American Heart Association Meeting In Brief
This article was originally published in The Gray Sheet
Executive Summary
Evidence-Based HF treatment: Eligible heart failure patients in the United States are underutilizing professional guideline-recommended device and drug treatments, according to data from the Medtronic-sponsored, 40,000-patient IMPROVE HF registry presented at the American Heart Association Scientific Sessions in Orlando Nov. 7. According to the registry data, only about 39% of eligible patients are receiving cardiac resynchronization therapy and about 51% of indicated patients receive an implantable defibrillator. The registry also found that 36% of eligible patients are taking aldosterone antagonist drugs to manage congestive heart failure and 69% of eligible patients receive anticoagulants to mitigate the risk of atrial fibrillation. About 61% of patients receive heart failure education. Previous data from IMPROVE HF showed that, overall, fewer than 30% of patients were getting all the therapies they were eligible for under the guidelines, with women and older patients the most likely to be undertreated (1"The Gray Sheet" Sept. 25, 2006, p. 5)
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Research In Brief
Is MTWA useful? Two new studies cast doubt on the potential for microvolt T-wave alternans (MTWA) testing to predict ventricular tachyarrhythmic events in heart failure patients. Results of a 490-patient substudy of Medtronic's Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) published in the journal Circulation found that MTWA testing did not predict arrhythmic events or mortality, suggesting that MTWA is "not useful as an aid in clinical decision making on implantable cardioverter defibrillator therapy among patients with heart failure and left-ventricular diastolic dysfunction," according to authors Michael Gold, Medical University of South Carolina, et al.. Results of the 575-patient Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients (MASTER) trial, recently published in the Journal of the American College of Cardiology, found that the risk of ventricular tachyarrhythmia did not correlate to differences in MTWA test results in heart failure patients with an ICD that was implanted to prevent sudden cardiac death (1"The Gray Sheet" Nov. 12, 2007, p. 17). More studies needed: In an editorial accompanying the Gold study in Circulation, an expert on mechanisms of cardiac arrhythmias, David Rosenbaum, Case Western Reserve University in Cleveland, points out that the SCD-HeFT substudy suggests MTWA "does indeed track susceptibility to sudden cardiac death in a population where primary prevention strategies are highly relevant ... Further advances in risk stratification will also require trials where therapy is randomized on the basis of risk markets that reflect electrophysiological substrates for sudden cardiac death.
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