brain oscillations that are linked to the suppression of movement,” Dr. Joyce said. “So based on physiological knowledge, they have developed a median nerve stimulator to entrain cortical rhythms.”
 

Simple and exciting

The new device is “really exciting”, she added. “It’s not invasive and is quite simple to use and could help a lot of people with Tourette syndrome.”

Asked to comment, Alan Carson, MD, consultant neuropsychiatrist and honorary professor of neuropsychiatry, University of Edinburgh, who co-chaired the neuropsychiatry session featuring this presentation, called the device “promising.”

“Deep brain stimulation appears to be very effective but it’s a major procedure, so a simple wearable device seems highly desirable,” Dr. Carson said.

Dr. Joyce also discussed a study on the efficacy of cannabis (nabiximols; Sativex) as an intervention for tic management in males, those with severe tics, and those with comorbid ADHD.

And a new oral medication, ecopipam, a highly selective D1 receptor antagonist, is also raising hopes, said Dr. Joyce, with results from a randomized controlled trial  showing the drug significantly improved tics and had few adverse effects.

Dr. Joyce and Dr. Carson report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

A device that stimulates the median nerve and a D1 receptor antagonist are among the promising new treatment approaches for patients with Tourette syndrome (TS), according to an overview of new therapies presented at the XXVI World Congress of Neurology.

One recent study by University of Nottingham researchers showed a wrist-worn stimulating device significantly reduces the frequency and severity of tics – repetitive movements or vocalizations that can occur several times a day.

“Wearable nerve stimulation holds great promise because it will be good across the age spectrum; adults can wear it to work, and children can go to school with it to help them concentrate on their schoolwork, and then they take it off at night,” Eileen Joyce, PhD, MB BChir, professor of neuropsychiatry at the Institute of Neurology, University College London, told this news organization.

Dr. Joyce, who was not part of the study, discussed this and other new advances in tic therapy at the meeting.

About 24% of children will suffer from tics at some point. The prevalence of Tourette syndrome among males is about four times that of females, Dr. Joyce told delegates. She added the typical age of onset is about 7 years with peak severity at about 12 years.

Predictors of tics persisting into adulthood include comorbid attention deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder, and autism spectrum disorder, said Dr. Joyce, who also discussed the “highly heritable” nature of the syndrome and the numerous related genes identified to date.
 

Current and emerging treatments

Current treatments include psychological therapy, Botox for focal tics, and medications such as antipsychotics. Emerging therapies included deep brain stimulation and the new median nerve stimulation approach.

A study published  earlier this year included 135 patients with moderate to severe tic disorder who were randomly assigned to receive the investigational neuromodulation treatment, a sham treatment, or a wait-list treatment group.

The intervention involves rhythmic pulse trains of median nerve stimulation delivered via a device worn at the wrist. The device was programmed to deliver rhythmic (10 Hz) trains of low-intensity (1-19 mA) electrical stimulation to the median nerve at home once daily, 5 days a week for 4 weeks.

At 4 weeks, tic severity, as measured by the Yale Global Tic Severity Scale-Total Tic Severity Score (YGTSS-TTSS), was reduced by 7.1 points (35% reduction) in the active stimulation group compared to 2.13 points in the sham and 2.11 points in wait-list control groups.

The reduction for active stimulation was substantially larger, clinically meaningful (effect size, 0.5), and statistically significant (P = .02) compared to both the sham stimulation and wait-list control groups, which did not differ from one another.

Tic frequency (tics per minute or TPM) was reduced more in the active than sham stimulation groups (−15.6 TPM vs. −7.7 TPM; P < .03) and the reduction in tic frequency was clinically meaningful (>25% reduction; effect-size, 0.3).

When the active stimulator was turned off, the tics worsened, noted Dr. Joyce.

“The study showed that if you stimulate the median nerve at the wrist, you can train brain oscillations that are linked to the suppression of movement,” Dr. Joyce said. “So based on physiological knowledge, they have developed a median nerve stimulator to entrain cortical rhythms.”
 

Simple and exciting

The new device is “really exciting”, she added. “It’s not invasive and is quite simple to use and could help a lot of people with Tourette syndrome.”

Asked to comment, Alan Carson, MD, consultant neuropsychiatrist and honorary professor of neuropsychiatry, University of Edinburgh, who co-chaired the neuropsychiatry session featuring this presentation, called the device “promising.”

“Deep brain stimulation appears to be very effective but it’s a major procedure, so a simple wearable device seems highly desirable,” Dr. Carson said.

Dr. Joyce also discussed a study on the efficacy of cannabis (nabiximols; Sativex) as an intervention for tic management in males, those with severe tics, and those with comorbid ADHD.

And a new oral medication, ecopipam, a highly selective D1 receptor antagonist, is also raising hopes, said Dr. Joyce, with results from a randomized controlled trial  showing the drug significantly improved tics and had few adverse effects.

Dr. Joyce and Dr. Carson report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

TOPLINE:

Tongxinluo, a traditional Chinese medicine made from extracts of multiple plants and insects, significantly reduced myocardial infarction (MI), stroke, and related events when used alongside guideline-directed treatments in patients with ST-segment elevation myocardial infarction (STEMI), results of a large trial suggest.

METHODOLOGY:

• The double-blind China Tongxinluo Study for Myocardial Protection in Patients With Acute Myocardial Infarction (CTS-AMI) included 3,777 adult patients, mean age 61 years, 76.9% men, with STEMI at 124 centers in China.
• Researchers randomly assigned patients to receive oral Tongxinluo using a loading dose of eight capsules (2.08 g) followed by a maintenance dose of four capsules (1.04 g) or oral placebo three times a day for 12 months.
• Doctors were instructed to also provide STEMI guideline-directed treatments, which include dual antiplatelet therapy and coronary reperfusion (percutaneous coronary intervention or thrombolysis).
• The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs) at 30 days, a composite of cardiac death, myocardial reinfarction, emergent coronary revascularization, and stroke.

TAKEAWAY:

• At 30 days, 3.4% in the Tongxinluo group and 5.2% in the placebo group had a MACCE (relative risk, 0.64; 95% confidence interval, 0.47-0.88; risk difference, –1.8%; 95% CI, –3.2% to –0.6%; P = .006).
• Individual components of MACCEs were also significantly lower in the Tongxinluo group, including 30-day cardiac death (3.0% vs. 4.2%; RR, 0.70; 95% CI, 0.50-0.99; P = .04) and myocardial reinfarction (0% vs. 0.5%; RR, 0.35; 95% CI, 0.13-0.99; P = .003), but there was no significant difference in 30-day stroke rate.
• At 1 year, the Tongxinluo group had a lower MACCE rate than did the placebo group (5.3% vs. 8.3%; hazard ratio, 0.64; 95% CI, 0.49-0.82; P = .001), an almost significant lower rate of all-cause death (5.1% vs. 6.6%; HR, 0.77; 95% CI, 0.59-1.01; P = .06), and lower rates of other outcomes.
• Rates of nonfatal serious adverse events were similar (2.2% in the Tongxinluo and 2.8% in the placebo groups; P = .25), but the Tongxinluo group had more adverse drug reactions (2.1% vs 1.1%; P = .02), which were mainly driven by symptoms in the digestive system such as stomach discomfort and nausea.

IN PRACTICE:

Unlike most traditional Chinese medicine research, the design of this study incorporated all key elements of randomized clinical trials, including placebo control and blinding in addition to randomization, so it “may serve as a model for future clinical trials to evaluate the safety and efficacy of traditional Chinese medicine,” the authors conclude.

In an accompanying editorial, Richard G. Bach, MD, cardiovascular division, Washington University School of Medicine, St. Louis, expressed skepticism about whether the benefits of Tongxinluo can be extrapolated to populations outside China that have distinct genetic backgrounds, lipid profiles, and diets. He also stressed that the active ingredients and mechanisms of action of Tongxinluo are unknown and noted reports suggesting that traditional Chinese medicines can contain undeclared material, heavy metals, and other adulterants associated with potentially toxic effects.

In an Editor’s Note, Gregory Curfman, MD, said in making a judgment about the validity of this research, “the editors were faced with the task of walking a fine line between skepticism and plausibility.” Though all patients should receive beta-blockers and an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker after STEMI, use of these drugs was suboptimal in these patients. Still, the benefits of Chinese medicine are plausible, said Dr. Curfman, noting research on the malaria drug artemisinin, which was isolated from a traditional Chinese medicine, was awarded the Nobel Prize.

SOURCE:

The research was led by Yuejin Yang, MD, PhD, department of cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, and colleagues. It was published online on Oct. 24 in JAMA. The results were previously reported at the American Heart Association Scientific Sessions 2022.

LIMITATIONS:

Despite the demonstrated clinical benefit of Tongxinluo, its active ingredients and the exact mechanisms of action have not been established. Use of guideline-directed medical therapy was suboptimal, with only 64% of patients prescribed beta-blockers and 51%-52% prescribed an ACE inhibitor or ARB during hospitalization, which may have affected the magnitude of the benefit of Tongxinluo. As study patients were all Chinese, the generalizability to other populations, especially in countries with higher adherence to guideline-directed medical therapy, is unknown.

DISCLOSURES:

The study received funding from the National Key Research and Development Program of China and a research grant from Shijiazhuang Yiling Pharmaceutical. Yuejin Yang reported receiving grants from Shijiazhuang Yiling Pharmaceutical and the National Key Research and Development Program of China; in addition, he has a patent related to the mechanisms of Tongxinluo in alleviating rat myocardial reperfusion injury and a patent related to the mechanisms of Tongxinluo on enhancing the protective effects of exosomes derived from mesenchymal stem cells in rat acute myocardial infarction. See paper for disclosures of other authors.

A version of this article first appeared on Medscape.com.

TOPLINE:

Tongxinluo, a traditional Chinese medicine made from extracts of multiple plants and insects, significantly reduced myocardial infarction (MI), stroke, and related events when used alongside guideline-directed treatments in patients with ST-segment elevation myocardial infarction (STEMI), results of a large trial suggest.

METHODOLOGY:

• The double-blind China Tongxinluo Study for Myocardial Protection in Patients With Acute Myocardial Infarction (CTS-AMI) included 3,777 adult patients, mean age 61 years, 76.9% men, with STEMI at 124 centers in China.
• Researchers randomly assigned patients to receive oral Tongxinluo using a loading dose of eight capsules (2.08 g) followed by a maintenance dose of four capsules (1.04 g) or oral placebo three times a day for 12 months.
• Doctors were instructed to also provide STEMI guideline-directed treatments, which include dual antiplatelet therapy and coronary reperfusion (percutaneous coronary intervention or thrombolysis).
• The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs) at 30 days, a composite of cardiac death, myocardial reinfarction, emergent coronary revascularization, and stroke.

TAKEAWAY:

• At 30 days, 3.4% in the Tongxinluo group and 5.2% in the placebo group had a MACCE (relative risk, 0.64; 95% confidence interval, 0.47-0.88; risk difference, –1.8%; 95% CI, –3.2% to –0.6%; P = .006).
• Individual components of MACCEs were also significantly lower in the Tongxinluo group, including 30-day cardiac death (3.0% vs. 4.2%; RR, 0.70; 95% CI, 0.50-0.99; P = .04) and myocardial reinfarction (0% vs. 0.5%; RR, 0.35; 95% CI, 0.13-0.99; P = .003), but there was no significant difference in 30-day stroke rate.
• At 1 year, the Tongxinluo group had a lower MACCE rate than did the placebo group (5.3% vs. 8.3%; hazard ratio, 0.64; 95% CI, 0.49-0.82; P = .001), an almost significant lower rate of all-cause death (5.1% vs. 6.6%; HR, 0.77; 95% CI, 0.59-1.01; P = .06), and lower rates of other outcomes.
• Rates of nonfatal serious adverse events were similar (2.2% in the Tongxinluo and 2.8% in the placebo groups; P = .25), but the Tongxinluo group had more adverse drug reactions (2.1% vs 1.1%; P = .02), which were mainly driven by symptoms in the digestive system such as stomach discomfort and nausea.

