CVD Winners and Losers; Stroke Reperfusion ‘Success’; Financial Toxicity

 

 

 

 

 

Cardiovascular Daily wraps up the top cardiology news of the week

Cardiovascular disease is stealing fewer disability-adjusted life-years nationwide now than in 1990, researchers reported in JAMA Cardiology.

However, big differences emerged among the states, with Arkansas, Oklahoma, Alabama, Kentucky, Missouri, Indiana, Kansas, Alaska, and Iowa making big strides but a few states actually increasing in life-year burden. The biggest driver appeared to be “dietary risk exposures followed by high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking, and low levels of physical activity,” study authors said.

A statement from American Heart Association Chief Medical Officer for Prevention, Eduardo Sanchez, MD, MPH, called the geographic disparities with increases in some states “troubling” as it may signal that the overall gains in CVD mortality over the past 50 years could be in jeopardy.

“These statistics serve as a call to action to seize opportunities to renew tested public health and clinical approaches, forge new partnerships, and test innovative interventions to prevent and control CVD,” he said. “One of our best bets is to focus on the social dynamic of CVD.”

Stroke Reperfusion ‘Success’

A successful stroke thrombectomy has been defined by Modified Thrombolysis in Cerebral Infarction (mTICI) 2B to 3 flow at the end of the procedure. However, analysis of the ASTER trial reported in Stroke suggests that it might be worth considering narrowing the definition to mTICI 2C and 3 only.

Those two higher flow grades together were associated with 72% better likelihood of a good outcome defined by modified Rankin Scale score 0 to 2 at 90 days compared with grade 2B flow patients, a difference that persisted with adjustment for other factors. Neurologic improvement also significantly favored mTICI 2C and 3 over 2B.

Commenting on the study, Gregory Albers, MD, of California’s Stanford University Medical Center, told MedPage Today that his DEFUSE 3 trial also showed better outcomes the closer to perfect reperfusion. “However, it is not always possible to achieve at 2C-3 and it is very important not to do additional interventions that place the patient at risk for complications,” he cautioned.

MedPage Today has the rest of the story here.

Bad Advice Common Online

Advice found on online message boards about implanted cardiac defibrillators (ICDs) may be accurate for most patients only half the time, according to 2 years of messages analyzed in a study presented at the American Heart Association’s Quality of Care and Outcomes Research (QCOR) meeting in Arlington, Virginia.

Nearly a quarter of the advice was deemed inappropriate for most patients, while 6% was controversial and the rest didn’t have enough context to support analysis of appropriateness. The category with the most inappropriate advice, a whopping 67%, related to procedures. The most controversial advice was found related to lead management (50%).

“Clinicians should caution patients it’s impossible for anyone not familiar with his or her case and full medical history to help put information into context for their individual patient needs,” the lead investigator said in a statement.

Financial Toxicity

Even with insurance, low-income families often pay a steep price for atherosclerotic cardiovascular disease (ASCVD), researchers reported at the QCOR meeting.

Based on the Medical Expenditure Panel Survey’s data for 2006-2015, annual inflation-adjusted out-of-pocket expenses (including insurance premiums) represented a median 6.4% of income in low-income families (making under $20,000 to $24,250 annually) and 5.5% of that for mid- or high-income families.

One in four low-income families with a member with ASCVD had a healthcare expense burden of at least 20% of the family income. And one in 10 had a “catastrophic” burden of more than 40% of family income, even with insurance coverage.

“While more low-income families gained insurance coverage over the period of time for which we evaluated the expense data, those with insurance had high rates of out-of-pocket expenses that frequently exceeded expenses of those without insurance,” the lead author said in a statement. “To alleviate economic disparities, the quality of insurance coverage for low-income families must improve.”

Link Original: https://www.medpagetoday.com/cardiology/prevention/72327

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