IN PRACTICE:

Unlike most traditional Chinese medicine research, the design of this study incorporated all key elements of randomized clinical trials, including placebo control and blinding in addition to randomization, so it “may serve as a model for future clinical trials to evaluate the safety and efficacy of traditional Chinese medicine,” the authors conclude.

In an accompanying editorial, Richard G. Bach, MD, cardiovascular division, Washington University School of Medicine, St. Louis, expressed skepticism about whether the benefits of Tongxinluo can be extrapolated to populations outside China that have distinct genetic backgrounds, lipid profiles, and diets. He also stressed that the active ingredients and mechanisms of action of Tongxinluo are unknown and noted reports suggesting that traditional Chinese medicines can contain undeclared material, heavy metals, and other adulterants associated with potentially toxic effects.

In an Editor’s Note, Gregory Curfman, MD, said in making a judgment about the validity of this research, “the editors were faced with the task of walking a fine line between skepticism and plausibility.” Though all patients should receive beta-blockers and an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker after STEMI, use of these drugs was suboptimal in these patients. Still, the benefits of Chinese medicine are plausible, said Dr. Curfman, noting research on the malaria drug artemisinin, which was isolated from a traditional Chinese medicine, was awarded the Nobel Prize.

SOURCE:

The research was led by Yuejin Yang, MD, PhD, department of cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, and colleagues. It was published online on Oct. 24 in JAMA. The results were previously reported at the American Heart Association Scientific Sessions 2022.

LIMITATIONS:

Despite the demonstrated clinical benefit of Tongxinluo, its active ingredients and the exact mechanisms of action have not been established. Use of guideline-directed medical therapy was suboptimal, with only 64% of patients prescribed beta-blockers and 51%-52% prescribed an ACE inhibitor or ARB during hospitalization, which may have affected the magnitude of the benefit of Tongxinluo. As study patients were all Chinese, the generalizability to other populations, especially in countries with higher adherence to guideline-directed medical therapy, is unknown.

DISCLOSURES:

The study received funding from the National Key Research and Development Program of China and a research grant from Shijiazhuang Yiling Pharmaceutical. Yuejin Yang reported receiving grants from Shijiazhuang Yiling Pharmaceutical and the National Key Research and Development Program of China; in addition, he has a patent related to the mechanisms of Tongxinluo in alleviating rat myocardial reperfusion injury and a patent related to the mechanisms of Tongxinluo on enhancing the protective effects of exosomes derived from mesenchymal stem cells in rat acute myocardial infarction. See paper for disclosures of other authors.

A version of this article first appeared on Medscape.com.

TOPLINE:

Tongxinluo, a traditional Chinese medicine made from extracts of multiple plants and insects, significantly reduced myocardial infarction (MI), stroke, and related events when used alongside guideline-directed treatments in patients with ST-segment elevation myocardial infarction (STEMI), results of a large trial suggest.

METHODOLOGY:

• The double-blind China Tongxinluo Study for Myocardial Protection in Patients With Acute Myocardial Infarction (CTS-AMI) included 3,777 adult patients, mean age 61 years, 76.9% men, with STEMI at 124 centers in China.
• Researchers randomly assigned patients to receive oral Tongxinluo using a loading dose of eight capsules (2.08 g) followed by a maintenance dose of four capsules (1.04 g) or oral placebo three times a day for 12 months.
• Doctors were instructed to also provide STEMI guideline-directed treatments, which include dual antiplatelet therapy and coronary reperfusion (percutaneous coronary intervention or thrombolysis).
• The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs) at 30 days, a composite of cardiac death, myocardial reinfarction, emergent coronary revascularization, and stroke.

TAKEAWAY:

• At 30 days, 3.4% in the Tongxinluo group and 5.2% in the placebo group had a MACCE (relative risk, 0.64; 95% confidence interval, 0.47-0.88; risk difference, –1.8%; 95% CI, –3.2% to –0.6%; P = .006).
• Individual components of MACCEs were also significantly lower in the Tongxinluo group, including 30-day cardiac death (3.0% vs. 4.2%; RR, 0.70; 95% CI, 0.50-0.99; P = .04) and myocardial reinfarction (0% vs. 0.5%; RR, 0.35; 95% CI, 0.13-0.99; P = .003), but there was no significant difference in 30-day stroke rate.
• At 1 year, the Tongxinluo group had a lower MACCE rate than did the placebo group (5.3% vs. 8.3%; hazard ratio, 0.64; 95% CI, 0.49-0.82; P = .001), an almost significant lower rate of all-cause death (5.1% vs. 6.6%; HR, 0.77; 95% CI, 0.59-1.01; P = .06), and lower rates of other outcomes.
• Rates of nonfatal serious adverse events were similar (2.2% in the Tongxinluo and 2.8% in the placebo groups; P = .25), but the Tongxinluo group had more adverse drug reactions (2.1% vs 1.1%; P = .02), which were mainly driven by symptoms in the digestive system such as stomach discomfort and nausea.

IN PRACTICE:

Unlike most traditional Chinese medicine research, the design of this study incorporated all key elements of randomized clinical trials, including placebo control and blinding in addition to randomization, so it “may serve as a model for future clinical trials to evaluate the safety and efficacy of traditional Chinese medicine,” the authors conclude.

In an accompanying editorial, Richard G. Bach, MD, cardiovascular division, Washington University School of Medicine, St. Louis, expressed skepticism about whether the benefits of Tongxinluo can be extrapolated to populations outside China that have distinct genetic backgrounds, lipid profiles, and diets. He also stressed that the active ingredients and mechanisms of action of Tongxinluo are unknown and noted reports suggesting that traditional Chinese medicines can contain undeclared material, heavy metals, and other adulterants associated with potentially toxic effects.

In an Editor’s Note, Gregory Curfman, MD, said in making a judgment about the validity of this research, “the editors were faced with the task of walking a fine line between skepticism and plausibility.” Though all patients should receive beta-blockers and an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker after STEMI, use of these drugs was suboptimal in these patients. Still, the benefits of Chinese medicine are plausible, said Dr. Curfman, noting research on the malaria drug artemisinin, which was isolated from a traditional Chinese medicine, was awarded the Nobel Prize.

SOURCE:

The research was led by Yuejin Yang, MD, PhD, department of cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, and colleagues. It was published online on Oct. 24 in JAMA. The results were previously reported at the American Heart Association Scientific Sessions 2022.

LIMITATIONS:

Despite the demonstrated clinical benefit of Tongxinluo, its active ingredients and the exact mechanisms of action have not been established. Use of guideline-directed medical therapy was suboptimal, with only 64% of patients prescribed beta-blockers and 51%-52% prescribed an ACE inhibitor or ARB during hospitalization, which may have affected the magnitude of the benefit of Tongxinluo. As study patients were all Chinese, the generalizability to other populations, especially in countries with higher adherence to guideline-directed medical therapy, is unknown.

DISCLOSURES:

The study received funding from the National Key Research and Development Program of China and a research grant from Shijiazhuang Yiling Pharmaceutical. Yuejin Yang reported receiving grants from Shijiazhuang Yiling Pharmaceutical and the National Key Research and Development Program of China; in addition, he has a patent related to the mechanisms of Tongxinluo in alleviating rat myocardial reperfusion injury and a patent related to the mechanisms of Tongxinluo on enhancing the protective effects of exosomes derived from mesenchymal stem cells in rat acute myocardial infarction. See paper for disclosures of other authors.

A version of this article first appeared on Medscape.com.

TOPLINE:

New Canadian guidelines for the management of high-risk drinking and alcohol use disorder (AUD) include 15 recommendations on screening, diagnosis, withdrawal management, and ongoing treatment including psychosocial interventions, drug therapies, and community-based programs.

METHODOLOGY:

• The Canadian Research Initiative in Substance Misuse convened a 36-member committee of clinicians, researchers, people with personal experience of alcohol use, and Indigenous or Métis individuals to develop the guidelines, using the Appraisal of Guidelines for Research and Evaluation Instrument.
• Risk assessment was based on Alcohol Use Disorders Identification Test-Consumption scores.
• The definition of AUD was based on patients experiencing “clinically significant impairment or distress” from their alcohol use, with severity being mild, moderate, or severe.

TAKEAWAY:

• All adult and youth patients at moderate or high risk for AUD should be screened annually for alcohol use, and those screening positive should receive a diagnostic interview for AUD and an individualized treatment plan.
• Assessment of severe alcohol withdrawal complications should include clinical parameters such as past seizures or delirium tremens and the Prediction of Alcohol Withdrawal Severity Scale, with treatment including nonbenzodiazepine medications for low-risk patients and a short-term benzodiazepine prescription for high-risk patients, ideally in an inpatient setting.
• All patients with AUD should be referred for psychosocial treatment, and those with moderate to severe AUD should be offered naltrexone, acamprosate, topiramate, or gabapentin, depending on contraindications and effectiveness.
• Antipsychotics or SSRI antidepressants have little benefit and may worsen outcomes and should not be prescribed for AUD.

IN PRACTICE:

The authors noted that more than half of people aged 15 years or older in Canada drink more than the recommended amount, and about 18% meet the definition for AUD. “The aim of this guideline is to support primary care providers and services to offer more effective treatments routinely to patients with AUD as the standard of practice, with resulting improvements in health as well as potential for considerable cost savings in health and social systems,” the investigators write. They also note that policy makers can substantially improve standards of care by promoting adoption of the guideline and its recommendations.

SOURCE:

The article was written by Evan Wood, MD, PhD, professor of medicine, University of British Columbia, Vancouver, and colleagues. It was published online in the Canadian Medical Association Journal.

LIMITATIONS:

The guideline was published more than 3 years after the initial literature search in September 2020 and did not include comprehensive guidance for AUD with co-occurring substance use disorders or with severe mental health conditions. Certain groups, including immigrant and refugee populations, were not represented.

DISCLOSURES:

Development of the guideline received support from Health Canada’s Substance Use and Addictions Program, Canadian Institutes of Health Research, and BC Centre on Substance Use. No committee members disclosed direct monetary or nonmonetary support from alcohol or pharmaceutical industry sources within the past 5 years, or that their clinical revenue would be influenced by the guideline recommendations.

A version of this article first appeared on Medscape.com.

TOPLINE:

New Canadian guidelines for the management of high-risk drinking and alcohol use disorder (AUD) include 15 recommendations on screening, diagnosis, withdrawal management, and ongoing treatment including psychosocial interventions, drug therapies, and community-based programs.

METHODOLOGY:

• The Canadian Research Initiative in Substance Misuse convened a 36-member committee of clinicians, researchers, people with personal experience of alcohol use, and Indigenous or Métis individuals to develop the guidelines, using the Appraisal of Guidelines for Research and Evaluation Instrument.
• Risk assessment was based on Alcohol Use Disorders Identification Test-Consumption scores.
• The definition of AUD was based on patients experiencing “clinically significant impairment or distress” from their alcohol use, with severity being mild, moderate, or severe.

TAKEAWAY:

• All adult and youth patients at moderate or high risk for AUD should be screened annually for alcohol use, and those screening positive should receive a diagnostic interview for AUD and an individualized treatment plan.
• Assessment of severe alcohol withdrawal complications should include clinical parameters such as past seizures or delirium tremens and the Prediction of Alcohol Withdrawal Severity Scale, with treatment including nonbenzodiazepine medications for low-risk patients and a short-term benzodiazepine prescription for high-risk patients, ideally in an inpatient setting.
• All patients with AUD should be referred for psychosocial treatment, and those with moderate to severe AUD should be offered naltrexone, acamprosate, topiramate, or gabapentin, depending on contraindications and effectiveness.
• Antipsychotics or SSRI antidepressants have little benefit and may worsen outcomes and should not be prescribed for AUD.

IN PRACTICE:

The authors noted that more than half of people aged 15 years or older in Canada drink more than the recommended amount, and about 18% meet the definition for AUD. “The aim of this guideline is to support primary care providers and services to offer more effective treatments routinely to patients with AUD as the standard of practice, with resulting improvements in health as well as potential for considerable cost savings in health and social systems,” the investigators write. They also note that policy makers can substantially improve standards of care by promoting adoption of the guideline and its recommendations.

SOURCE:

The article was written by Evan Wood, MD, PhD, professor of medicine, University of British Columbia, Vancouver, and colleagues. It was published online in the Canadian Medical Association Journal.

LIMITATIONS:

The guideline was published more than 3 years after the initial literature search in September 2020 and did not include comprehensive guidance for AUD with co-occurring substance use disorders or with severe mental health conditions. Certain groups, including immigrant and refugee populations, were not represented.

DISCLOSURES:

Development of the guideline received support from Health Canada’s Substance Use and Addictions Program, Canadian Institutes of Health Research, and BC Centre on Substance Use. No committee members disclosed direct monetary or nonmonetary support from alcohol or pharmaceutical industry sources within the past 5 years, or that their clinical revenue would be influenced by the guideline recommendations.

A version of this article first appeared on Medscape.com.

TOPLINE:

New Canadian guidelines for the management of high-risk drinking and alcohol use disorder (AUD) include 15 recommendations on screening, diagnosis, withdrawal management, and ongoing treatment including psychosocial interventions, drug therapies, and community-based programs.

METHODOLOGY:

• The Canadian Research Initiative in Substance Misuse convened a 36-member committee of clinicians, researchers, people with personal experience of alcohol use, and Indigenous or Métis individuals to develop the guidelines, using the Appraisal of Guidelines for Research and Evaluation Instrument.
• Risk assessment was based on Alcohol Use Disorders Identification Test-Consumption scores.
• The definition of AUD was based on patients experiencing “clinically significant impairment or distress” from their alcohol use, with severity being mild, moderate, or severe.

TAKEAWAY:

• All adult and youth patients at moderate or high risk for AUD should be screened annually for alcohol use, and those screening positive should receive a diagnostic interview for AUD and an individualized treatment plan.
• Assessment of severe alcohol withdrawal complications should include clinical parameters such as past seizures or delirium tremens and the Prediction of Alcohol Withdrawal Severity Scale, with treatment including nonbenzodiazepine medications for low-risk patients and a short-term benzodiazepine prescription for high-risk patients, ideally in an inpatient setting.
• All patients with AUD should be referred for psychosocial treatment, and those with moderate to severe AUD should be offered naltrexone, acamprosate, topiramate, or gabapentin, depending on contraindications and effectiveness.
• Antipsychotics or SSRI antidepressants have little benefit and may worsen outcomes and should not be prescribed for AUD.

IN PRACTICE:

The authors noted that more than half of people aged 15 years or older in Canada drink more than the recommended amount, and about 18% meet the definition for AUD. “The aim of this guideline is to support primary care providers and services to offer more effective treatments routinely to patients with AUD as the standard of practice, with resulting improvements in health as well as potential for considerable cost savings in health and social systems,” the investigators write. They also note that policy makers can substantially improve standards of care by promoting adoption of the guideline and its recommendations.

SOURCE:

The article was written by Evan Wood, MD, PhD, professor of medicine, University of British Columbia, Vancouver, and colleagues. It was published online in the Canadian Medical Association Journal.

LIMITATIONS:

The guideline was published more than 3 years after the initial literature search in September 2020 and did not include comprehensive guidance for AUD with co-occurring substance use disorders or with severe mental health conditions. Certain groups, including immigrant and refugee populations, were not represented.

DISCLOSURES:

Development of the guideline received support from Health Canada’s Substance Use and Addictions Program, Canadian Institutes of Health Research, and BC Centre on Substance Use. No committee members disclosed direct monetary or nonmonetary support from alcohol or pharmaceutical industry sources within the past 5 years, or that their clinical revenue would be influenced by the guideline recommendations.

A version of this article first appeared on Medscape.com.

Playing chess or other board games slows cognitive decline and improves quality of life in older patients, results of a new systematic review suggest.
 

“For patients who are elderly and suffer from social isolation and mild cognitive issues, I would definitely recommend board games,” study investigator Frederico Emanuele Pozzi, MD, a neurology resident at Fondazione IRCCS San Gerardo dei Tintori in Monza, Italy, told this news organization.

The findings were presented at the virtual XXVI World Congress of Neurology (WCN).

After searching the published literature, Dr. Pozzi and his colleagues selected 15 studies for the review. The studies assessed the impact of board games on older individuals at risk of or with cognitive impairment, or those with mild cognitive impairment (MCI) at any age.

The studies included different board games including chess, Mah-jongg, and Go, a two-player game popular in China, Japan, and Korea that involves moving board pieces to surround and capture as much territory as possible.

Most interventions lasted about an hour and were held once or twice per week for 3-4 months.
 

Which games are best?

Researchers found that board games improved cognitive function, as measured by improved scores on the Montreal Cognitive Assessment (P = .003) and Mini-Mental State Examination (P = .02).

Playing Go was linked with improved working memory, as measured by the Trail Making Test-A. Those who played Mah-jongg reported improved executive functioning and a temporary decrease in depressive symptoms. And chess players reported improved quality of life on the World Health Organization Quality of Life scale from playing chess (P < .00001).

In general, cognition improved across different populations. For example, some studies looked at unimpaired elderly while others looked at MCI, said Dr. Pozzi.

Playing board games in a social context appeared to be especially good at boosting brain power. One Japanese study included a control group that just did tai chi, a group that did Go alone on tablets, and another group that did Go in groups. Both Go groups improved cognitively, but participants who played together improved the most.

The results also seemed to suggest that Go and chess have different biological effects. “For example, Go increased [brain-derived neurotrophic factor] (BDNF) levels and metabolism in areas key for cognition like the middle temporal gyrus,” Dr. Pozzi said.

He noted that the methodology of the studies was generally “not bad,” although in some cases the analyses were per protocol and in others intention-to-treat. Outcomes varied across studies, there were a lot of dropouts, and some were not randomized, meaning reverse causality can’t be ruled out.

Dr. Pozzi has started a randomized controlled trial at a Go and chess club in Italy. He’s enrolling patients aged 60 and over with subjective cognitive decline or MCI and separating participants into a control group, a group that plays chess, another that plays Go, and another that plays both Go and chess.

In addition to the standard cognitive tests, and measures of depression and quality of life, Dr. Pozzi aims to assess cognitive reserve and is in the process of validating a questionnaire that will look at leisure activities and lifestyle.
 

Social and cognitive value

Commenting on the research for this news organization, Vladimir Hachinski, MD, a professor of clinical neurological sciences at Western University in London, Ont., said the results make sense.

Playing a board game involves concentration, strategy, and intermittent rewards – all of which are good for the brain and may involve the prefrontal cortex, he noted. Board games are also typically timed, which involves brain speed processing, and they have a winner and loser so emotions can run high, which also affects the brain, Dr. Hachinski added.

There may also be social value in playing a board game with someone else, added Dr. Hachinski.

“It’s encouraging that people can improve what they’re doing, and the longer they’re at it, the more of the brain they use,” he said. “There might be a long-term effect because players are building up networks.”

But Dr. Hachinski cautioned that playing a lot of chess does not necessarily make you a better thinker, just as learning to play one instrument doesn’t mean you can automatically play others.

“Learning one skill will translate only partially to another, and only if it’s related,” he said. “It increases cognition in the area you’re practicing in, but it doesn’t spread to other areas.”

Dr. Pozzi and Dr. Hachinski report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Playing chess or other board games slows cognitive decline and improves quality of life in older patients, results of a new systematic review suggest.
 

“For patients who are elderly and suffer from social isolation and mild cognitive issues, I would definitely recommend board games,” study investigator Frederico Emanuele Pozzi, MD, a neurology resident at Fondazione IRCCS San Gerardo dei Tintori in Monza, Italy, told this news organization.

The findings were presented at the virtual XXVI World Congress of Neurology (WCN).

After searching the published literature, Dr. Pozzi and his colleagues selected 15 studies for the review. The studies assessed the impact of board games on older individuals at risk of or with cognitive impairment, or those with mild cognitive impairment (MCI) at any age.

The studies included different board games including chess, Mah-jongg, and Go, a two-player game popular in China, Japan, and Korea that involves moving board pieces to surround and capture as much territory as possible.

Most interventions lasted about an hour and were held once or twice per week for 3-4 months.
 

Which games are best?

Researchers found that board games improved cognitive function, as measured by improved scores on the Montreal Cognitive Assessment (P = .003) and Mini-Mental State Examination (P = .02).

Playing Go was linked with improved working memory, as measured by the Trail Making Test-A. Those who played Mah-jongg reported improved executive functioning and a temporary decrease in depressive symptoms. And chess players reported improved quality of life on the World Health Organization Quality of Life scale from playing chess (P < .00001).

In general, cognition improved across different populations. For example, some studies looked at unimpaired elderly while others looked at MCI, said Dr. Pozzi.

Playing board games in a social context appeared to be especially good at boosting brain power. One Japanese study included a control group that just did tai chi, a group that did Go alone on tablets, and another group that did Go in groups. Both Go groups improved cognitively, but participants who played together improved the most.

The results also seemed to suggest that Go and chess have different biological effects. “For example, Go increased [brain-derived neurotrophic factor] (BDNF) levels and metabolism in areas key for cognition like the middle temporal gyrus,” Dr. Pozzi said.

He noted that the methodology of the studies was generally “not bad,” although in some cases the analyses were per protocol and in others intention-to-treat. Outcomes varied across studies, there were a lot of dropouts, and some were not randomized, meaning reverse causality can’t be ruled out.

Dr. Pozzi has started a randomized controlled trial at a Go and chess club in Italy. He’s enrolling patients aged 60 and over with subjective cognitive decline or MCI and separating participants into a control group, a group that plays chess, another that plays Go, and another that plays both Go and chess.

In addition to the standard cognitive tests, and measures of depression and quality of life, Dr. Pozzi aims to assess cognitive reserve and is in the process of validating a questionnaire that will look at leisure activities and lifestyle.
 

Social and cognitive value

Commenting on the research for this news organization, Vladimir Hachinski, MD, a professor of clinical neurological sciences at Western University in London, Ont., said the results make sense.

Playing a board game involves concentration, strategy, and intermittent rewards – all of which are good for the brain and may involve the prefrontal cortex, he noted. Board games are also typically timed, which involves brain speed processing, and they have a winner and loser so emotions can run high, which also affects the brain, Dr. Hachinski added.

There may also be social value in playing a board game with someone else, added Dr. Hachinski.

“It’s encouraging that people can improve what they’re doing, and the longer they’re at it, the more of the brain they use,” he said. “There might be a long-term effect because players are building up networks.”

But Dr. Hachinski cautioned that playing a lot of chess does not necessarily make you a better thinker, just as learning to play one instrument doesn’t mean you can automatically play others.

“Learning one skill will translate only partially to another, and only if it’s related,” he said. “It increases cognition in the area you’re practicing in, but it doesn’t spread to other areas.”

Dr. Pozzi and Dr. Hachinski report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

Playing chess or other board games slows cognitive decline and improves quality of life in older patients, results of a new systematic review suggest.
 

“For patients who are elderly and suffer from social isolation and mild cognitive issues, I would definitely recommend board games,” study investigator Frederico Emanuele Pozzi, MD, a neurology resident at Fondazione IRCCS San Gerardo dei Tintori in Monza, Italy, told this news organization.

The findings were presented at the virtual XXVI World Congress of Neurology (WCN).

After searching the published literature, Dr. Pozzi and his colleagues selected 15 studies for the review. The studies assessed the impact of board games on older individuals at risk of or with cognitive impairment, or those with mild cognitive impairment (MCI) at any age.

The studies included different board games including chess, Mah-jongg, and Go, a two-player game popular in China, Japan, and Korea that involves moving board pieces to surround and capture as much territory as possible.

Most interventions lasted about an hour and were held once or twice per week for 3-4 months.
 

Which games are best?

Researchers found that board games improved cognitive function, as measured by improved scores on the Montreal Cognitive Assessment (P = .003) and Mini-Mental State Examination (P = .02).

Playing Go was linked with improved working memory, as measured by the Trail Making Test-A. Those who played Mah-jongg reported improved executive functioning and a temporary decrease in depressive symptoms. And chess players reported improved quality of life on the World Health Organization Quality of Life scale from playing chess (P < .00001).

In general, cognition improved across different populations. For example, some studies looked at unimpaired elderly while others looked at MCI, said Dr. Pozzi.

Playing board games in a social context appeared to be especially good at boosting brain power. One Japanese study included a control group that just did tai chi, a group that did Go alone on tablets, and another group that did Go in groups. Both Go groups improved cognitively, but participants who played together improved the most.

The results also seemed to suggest that Go and chess have different biological effects. “For example, Go increased [brain-derived neurotrophic factor] (BDNF) levels and metabolism in areas key for cognition like the middle temporal gyrus,” Dr. Pozzi said.

He noted that the methodology of the studies was generally “not bad,” although in some cases the analyses were per protocol and in others intention-to-treat. Outcomes varied across studies, there were a lot of dropouts, and some were not randomized, meaning reverse causality can’t be ruled out.

Dr. Pozzi has started a randomized controlled trial at a Go and chess club in Italy. He’s enrolling patients aged 60 and over with subjective cognitive decline or MCI and separating participants into a control group, a group that plays chess, another that plays Go, and another that plays both Go and chess.

In addition to the standard cognitive tests, and measures of depression and quality of life, Dr. Pozzi aims to assess cognitive reserve and is in the process of validating a questionnaire that will look at leisure activities and lifestyle.
 

Social and cognitive value

Commenting on the research for this news organization, Vladimir Hachinski, MD, a professor of clinical neurological sciences at Western University in London, Ont., said the results make sense.

Playing a board game involves concentration, strategy, and intermittent rewards – all of which are good for the brain and may involve the prefrontal cortex, he noted. Board games are also typically timed, which involves brain speed processing, and they have a winner and loser so emotions can run high, which also affects the brain, Dr. Hachinski added.

There may also be social value in playing a board game with someone else, added Dr. Hachinski.

“It’s encouraging that people can improve what they’re doing, and the longer they’re at it, the more of the brain they use,” he said. “There might be a long-term effect because players are building up networks.”

But Dr. Hachinski cautioned that playing a lot of chess does not necessarily make you a better thinker, just as learning to play one instrument doesn’t mean you can automatically play others.

“Learning one skill will translate only partially to another, and only if it’s related,” he said. “It increases cognition in the area you’re practicing in, but it doesn’t spread to other areas.”

Dr. Pozzi and Dr. Hachinski report no relevant financial relationships.

A version of this article first appeared on Medscape.com.

TOPLINE:

Chronic kidney disease is the strongest predictor of sudden cardiac arrest (SCA) in a population of Hispanic and Latinx patients, new data show, suggesting early identification of CKD may provide an opportunity to reduce the risk in these groups. Other predictors included heavy drinking, atrial fibrillation, coronary artery disease, heart failure and diabetes.

METHODOLOGY:

• The study included 295 Hispanic or Latinx patients with out-of-hospital SCA from the PRESTO study in Ventura County, California, and 590 frequency-matched controls from the San Diego site of the population-based HCHS/SOL (Hispanic Community Health Survey/Study of Latinos); in both cohorts, men made up 70% of participants, and the median age was about 63 years.
• Researchers collected data on demographics, medical history, and current health conditions. Of note, 51.2% of SCA cases and 8.8% of control participants had CKD, and 20.0% of cases and 0.7% of the control group were on dialysis.
• Pre-SCA echocardiograms were available for 48% of SCA cases and baseline echocardiograms for more than 99% of control participants.

TAKEAWAY:

• In analyses adjusted for age, sex, and clinical variables, predictors significantly associated with higher odds of SCA included: CKD (odds ratio, 7.3; 95% confidence interval, 3.8-14.3; P < .001), heavy drinking (OR, 4.5), stroke (OR, 3.1), atrial fibrillation (OR, 3.7), coronary artery disease (OR, 2.9), heart failure (OR, 2.5), and diabetes (OR, 1.5).
• Hypertension, hyperlipemia, body mass index, and current smoking status were not significantly associated with SCA.
• In adjusted analyses, heart rate (OR, 1.8 per one standard deviation [1-SD] increase), QTc interval (OR, 2.5 per 1-SD increase) and left ventricular ejection fraction (OR, 4.4 per 1-SD decrease) were significantly associated with SCA, suggesting echocardiogram evaluations could help identify Hispanic or Latinx individuals at increased risk for SCA, wrote the authors.

IN PRACTICE:

“Our study, the first to include feasible numbers of Hispanic or Latino individuals, highlights the importance of renal dysfunction as a risk factor for SCA in the community,” the authors wrote, adding that early identification and management of chronic kidney disease could reduce risk for SCA in this population.

SOURCE:

The study was conducted by Kyndaron Reinier, PhD, MPH, Cedars-Sinai Health System, Los Angeles, and colleagues. It was published online in the Journal of the American Heart Association.

LIMITATIONS:

Most participants from the HCHS/SOL study were born outside the United States, compared with about half the SCA cases, which could have influenced cardiovascular disease risk, although results did not change considerably when models were adjusted for place of birth. Study participants were predominantly of Mexican heritage, so results may not be generalizable to Hispanic or Latinx individuals from other regions. As medical history was assessed differently in the two studies, there could be some error in estimating the strength of associations. Results from echocardiographic data should be viewed as hypothesis generating because of the potential for residual bias.

DISCLOSURES:

The Ventura PRESTO study was funded, in part, by the National Institutes of Health, and National Heart, Lung, and Blood Institute. The HCHS/SOL was carried out as a collaborative study supported by contracts from the NHLBI.

A version of this article first appeared on Medscape.com.

TOPLINE:

Chronic kidney disease is the strongest predictor of sudden cardiac arrest (SCA) in a population of Hispanic and Latinx patients, new data show, suggesting early identification of CKD may provide an opportunity to reduce the risk in these groups. Other predictors included heavy drinking, atrial fibrillation, coronary artery disease, heart failure and diabetes.

METHODOLOGY:

• The study included 295 Hispanic or Latinx patients with out-of-hospital SCA from the PRESTO study in Ventura County, California, and 590 frequency-matched controls from the San Diego site of the population-based HCHS/SOL (Hispanic Community Health Survey/Study of Latinos); in both cohorts, men made up 70% of participants, and the median age was about 63 years.
• Researchers collected data on demographics, medical history, and current health conditions. Of note, 51.2% of SCA cases and 8.8% of control participants had CKD, and 20.0% of cases and 0.7% of the control group were on dialysis.
• Pre-SCA echocardiograms were available for 48% of SCA cases and baseline echocardiograms for more than 99% of control participants.

TAKEAWAY:

• In analyses adjusted for age, sex, and clinical variables, predictors significantly associated with higher odds of SCA included: CKD (odds ratio, 7.3; 95% confidence interval, 3.8-14.3; P < .001), heavy drinking (OR, 4.5), stroke (OR, 3.1), atrial fibrillation (OR, 3.7), coronary artery disease (OR, 2.9), heart failure (OR, 2.5), and diabetes (OR, 1.5).
• Hypertension, hyperlipemia, body mass index, and current smoking status were not significantly associated with SCA.
• In adjusted analyses, heart rate (OR, 1.8 per one standard deviation [1-SD] increase), QTc interval (OR, 2.5 per 1-SD increase) and left ventricular ejection fraction (OR, 4.4 per 1-SD decrease) were significantly associated with SCA, suggesting echocardiogram evaluations could help identify Hispanic or Latinx individuals at increased risk for SCA, wrote the authors.

IN PRACTICE:

“Our study, the first to include feasible numbers of Hispanic or Latino individuals, highlights the importance of renal dysfunction as a risk factor for SCA in the community,” the authors wrote, adding that early identification and management of chronic kidney disease could reduce risk for SCA in this population.

SOURCE:

The study was conducted by Kyndaron Reinier, PhD, MPH, Cedars-Sinai Health System, Los Angeles, and colleagues. It was published online in the Journal of the American Heart Association.

LIMITATIONS:

Most participants from the HCHS/SOL study were born outside the United States, compared with about half the SCA cases, which could have influenced cardiovascular disease risk, although results did not change considerably when models were adjusted for place of birth. Study participants were predominantly of Mexican heritage, so results may not be generalizable to Hispanic or Latinx individuals from other regions. As medical history was assessed differently in the two studies, there could be some error in estimating the strength of associations. Results from echocardiographic data should be viewed as hypothesis generating because of the potential for residual bias.

DISCLOSURES:

The Ventura PRESTO study was funded, in part, by the National Institutes of Health, and National Heart, Lung, and Blood Institute. The HCHS/SOL was carried out as a collaborative study supported by contracts from the NHLBI.

A version of this article first appeared on Medscape.com.

TOPLINE:

Chronic kidney disease is the strongest predictor of sudden cardiac arrest (SCA) in a population of Hispanic and Latinx patients, new data show, suggesting early identification of CKD may provide an opportunity to reduce the risk in these groups. Other predictors included heavy drinking, atrial fibrillation, coronary artery disease, heart failure and diabetes.

METHODOLOGY:

• The study included 295 Hispanic or Latinx patients with out-of-hospital SCA from the PRESTO study in Ventura County, California, and 590 frequency-matched controls from the San Diego site of the population-based HCHS/SOL (Hispanic Community Health Survey/Study of Latinos); in both cohorts, men made up 70% of participants, and the median age was about 63 years.
• Researchers collected data on demographics, medical history, and current health conditions. Of note, 51.2% of SCA cases and 8.8% of control participants had CKD, and 20.0% of cases and 0.7% of the control group were on dialysis.
• Pre-SCA echocardiograms were available for 48% of SCA cases and baseline echocardiograms for more than 99% of control participants.

TAKEAWAY:

• In analyses adjusted for age, sex, and clinical variables, predictors significantly associated with higher odds of SCA included: CKD (odds ratio, 7.3; 95% confidence interval, 3.8-14.3; P < .001), heavy drinking (OR, 4.5), stroke (OR, 3.1), atrial fibrillation (OR, 3.7), coronary artery disease (OR, 2.9), heart failure (OR, 2.5), and diabetes (OR, 1.5).
• Hypertension, hyperlipemia, body mass index, and current smoking status were not significantly associated with SCA.
• In adjusted analyses, heart rate (OR, 1.8 per one standard deviation [1-SD] increase), QTc interval (OR, 2.5 per 1-SD increase) and left ventricular ejection fraction (OR, 4.4 per 1-SD decrease) were significantly associated with SCA, suggesting echocardiogram evaluations could help identify Hispanic or Latinx individuals at increased risk for SCA, wrote the authors.

IN PRACTICE:

“Our study, the first to include feasible numbers of Hispanic or Latino individuals, highlights the importance of renal dysfunction as a risk factor for SCA in the community,” the authors wrote, adding that early identification and management of chronic kidney disease could reduce risk for SCA in this population.

SOURCE:

The study was conducted by Kyndaron Reinier, PhD, MPH, Cedars-Sinai Health System, Los Angeles, and colleagues. It was published online in the Journal of the American Heart Association.

LIMITATIONS:

Most participants from the HCHS/SOL study were born outside the United States, compared with about half the SCA cases, which could have influenced cardiovascular disease risk, although results did not change considerably when models were adjusted for place of birth. Study participants were predominantly of Mexican heritage, so results may not be generalizable to Hispanic or Latinx individuals from other regions. As medical history was assessed differently in the two studies, there could be some error in estimating the strength of associations. Results from echocardiographic data should be viewed as hypothesis generating because of the potential for residual bias.

DISCLOSURES:

The Ventura PRESTO study was funded, in part, by the National Institutes of Health, and National Heart, Lung, and Blood Institute. The HCHS/SOL was carried out as a collaborative study supported by contracts from the NHLBI.

A version of this article first appeared on Medscape.com.

TOPLINE:

User-friendly transjugular intracardiac echocardiography (TJ-ICE)–guided transcatheter aortic valve replacement (TAVR) lowers the rate of atrioventricular block requiring permanent pacemaker implantation (PPMI) and has minimal complications, results of a new study suggest.

Researchers developed TJ-ICE–guided TAVR to facilitate implanting a heart valve at an optimal depth, guided by direct visualization of the membranous septum (MS) during the procedure.

METHODOLOGY:

• The single-center study included 163 patients with severe aortic stenosis (AS) from an ongoing registry, mean age 85 years, 71% women, and median Society of Thoracic Surgeons score of 6.3%, who underwent TAVR.
• The primary endpoint was the incidence at 30 days of PPMI; secondary endpoints included the feasibility of TJ-ICE–guided TAVR and safety, including complications related to TJ-ICE.

TAKEAWAY:

• Although all patients underwent valve placement in the proper anatomical location, moderate paravalvular leakage (PVL) occurred in four patients, and a second valve was required in two patients, resulting in a device success of 96.3%.
• New PPMI within 30 days was required in 11 patients (6.7%), all because of complete atrioventricular block; patients with baseline right bundle branch block (RBBB) had a higher incidence of new PPMI than did those without RBBB (23.8% vs. 4.2%; P < .001).
• Patients whose device was implanted inside the MS had a significantly lower incidence of new PPMI (overall 2.1% vs. 13.4%; P = .005); this finding was consistent in patients with baseline RBBB (6.7% vs. 66.7%; P = .004) or without RBBB (1.2% vs. 8.2%; P = .041).
• By 30 days, there was one death, which occurred as a result of bleeding in a patient with liver cirrhosis after a successful TAVR procedure; four patients experienced disabling strokes, and vascular complications developed in 16 patients.

IN PRACTICE:

The study demonstrated the “notable feasibility and safety” of TJ-ICE–guided TAVR, the authors write. They point to the “strong association of TAV position with new PPMI rate, which was clearly visualized by ICE during the procedure.”

In an accompanying editorial, Thomas Bartel, MD, PHD, Flexdoc Inc., Düsseldorf, Germany, noted that the study is the first to report a clinical benefit using a TJ-ICE approach, although barriers such as cost and lack of expertise could prevent interventional cardiologists from taking full advantage of ICE monitoring during TAVR, and further research is warranted.

Randomized and prospective trials comparing the accuracy, reproducibility, and outcomes of ICE guidance vs. guidance by transesophageal echocardiography, and pure fluoroscopy and angiography, “need to be performed before ICE imaging is adopted as the primary nonradiographic imaging modality for TAVR.”

SOURCE:

The study was carried out by Tsutomu Murakami, MD, department of cardiology, Tokai University, Isehara, Japan, and colleagues. It was published online in JACC: Asia.

LIMITATIONS:

The retrospective nonrandomized design has inherent limitations. The choice of intraprocedural imaging modality was decided based on heart team discussion, which may have introduced selection bias. Operators’ implantation skills could have influenced the results although most cases involved highly experienced board-certified operators. The limited number of subjects and the relatively low event rates preclude definitive conclusions.

DISCLOSURES:

Dr. Murakami has no relevant conflicts of interest; see paper for disclosures of other study authors. Dr. Bartel has no relevant conflicts of interest.

A version of this article first appeared on Medscape.com.

TOPLINE:

User-friendly transjugular intracardiac echocardiography (TJ-ICE)–guided transcatheter aortic valve replacement (TAVR) lowers the rate of atrioventricular block requiring permanent pacemaker implantation (PPMI) and has minimal complications, results of a new study suggest.

Researchers developed TJ-ICE–guided TAVR to facilitate implanting a heart valve at an optimal depth, guided by direct visualization of the membranous septum (MS) during the procedure.

METHODOLOGY:

• The single-center study included 163 patients with severe aortic stenosis (AS) from an ongoing registry, mean age 85 years, 71% women, and median Society of Thoracic Surgeons score of 6.3%, who underwent TAVR.
• The primary endpoint was the incidence at 30 days of PPMI; secondary endpoints included the feasibility of TJ-ICE–guided TAVR and safety, including complications related to TJ-ICE.

TAKEAWAY:

• Although all patients underwent valve placement in the proper anatomical location, moderate paravalvular leakage (PVL) occurred in four patients, and a second valve was required in two patients, resulting in a device success of 96.3%.
• New PPMI within 30 days was required in 11 patients (6.7%), all because of complete atrioventricular block; patients with baseline right bundle branch block (RBBB) had a higher incidence of new PPMI than did those without RBBB (23.8% vs. 4.2%; P < .001).
• Patients whose device was implanted inside the MS had a significantly lower incidence of new PPMI (overall 2.1% vs. 13.4%; P = .005); this finding was consistent in patients with baseline RBBB (6.7% vs. 66.7%; P = .004) or without RBBB (1.2% vs. 8.2%; P = .041).
• By 30 days, there was one death, which occurred as a result of bleeding in a patient with liver cirrhosis after a successful TAVR procedure; four patients experienced disabling strokes, and vascular complications developed in 16 patients.

IN PRACTICE:

The study demonstrated the “notable feasibility and safety” of TJ-ICE–guided TAVR, the authors write. They point to the “strong association of TAV position with new PPMI rate, which was clearly visualized by ICE during the procedure.”

In an accompanying editorial, Thomas Bartel, MD, PHD, Flexdoc Inc., Düsseldorf, Germany, noted that the study is the first to report a clinical benefit using a TJ-ICE approach, although barriers such as cost and lack of expertise could prevent interventional cardiologists from taking full advantage of ICE monitoring during TAVR, and further research is warranted.

Randomized and prospective trials comparing the accuracy, reproducibility, and outcomes of ICE guidance vs. guidance by transesophageal echocardiography, and pure fluoroscopy and angiography, “need to be performed before ICE imaging is adopted as the primary nonradiographic imaging modality for TAVR.”

SOURCE:

The study was carried out by Tsutomu Murakami, MD, department of cardiology, Tokai University, Isehara, Japan, and colleagues. It was published online in JACC: Asia.

LIMITATIONS:

The retrospective nonrandomized design has inherent limitations. The choice of intraprocedural imaging modality was decided based on heart team discussion, which may have introduced selection bias. Operators’ implantation skills could have influenced the results although most cases involved highly experienced board-certified operators. The limited number of subjects and the relatively low event rates preclude definitive conclusions.

DISCLOSURES:

Dr. Murakami has no relevant conflicts of interest; see paper for disclosures of other study authors. Dr. Bartel has no relevant conflicts of interest.

A version of this article first appeared on Medscape.com.

TOPLINE:

User-friendly transjugular intracardiac echocardiography (TJ-ICE)–guided transcatheter aortic valve replacement (TAVR) lowers the rate of atrioventricular block requiring permanent pacemaker implantation (PPMI) and has minimal complications, results of a new study suggest.

Researchers developed TJ-ICE–guided TAVR to facilitate implanting a heart valve at an optimal depth, guided by direct visualization of the membranous septum (MS) during the procedure.

METHODOLOGY:

• The single-center study included 163 patients with severe aortic stenosis (AS) from an ongoing registry, mean age 85 years, 71% women, and median Society of Thoracic Surgeons score of 6.3%, who underwent TAVR.
• The primary endpoint was the incidence at 30 days of PPMI; secondary endpoints included the feasibility of TJ-ICE–guided TAVR and safety, including complications related to TJ-ICE.

TAKEAWAY:

• Although all patients underwent valve placement in the proper anatomical location, moderate paravalvular leakage (PVL) occurred in four patients, and a second valve was required in two patients, resulting in a device success of 96.3%.
• New PPMI within 30 days was required in 11 patients (6.7%), all because of complete atrioventricular block; patients with baseline right bundle branch block (RBBB) had a higher incidence of new PPMI than did those without RBBB (23.8% vs. 4.2%; P < .001).
• Patients whose device was implanted inside the MS had a significantly lower incidence of new PPMI (overall 2.1% vs. 13.4%; P = .005); this finding was consistent in patients with baseline RBBB (6.7% vs. 66.7%; P = .004) or without RBBB (1.2% vs. 8.2%; P = .041).
• By 30 days, there was one death, which occurred as a result of bleeding in a patient with liver cirrhosis after a successful TAVR procedure; four patients experienced disabling strokes, and vascular complications developed in 16 patients.

IN PRACTICE:

The study demonstrated the “notable feasibility and safety” of TJ-ICE–guided TAVR, the authors write. They point to the “strong association of TAV position with new PPMI rate, which was clearly visualized by ICE during the procedure.”

In an accompanying editorial, Thomas Bartel, MD, PHD, Flexdoc Inc., Düsseldorf, Germany, noted that the study is the first to report a clinical benefit using a TJ-ICE approach, although barriers such as cost and lack of expertise could prevent interventional cardiologists from taking full advantage of ICE monitoring during TAVR, and further research is warranted.

Randomized and prospective trials comparing the accuracy, reproducibility, and outcomes of ICE guidance vs. guidance by transesophageal echocardiography, and pure fluoroscopy and angiography, “need to be performed before ICE imaging is adopted as the primary nonradiographic imaging modality for TAVR.”

SOURCE:

The study was carried out by Tsutomu Murakami, MD, department of cardiology, Tokai University, Isehara, Japan, and colleagues. It was published online in JACC: Asia.

LIMITATIONS:

The retrospective nonrandomized design has inherent limitations. The choice of intraprocedural imaging modality was decided based on heart team discussion, which may have introduced selection bias. Operators’ implantation skills could have influenced the results although most cases involved highly experienced board-certified operators. The limited number of subjects and the relatively low event rates preclude definitive conclusions.

DISCLOSURES:

Dr. Murakami has no relevant conflicts of interest; see paper for disclosures of other study authors. Dr. Bartel has no relevant conflicts of interest.

A version of this article first appeared on Medscape.com.

TOPLINE:

Compared with supervised treadmill workouts at a gym, which is considered first-line therapy for walking impairment in lower extremity peripheral artery disease (PAD), exercising at home significantly improves 6-minute walking (6MW) distance, but not maximal treadmill walking distance, results of a new meta-analysis show.

METHODOLOGY:

• The analysis included five randomized clinical trials with a total of 719 participants, mean age 68.6 years, all led by researchers at Northwestern University, Chicago, that compared either supervised treadmill or home-based walking exercise with a nonexercise control group in people with PAD (defined as Ankle Brachial Index ≤ 0.90).
• All trials measured 6-minute walk (6MW) distance (walking as far as possible in 6 minutes), treadmill walking performance, and outcomes from the Walking Impairment Questionnaire (WIQ), which includes distance, walking speed, and stair-climbing domains, at baseline and at 6 months.
• Supervised treadmill exercise interventions included three individualized exercise sessions per week with an exercise physiologist at an exercise center, and home-based exercises involved walking near home 5 days per week, both for up to 50 minutes per session.

TAKEAWAY:

• After adjusting for study, age, sex, race, smoking, history of myocardial infarction, heart failure, and baseline 6MW distance, the study found both exercise interventions were better than nonexercise controls for 6MW distance.
• Compared with supervised treadmill exercise, home-based walking was associated with significantly improved mean 6MW distance (31.8 m vs. 55.6 m; adjusted between-group difference: −23.8 m; 95% confidence interval, −44.0 to −3.6; P = .021), and significantly improved WIQ walking speed score.
• However, home-based walking was associated with significantly less improvement in maximal treadmill walking distance, compared with supervised treadmill exercise (adjusted between-group difference: 132.5 m; 95% CI, 72.1-192.9; P < .001).

IN PRACTICE:

Home-based walking exercise “circumvents” barriers to accessing supervised exercise such as having to travel to a facility, said the authors, who noted the new data “demonstrated a large and consistent effect of home-based walking exercise on improved 6MW distance and also significantly improved the WIQ walking speed score, compared with supervised treadmill exercise.”

SOURCE:

The study was conducted by Neela D. Thangada, MD, Northwestern University, Chicago, and colleagues. It was published online in JAMA Network Open.

LIMITATIONS:

Data were combined from different randomized clinical trials that were led by one investigative team, and reported comparisons were not prespecified. Comparisons between supervised and home-based exercise lacked statistical power for the WIQ distance and stair-climbing measures.

DISCLOSURES:

The study was sponsored by the National Center for Research Resources and the National Heart, Lung, and Blood Institute of the National Institutes of Health. Dr. Thangada reports no relevant financial relationships. Disclosures for study coauthors can be found with the original article.

A version of this article first appeared on Medscape.com.

TOPLINE:

Compared with supervised treadmill workouts at a gym, which is considered first-line therapy for walking impairment in lower extremity peripheral artery disease (PAD), exercising at home significantly improves 6-minute walking (6MW) distance, but not maximal treadmill walking distance, results of a new meta-analysis show.

METHODOLOGY:

• The analysis included five randomized clinical trials with a total of 719 participants, mean age 68.6 years, all led by researchers at Northwestern University, Chicago, that compared either supervised treadmill or home-based walking exercise with a nonexercise control group in people with PAD (defined as Ankle Brachial Index ≤ 0.90).
• All trials measured 6-minute walk (6MW) distance (walking as far as possible in 6 minutes), treadmill walking performance, and outcomes from the Walking Impairment Questionnaire (WIQ), which includes distance, walking speed, and stair-climbing domains, at baseline and at 6 months.
• Supervised treadmill exercise interventions included three individualized exercise sessions per week with an exercise physiologist at an exercise center, and home-based exercises involved walking near home 5 days per week, both for up to 50 minutes per session.

TAKEAWAY:

• After adjusting for study, age, sex, race, smoking, history of myocardial infarction, heart failure, and baseline 6MW distance, the study found both exercise interventions were better than nonexercise controls for 6MW distance.
• Compared with supervised treadmill exercise, home-based walking was associated with significantly improved mean 6MW distance (31.8 m vs. 55.6 m; adjusted between-group difference: −23.8 m; 95% confidence interval, −44.0 to −3.6; P = .021), and significantly improved WIQ walking speed score.
• However, home-based walking was associated with significantly less improvement in maximal treadmill walking distance, compared with supervised treadmill exercise (adjusted between-group difference: 132.5 m; 95% CI, 72.1-192.9; P < .001).

IN PRACTICE:

Home-based walking exercise “circumvents” barriers to accessing supervised exercise such as having to travel to a facility, said the authors, who noted the new data “demonstrated a large and consistent effect of home-based walking exercise on improved 6MW distance and also significantly improved the WIQ walking speed score, compared with supervised treadmill exercise.”

SOURCE:

The study was conducted by Neela D. Thangada, MD, Northwestern University, Chicago, and colleagues. It was published online in JAMA Network Open.

LIMITATIONS:

Data were combined from different randomized clinical trials that were led by one investigative team, and reported comparisons were not prespecified. Comparisons between supervised and home-based exercise lacked statistical power for the WIQ distance and stair-climbing measures.

DISCLOSURES:

The study was sponsored by the National Center for Research Resources and the National Heart, Lung, and Blood Institute of the National Institutes of Health. Dr. Thangada reports no relevant financial relationships. Disclosures for study coauthors can be found with the original article.

A version of this article first appeared on Medscape.com.

TOPLINE:

Compared with supervised treadmill workouts at a gym, which is considered first-line therapy for walking impairment in lower extremity peripheral artery disease (PAD), exercising at home significantly improves 6-minute walking (6MW) distance, but not maximal treadmill walking distance, results of a new meta-analysis show.

METHODOLOGY:

• The analysis included five randomized clinical trials with a total of 719 participants, mean age 68.6 years, all led by researchers at Northwestern University, Chicago, that compared either supervised treadmill or home-based walking exercise with a nonexercise control group in people with PAD (defined as Ankle Brachial Index ≤ 0.90).
• All trials measured 6-minute walk (6MW) distance (walking as far as possible in 6 minutes), treadmill walking performance, and outcomes from the Walking Impairment Questionnaire (WIQ), which includes distance, walking speed, and stair-climbing domains, at baseline and at 6 months.
• Supervised treadmill exercise interventions included three individualized exercise sessions per week with an exercise physiologist at an exercise center, and home-based exercises involved walking near home 5 days per week, both for up to 50 minutes per session.

TAKEAWAY:

• After adjusting for study, age, sex, race, smoking, history of myocardial infarction, heart failure, and baseline 6MW distance, the study found both exercise interventions were better than nonexercise controls for 6MW distance.
• Compared with supervised treadmill exercise, home-based walking was associated with significantly improved mean 6MW distance (31.8 m vs. 55.6 m; adjusted between-group difference: −23.8 m; 95% confidence interval, −44.0 to −3.6; P = .021), and significantly improved WIQ walking speed score.
• However, home-based walking was associated with significantly less improvement in maximal treadmill walking distance, compared with supervised treadmill exercise (adjusted between-group difference: 132.5 m; 95% CI, 72.1-192.9; P < .001).

IN PRACTICE:

Home-based walking exercise “circumvents” barriers to accessing supervised exercise such as having to travel to a facility, said the authors, who noted the new data “demonstrated a large and consistent effect of home-based walking exercise on improved 6MW distance and also significantly improved the WIQ walking speed score, compared with supervised treadmill exercise.”

SOURCE:

The study was conducted by Neela D. Thangada, MD, Northwestern University, Chicago, and colleagues. It was published online in JAMA Network Open.

LIMITATIONS:

Data were combined from different randomized clinical trials that were led by one investigative team, and reported comparisons were not prespecified. Comparisons between supervised and home-based exercise lacked statistical power for the WIQ distance and stair-climbing measures.

DISCLOSURES:

The study was sponsored by the National Center for Research Resources and the National Heart, Lung, and Blood Institute of the National Institutes of Health. Dr. Thangada reports no relevant financial relationships. Disclosures for study coauthors can be found with the original article.

A version of this article first appeared on Medscape.com.

TOPLINE:

Almost one-quarter of pregnant women who have had a heart transplant (HT) will experience severe maternal morbidity (SMM) during their hospital stay for delivery, and they have sevenfold greater risk for preterm birth than do other pregnant women, results of a large study with a nationwide sample suggest.

METHODOLOGY:

• The retrospective cohort study included 2010-2020 information from the Nationwide Readmissions Database (NRD), a large, all-payer administrative dataset that allows for tracking of patient hospital readmissions in the same U.S. state within the same calendar year and includes patient demographics, hospital characteristics, diagnosis and procedure codes (including for cardiac transplants), length of stay, and discharge disposition.
• The primary outcome was nontransfusion SMM which, among other conditions, included acute myocardial infarction, aortic aneurysm, acute renal failure, adult respiratory distress syndrome, amniotic fluid embolism, cardiac arrest/ventricular fibrillation, and heart failure/arrest, during the delivery hospitalization.
• Additional outcomes included rates of all SMMs (including transfusion), a composite cardiovascular SMM (cSMM) outcome that included acute myocardial infarction, aortic aneurysm, cardiac arrest/ventricular fibrillation, cardioversion, and acute heart failure, preterm birth, and readmission rates.

TAKEAWAY:

• From 2010 to 2020, there were 19,399,521 hospital deliveries, of which, 105 were in HT recipients.
• In unadjusted comparisons, rates of all outcomes were higher in HT, compared with non-HT delivery hospitalizations, and after adjusting for age, demographic and facility characteristics, comorbid conditions, and calendar year, HT recipients continued to have higher odds of adverse maternal outcomes. For example, HT recipients had higher rates of nontransfusion SMM (adjusted odds ratio, 28.12; 95% confidence interval, 15.65-50.53), all SMM (aOR, 15.73; 95% CI, 9.17-27.00), cSMM (aOR, 37.7; 95% CI, 17.39-82.01), and preterm birth (aOR, 7.15; 95%, CI 4.75-10.77).
• HT recipients also had longer hospital stays and higher rates of cesarean delivery, although the authors noted that it’s unclear whether this increase was caused by the HT or complications of pregnancy because data were unavailable regarding indication for cesareans.
• Patients with HT were also at increased risk for hospital readmission within the first year after delivery, particularly within the first 6 months, including for HT-related complications, a finding that supports guidelines recommending an initial postpartum visit within 7-14 days of discharge for patients with cardiac conditions, write the authors.

IN PRACTICE:

The findings demonstrate the importance of counseling HT patients at early gestational ages “to provide information about anticipated risks in pregnancy and the postpartum period to allow patients the opportunity to make informed choices regarding their reproductive options,” the authors conclude.

SOURCE:

The study was conducted by Amanda M. Craig, MD, division of maternal fetal medicine, department of obstetrics and gynecology, Duke University Medical Center, Durham, N.C., and colleagues. It was published online in JACC Heart Failure.

LIMITATIONS:

Relying on diagnosis and procedure codes in administrative datasets like NRD may result in underestimation of outcomes. In this study, outcomes were limited to delivery hospitalizations, which may underestimate the true incidence of complications or fail to include pregnancies that didn’t end in a delivery, including pregnancy terminations or spontaneous abortions. Information related to race, ethnicity, hospital regions, and cause of death are not captured in the NRD dataset.

DISCLOSURES:

The authors have no relevant conflicts of interest.

A version of this article first appeared on Medscape.com.

TOPLINE:

Almost one-quarter of pregnant women who have had a heart transplant (HT) will experience severe maternal morbidity (SMM) during their hospital stay for delivery, and they have sevenfold greater risk for preterm birth than do other pregnant women, results of a large study with a nationwide sample suggest.

METHODOLOGY:

• The retrospective cohort study included 2010-2020 information from the Nationwide Readmissions Database (NRD), a large, all-payer administrative dataset that allows for tracking of patient hospital readmissions in the same U.S. state within the same calendar year and includes patient demographics, hospital characteristics, diagnosis and procedure codes (including for cardiac transplants), length of stay, and discharge disposition.
• The primary outcome was nontransfusion SMM which, among other conditions, included acute myocardial infarction, aortic aneurysm, acute renal failure, adult respiratory distress syndrome, amniotic fluid embolism, cardiac arrest/ventricular fibrillation, and heart failure/arrest, during the delivery hospitalization.
• Additional outcomes included rates of all SMMs (including transfusion), a composite cardiovascular SMM (cSMM) outcome that included acute myocardial infarction, aortic aneurysm, cardiac arrest/ventricular fibrillation, cardioversion, and acute heart failure, preterm birth, and readmission rates.

TAKEAWAY:

• From 2010 to 2020, there were 19,399,521 hospital deliveries, of which, 105 were in HT recipients.
• In unadjusted comparisons, rates of all outcomes were higher in HT, compared with non-HT delivery hospitalizations, and after adjusting for age, demographic and facility characteristics, comorbid conditions, and calendar year, HT recipients continued to have higher odds of adverse maternal outcomes. For example, HT recipients had higher rates of nontransfusion SMM (adjusted odds ratio, 28.12; 95% confidence interval, 15.65-50.53), all SMM (aOR, 15.73; 95% CI, 9.17-27.00), cSMM (aOR, 37.7; 95% CI, 17.39-82.01), and preterm birth (aOR, 7.15; 95%, CI 4.75-10.77).
• HT recipients also had longer hospital stays and higher rates of cesarean delivery, although the authors noted that it’s unclear whether this increase was caused by the HT or complications of pregnancy because data were unavailable regarding indication for cesareans.
• Patients with HT were also at increased risk for hospital readmission within the first year after delivery, particularly within the first 6 months, including for HT-related complications, a finding that supports guidelines recommending an initial postpartum visit within 7-14 days of discharge for patients with cardiac conditions, write the authors.

IN PRACTICE:

The findings demonstrate the importance of counseling HT patients at early gestational ages “to provide information about anticipated risks in pregnancy and the postpartum period to allow patients the opportunity to make informed choices regarding their reproductive options,” the authors conclude.

SOURCE:

The study was conducted by Amanda M. Craig, MD, division of maternal fetal medicine, department of obstetrics and gynecology, Duke University Medical Center, Durham, N.C., and colleagues. It was published online in JACC Heart Failure.

LIMITATIONS:

Relying on diagnosis and procedure codes in administrative datasets like NRD may result in underestimation of outcomes. In this study, outcomes were limited to delivery hospitalizations, which may underestimate the true incidence of complications or fail to include pregnancies that didn’t end in a delivery, including pregnancy terminations or spontaneous abortions. Information related to race, ethnicity, hospital regions, and cause of death are not captured in the NRD dataset.

DISCLOSURES:

The authors have no relevant conflicts of interest.

A version of this article first appeared on Medscape.com.

TOPLINE:

Almost one-quarter of pregnant women who have had a heart transplant (HT) will experience severe maternal morbidity (SMM) during their hospital stay for delivery, and they have sevenfold greater risk for preterm birth than do other pregnant women, results of a large study with a nationwide sample suggest.

METHODOLOGY:

• The retrospective cohort study included 2010-2020 information from the Nationwide Readmissions Database (NRD), a large, all-payer administrative dataset that allows for tracking of patient hospital readmissions in the same U.S. state within the same calendar year and includes patient demographics, hospital characteristics, diagnosis and procedure codes (including for cardiac transplants), length of stay, and discharge disposition.
• The primary outcome was nontransfusion SMM which, among other conditions, included acute myocardial infarction, aortic aneurysm, acute renal failure, adult respiratory distress syndrome, amniotic fluid embolism, cardiac arrest/ventricular fibrillation, and heart failure/arrest, during the delivery hospitalization.
• Additional outcomes included rates of all SMMs (including transfusion), a composite cardiovascular SMM (cSMM) outcome that included acute myocardial infarction, aortic aneurysm, cardiac arrest/ventricular fibrillation, cardioversion, and acute heart failure, preterm birth, and readmission rates.

TAKEAWAY:

• From 2010 to 2020, there were 19,399,521 hospital deliveries, of which, 105 were in HT recipients.
• In unadjusted comparisons, rates of all outcomes were higher in HT, compared with non-HT delivery hospitalizations, and after adjusting for age, demographic and facility characteristics, comorbid conditions, and calendar year, HT recipients continued to have higher odds of adverse maternal outcomes. For example, HT recipients had higher rates of nontransfusion SMM (adjusted odds ratio, 28.12; 95% confidence interval, 15.65-50.53), all SMM (aOR, 15.73; 95% CI, 9.17-27.00), cSMM (aOR, 37.7; 95% CI, 17.39-82.01), and preterm birth (aOR, 7.15; 95%, CI 4.75-10.77).
• HT recipients also had longer hospital stays and higher rates of cesarean delivery, although the authors noted that it’s unclear whether this increase was caused by the HT or complications of pregnancy because data were unavailable regarding indication for cesareans.
• Patients with HT were also at increased risk for hospital readmission within the first year after delivery, particularly within the first 6 months, including for HT-related complications, a finding that supports guidelines recommending an initial postpartum visit within 7-14 days of discharge for patients with cardiac conditions, write the authors.

IN PRACTICE:

The findings demonstrate the importance of counseling HT patients at early gestational ages “to provide information about anticipated risks in pregnancy and the postpartum period to allow patients the opportunity to make informed choices regarding their reproductive options,” the authors conclude.

SOURCE:

The study was conducted by Amanda M. Craig, MD, division of maternal fetal medicine, department of obstetrics and gynecology, Duke University Medical Center, Durham, N.C., and colleagues. It was published online in JACC Heart Failure.

LIMITATIONS:

Relying on diagnosis and procedure codes in administrative datasets like NRD may result in underestimation of outcomes. In this study, outcomes were limited to delivery hospitalizations, which may underestimate the true incidence of complications or fail to include pregnancies that didn’t end in a delivery, including pregnancy terminations or spontaneous abortions. Information related to race, ethnicity, hospital regions, and cause of death are not captured in the NRD dataset.

DISCLOSURES:

The authors have no relevant conflicts of interest.

A version of this article first appeared on Medscape.com.

TOPLINE:

There is an extensive genetic overlap between schizophrenia and smoking, but there are also schizophrenia genes that may protect against obesity, illustrating the bidirectional effects of shared loci across cardiovascular disease (CVD) risk factors, results of new research suggest.

METHODOLOGY:

• Genome-wide association studies (GWAS) have detected several loci associated with CVD risk factors, including body mass index (BMI), waist-to-hip ratio, type 2 diabetes, lipids, and blood pressure, with increasing evidence suggesting genetic overlap between such risk factors and schizophrenia.
• Researchers obtained what they call an “unprecedentedly large” set of GWAS samples, including schizophrenia (53,386 patients and 77,258 controls) and various CVD risk factors.
• They used analytic approaches to identify genetic links between schizophrenia and CVD risk factors, including bivariate causal mixture model (MiXeR), which estimates the number of shared genetic variants between pairs of phenotypes, and conditional and conjunctional false discovery rate (condFDR and conjFDR), to identify specific genetic loci; these approaches can identify genetic overlap regardless of the effect directions.

TAKEAWAY:

• Using MiXeR, the study showed that several genetic variants underlying schizophrenia also influence CVD phenotypes, particularly risk factors of smoking and BMI.
• A total of 825 distinct loci were jointly associated with schizophrenia and CVD phenotypes at conjFDR < .05.
• Most of the loci shared with smoking were in line with positive genetic correlations; the authors noted individuals with schizophrenia are more nicotine dependent than the general population, and they experience greater reinforcing effects of nicotine and worse withdrawal symptoms during abstinence than the general population.
• The overlapping loci with BMI had effect directions consistent with negative genetic correlations, suggesting people with schizophrenia are genetically predisposed to lower BMI; this is in line with evidence of low BMI being a risk factor for schizophrenia, although obesity is more common in people with schizophrenia.
• There was a pattern of mixed effect directions among loci jointly associated with schizophrenia and lipids, blood pressure, type 2 diabetes, waist-to-hip ratio, and coronary artery disease, which may reflect variation in genetic susceptibility to CVD across subgroups of schizophrenia.

IN PRACTICE:

The new results “shed light” on biological pathways associated with comorbidity between CVD and schizophrenia, said the authors, adding future work could provide insights into mechanisms underlying the comorbidity and could facilitate development of antipsychotics with lower metabolic side effects, which could help prevent comorbid CVD, “thereby helping to mitigate a major clinical and health care problem.”

SOURCE:

The study was led by Linn Rødevand, PhD, Norwegian Center for Mental Disorders Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, and colleagues. It was published online in the American Journal of Psychiatry.

LIMITATIONS:

Methods used in the study are limited by uncertainties in translating genetic loci to causal variants, which restricts the biological interpretation of the shared genetic variants. Among other methodological limitations are that discrepancies between the linkage disequilibrium structure of the samples used for the GWAS and that of the reference panel may have biased estimates underlying MiXeR.

DISCLOSURES:

The study received support from the Research Council of Norway, Norwegian Health Association, South-East Norway Regional Health Authority, and the European Union. Dr. Rødevand reports no relevant financial relationships.

A version of this article first appeared on Medscape.com.

TOPLINE:

There is an extensive genetic overlap between schizophrenia and smoking, but there are also schizophrenia genes that may protect against obesity, illustrating the bidirectional effects of shared loci across cardiovascular disease (CVD) risk factors, results of new research suggest.

METHODOLOGY:

• Genome-wide association studies (GWAS) have detected several loci associated with CVD risk factors, including body mass index (BMI), waist-to-hip ratio, type 2 diabetes, lipids, and blood pressure, with increasing evidence suggesting genetic overlap between such risk factors and schizophrenia.
• Researchers obtained what they call an “unprecedentedly large” set of GWAS samples, including schizophrenia (53,386 patients and 77,258 controls) and various CVD risk factors.
• They used analytic approaches to identify genetic links between schizophrenia and CVD risk factors, including bivariate causal mixture model (MiXeR), which estimates the number of shared genetic variants between pairs of phenotypes, and conditional and conjunctional false discovery rate (condFDR and conjFDR), to identify specific genetic loci; these approaches can identify genetic overlap regardless of the effect directions.

TAKEAWAY:

• Using MiXeR, the study showed that several genetic variants underlying schizophrenia also influence CVD phenotypes, particularly risk factors of smoking and BMI.
• A total of 825 distinct loci were jointly associated with schizophrenia and CVD phenotypes at conjFDR < .05.
• Most of the loci shared with smoking were in line with positive genetic correlations; the authors noted individuals with schizophrenia are more nicotine dependent than the general population, and they experience greater reinforcing effects of nicotine and worse withdrawal symptoms during abstinence than the general population.
• The overlapping loci with BMI had effect directions consistent with negative genetic correlations, suggesting people with schizophrenia are genetically predisposed to lower BMI; this is in line with evidence of low BMI being a risk factor for schizophrenia, although obesity is more common in people with schizophrenia.
• There was a pattern of mixed effect directions among loci jointly associated with schizophrenia and lipids, blood pressure, type 2 diabetes, waist-to-hip ratio, and coronary artery disease, which may reflect variation in genetic susceptibility to CVD across subgroups of schizophrenia.

IN PRACTICE:

The new results “shed light” on biological pathways associated with comorbidity between CVD and schizophrenia, said the authors, adding future work could provide insights into mechanisms underlying the comorbidity and could facilitate development of antipsychotics with lower metabolic side effects, which could help prevent comorbid CVD, “thereby helping to mitigate a major clinical and health care problem.”

SOURCE:

The study was led by Linn Rødevand, PhD, Norwegian Center for Mental Disorders Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, and colleagues. It was published online in the American Journal of Psychiatry.

LIMITATIONS:

Methods used in the study are limited by uncertainties in translating genetic loci to causal variants, which restricts the biological interpretation of the shared genetic variants. Among other methodological limitations are that discrepancies between the linkage disequilibrium structure of the samples used for the GWAS and that of the reference panel may have biased estimates underlying MiXeR.

DISCLOSURES:

The study received support from the Research Council of Norway, Norwegian Health Association, South-East Norway Regional Health Authority, and the European Union. Dr. Rødevand reports no relevant financial relationships.

A version of this article first appeared on Medscape.com.

TOPLINE:

There is an extensive genetic overlap between schizophrenia and smoking, but there are also schizophrenia genes that may protect against obesity, illustrating the bidirectional effects of shared loci across cardiovascular disease (CVD) risk factors, results of new research suggest.

METHODOLOGY:

• Genome-wide association studies (GWAS) have detected several loci associated with CVD risk factors, including body mass index (BMI), waist-to-hip ratio, type 2 diabetes, lipids, and blood pressure, with increasing evidence suggesting genetic overlap between such risk factors and schizophrenia.
• Researchers obtained what they call an “unprecedentedly large” set of GWAS samples, including schizophrenia (53,386 patients and 77,258 controls) and various CVD risk factors.
• They used analytic approaches to identify genetic links between schizophrenia and CVD risk factors, including bivariate causal mixture model (MiXeR), which estimates the number of shared genetic variants between pairs of phenotypes, and conditional and conjunctional false discovery rate (condFDR and conjFDR), to identify specific genetic loci; these approaches can identify genetic overlap regardless of the effect directions.

TAKEAWAY:

• Using MiXeR, the study showed that several genetic variants underlying schizophrenia also influence CVD phenotypes, particularly risk factors of smoking and BMI.
• A total of 825 distinct loci were jointly associated with schizophrenia and CVD phenotypes at conjFDR < .05.
• Most of the loci shared with smoking were in line with positive genetic correlations; the authors noted individuals with schizophrenia are more nicotine dependent than the general population, and they experience greater reinforcing effects of nicotine and worse withdrawal symptoms during abstinence than the general population.
• The overlapping loci with BMI had effect directions consistent with negative genetic correlations, suggesting people with schizophrenia are genetically predisposed to lower BMI; this is in line with evidence of low BMI being a risk factor for schizophrenia, although obesity is more common in people with schizophrenia.
• There was a pattern of mixed effect directions among loci jointly associated with schizophrenia and lipids, blood pressure, type 2 diabetes, waist-to-hip ratio, and coronary artery disease, which may reflect variation in genetic susceptibility to CVD across subgroups of schizophrenia.

IN PRACTICE:

The new results “shed light” on biological pathways associated with comorbidity between CVD and schizophrenia, said the authors, adding future work could provide insights into mechanisms underlying the comorbidity and could facilitate development of antipsychotics with lower metabolic side effects, which could help prevent comorbid CVD, “thereby helping to mitigate a major clinical and health care problem.”

SOURCE:

The study was led by Linn Rødevand, PhD, Norwegian Center for Mental Disorders Research, Division of Mental Health and Addiction, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, and colleagues. It was published online in the American Journal of Psychiatry.

LIMITATIONS:

Methods used in the study are limited by uncertainties in translating genetic loci to causal variants, which restricts the biological interpretation of the shared genetic variants. Among other methodological limitations are that discrepancies between the linkage disequilibrium structure of the samples used for the GWAS and that of the reference panel may have biased estimates underlying MiXeR.

DISCLOSURES:

The study received support from the Research Council of Norway, Norwegian Health Association, South-East Norway Regional Health Authority, and the European Union. Dr. Rødevand reports no relevant financial relationships.

A version of this article first appeared on Medscape.com.

TOPLINE:

There are no significant differences in 1-year mortality, survival to hospital discharge, severe primary graft dysfunction (PGD), and other outcomes post heart transplant between patients who receive a heart obtained by donation after circulatory death (DCD) and patients who receive a heart by donation after brain death (DBD), a new study has shown.

METHODOLOGY:

• The retrospective review included 385 patients (median age, 57.4 years; 26% women; 72.5% White) who underwent a heart transplant at Vanderbilt University Medical Center from January 2020 to January 2023. Of these, 263 received DBD hearts, and 122 received DCD hearts.
• In the DCD group, 17% of hearts were recovered by use of ex vivo machine perfusion (EVP), and 83% by use of normothermic regional perfusion followed by static cold storage; 4% of DBD hearts were recovered by use of EVP, and 96% by use of static cold storage.
• The primary outcome was survival at 1 year after transplantation; key secondary outcomes included survival to hospital discharge, survival at 30 days and 6 months after transplantation, and severe PGD.

TAKEAWAY:

• There was no difference in 1-year post-transplant survival between DCD (94.3%) and DBD (92.4%) recipients (hazard ratio, 0.77; 95% confidence interval, 0.32-1.81; P = .54), a finding that was unchanged when adjusted for recipient age.
• There were no significant differences in survival to hospital discharge (93.4% DBD vs. 94.5% DCD; HR, 0.72; 95% CI, 0.26-1.99; P = .53), to 30 days (95.1% DBD vs. 96.7% DCD; HR, 0.67; 95% CI, 0.22-2.05; P = .48), or to 6 months (92.8% DBD vs. 94.3% DCD; HR, 0.68; 95% CI, 0.25-1.85; P = .45) after transplantation.
• The incidence of severe PGD was similar between groups (5.7% DCD vs. 5.7% DBD; HR, 1.00; 95% CI, 0.41-2.4; P = .99).
• There were no significant between-group differences in other outcomes, including incidence of treated rejection and cases of cardiac allograft vasculopathy of grade 1 or greater on the International Society for scale at 1 year.

IN PRACTICE:

“Our findings add to the growing body of evidence in support of DCD heart transplantation,” the authors write, potentially expanding the heart donor pool. They note that outcomes remained similar between groups despite higher-risk patients being overrepresented in the DCD cohort.

In an accompanying editorial, Sean P. Pinney, MD, Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, and a colleague called the results “impressive” and “encouraging,” although there are still “important unknowns,” including longer-term outcomes, the financial impact of DCD, and whether results can be replicated in other centers.

“These results provide confidence that DCD can be safely and effectively performed without compromising outcomes, at least in a large-volume center of excellence,” and help provide evidence “to support the spreading acceptance of DCD among heart transplant programs.”

SOURCE:

The study was conducted by Hasan K. Siddiqi, MD, department of medicine, Vanderbilt University Medical Center, Nashville, Tenn., and colleagues. It was published online in the Journal of the American College of Cardiology.

LIMITATIONS:

The study was conducted at a single center and had a retrospective design and a modest sample size that prevented adjustment for all potentially confounding variables. Meaningful differences among DCD recipients could not be explored with regard to organ recovery technique, and small but statistically meaningful differences in outcomes could not be detected, the authors note. Follow-up was limited to 1 year after transplantation.

DISCLOSURES:

The authors report no relevant conflicts of interest. Dr. Pinney has received consulting fees from Abbott, ADI, Ancora, CareDx, ImpulseDynamics, Medtronic, Nuwellis, Procyrion, Restore Medical, Transmedics, and Valgen Medtech.

A version of this article first appeared on Medscape.com.

TOPLINE:

There are no significant differences in 1-year mortality, survival to hospital discharge, severe primary graft dysfunction (PGD), and other outcomes post heart transplant between patients who receive a heart obtained by donation after circulatory death (DCD) and patients who receive a heart by donation after brain death (DBD), a new study has shown.

METHODOLOGY:

• The retrospective review included 385 patients (median age, 57.4 years; 26% women; 72.5% White) who underwent a heart transplant at Vanderbilt University Medical Center from January 2020 to January 2023. Of these, 263 received DBD hearts, and 122 received DCD hearts.
• In the DCD group, 17% of hearts were recovered by use of ex vivo machine perfusion (EVP), and 83% by use of normothermic regional perfusion followed by static cold storage; 4% of DBD hearts were recovered by use of EVP, and 96% by use of static cold storage.
• The primary outcome was survival at 1 year after transplantation; key secondary outcomes included survival to hospital discharge, survival at 30 days and 6 months after transplantation, and severe PGD.

TAKEAWAY:

• There was no difference in 1-year post-transplant survival between DCD (94.3%) and DBD (92.4%) recipients (hazard ratio, 0.77; 95% confidence interval, 0.32-1.81; P = .54), a finding that was unchanged when adjusted for recipient age.
• There were no significant differences in survival to hospital discharge (93.4% DBD vs. 94.5% DCD; HR, 0.72; 95% CI, 0.26-1.99; P = .53), to 30 days (95.1% DBD vs. 96.7% DCD; HR, 0.67; 95% CI, 0.22-2.05; P = .48), or to 6 months (92.8% DBD vs. 94.3% DCD; HR, 0.68; 95% CI, 0.25-1.85; P = .45) after transplantation.
• The incidence of severe PGD was similar between groups (5.7% DCD vs. 5.7% DBD; HR, 1.00; 95% CI, 0.41-2.4; P = .99).
• There were no significant between-group differences in other outcomes, including incidence of treated rejection and cases of cardiac allograft vasculopathy of grade 1 or greater on the International Society for scale at 1 year.

IN PRACTICE:

“Our findings add to the growing body of evidence in support of DCD heart transplantation,” the authors write, potentially expanding the heart donor pool. They note that outcomes remained similar between groups despite higher-risk patients being overrepresented in the DCD cohort.

In an accompanying editorial, Sean P. Pinney, MD, Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, and a colleague called the results “impressive” and “encouraging,” although there are still “important unknowns,” including longer-term outcomes, the financial impact of DCD, and whether results can be replicated in other centers.

“These results provide confidence that DCD can be safely and effectively performed without compromising outcomes, at least in a large-volume center of excellence,” and help provide evidence “to support the spreading acceptance of DCD among heart transplant programs.”

SOURCE:

The study was conducted by Hasan K. Siddiqi, MD, department of medicine, Vanderbilt University Medical Center, Nashville, Tenn., and colleagues. It was published online in the Journal of the American College of Cardiology.

LIMITATIONS:

The study was conducted at a single center and had a retrospective design and a modest sample size that prevented adjustment for all potentially confounding variables. Meaningful differences among DCD recipients could not be explored with regard to organ recovery technique, and small but statistically meaningful differences in outcomes could not be detected, the authors note. Follow-up was limited to 1 year after transplantation.

DISCLOSURES:

The authors report no relevant conflicts of interest. Dr. Pinney has received consulting fees from Abbott, ADI, Ancora, CareDx, ImpulseDynamics, Medtronic, Nuwellis, Procyrion, Restore Medical, Transmedics, and Valgen Medtech.

A version of this article first appeared on Medscape.com.

TOPLINE:

There are no significant differences in 1-year mortality, survival to hospital discharge, severe primary graft dysfunction (PGD), and other outcomes post heart transplant between patients who receive a heart obtained by donation after circulatory death (DCD) and patients who receive a heart by donation after brain death (DBD), a new study has shown.

METHODOLOGY:

• The retrospective review included 385 patients (median age, 57.4 years; 26% women; 72.5% White) who underwent a heart transplant at Vanderbilt University Medical Center from January 2020 to January 2023. Of these, 263 received DBD hearts, and 122 received DCD hearts.
• In the DCD group, 17% of hearts were recovered by use of ex vivo machine perfusion (EVP), and 83% by use of normothermic regional perfusion followed by static cold storage; 4% of DBD hearts were recovered by use of EVP, and 96% by use of static cold storage.
• The primary outcome was survival at 1 year after transplantation; key secondary outcomes included survival to hospital discharge, survival at 30 days and 6 months after transplantation, and severe PGD.

TAKEAWAY:

• There was no difference in 1-year post-transplant survival between DCD (94.3%) and DBD (92.4%) recipients (hazard ratio, 0.77; 95% confidence interval, 0.32-1.81; P = .54), a finding that was unchanged when adjusted for recipient age.
• There were no significant differences in survival to hospital discharge (93.4% DBD vs. 94.5% DCD; HR, 0.72; 95% CI, 0.26-1.99; P = .53), to 30 days (95.1% DBD vs. 96.7% DCD; HR, 0.67; 95% CI, 0.22-2.05; P = .48), or to 6 months (92.8% DBD vs. 94.3% DCD; HR, 0.68; 95% CI, 0.25-1.85; P = .45) after transplantation.
• The incidence of severe PGD was similar between groups (5.7% DCD vs. 5.7% DBD; HR, 1.00; 95% CI, 0.41-2.4; P = .99).
• There were no significant between-group differences in other outcomes, including incidence of treated rejection and cases of cardiac allograft vasculopathy of grade 1 or greater on the International Society for scale at 1 year.

IN PRACTICE:

“Our findings add to the growing body of evidence in support of DCD heart transplantation,” the authors write, potentially expanding the heart donor pool. They note that outcomes remained similar between groups despite higher-risk patients being overrepresented in the DCD cohort.

In an accompanying editorial, Sean P. Pinney, MD, Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, and a colleague called the results “impressive” and “encouraging,” although there are still “important unknowns,” including longer-term outcomes, the financial impact of DCD, and whether results can be replicated in other centers.

“These results provide confidence that DCD can be safely and effectively performed without compromising outcomes, at least in a large-volume center of excellence,” and help provide evidence “to support the spreading acceptance of DCD among heart transplant programs.”

SOURCE:

The study was conducted by Hasan K. Siddiqi, MD, department of medicine, Vanderbilt University Medical Center, Nashville, Tenn., and colleagues. It was published online in the Journal of the American College of Cardiology.

LIMITATIONS:

The study was conducted at a single center and had a retrospective design and a modest sample size that prevented adjustment for all potentially confounding variables. Meaningful differences among DCD recipients could not be explored with regard to organ recovery technique, and small but statistically meaningful differences in outcomes could not be detected, the authors note. Follow-up was limited to 1 year after transplantation.

DISCLOSURES:

The authors report no relevant conflicts of interest. Dr. Pinney has received consulting fees from Abbott, ADI, Ancora, CareDx, ImpulseDynamics, Medtronic, Nuwellis, Procyrion, Restore Medical, Transmedics, and Valgen Medtech.

A version of this article first appeared on Medscape.com.