Comparing New Leadless Pacemakers: Micra vs. Nanostim

Posted on by Kurt Jensen

On the back of encouraging Phase III trial results, Medtronic's "Micra" leadless pacemaker was approved by the U.S. Food and Drug Administration in April, beating St. Jude Medical's "Nanostim" to approval—but does it have more limitations?

For leadless pacemakers, size matters.

Despite being small for pacemakers, both devices are rather large for transfemoral catheterization—the access site for both devices.

Sheaths for St. Jude Medical's Nanostim device measure 18 French or 6mm in diameter, to which Dr. Prapa Kanagaratnam of St. Mary's Hospital, Imperial College, London expressed some concern. "An 18-F sheath is a big sheath to put in the leg," he said to heartwire.

"A lot of the patients we're putting these devices into are small, elderly people," said Dr. Kanagaratnam. "So it's still a procedure that we feel anxious about."

Continue reading Comparing New Leadless Pacemakers: Micra vs. Nanostim

Routine Cardiac Catheterization Expanding to Saturdays?

Posted on by Kurt Jensen

Expanding availability of elective, non-emergent cardiac catheterization services to Saturdays might significantly reduce length of stay, with no effect on clinical quality reports a recent economic impact study.

The study, published online in the American Journal of Managed Care found that reduced length of stay did not result in total cost savings, however.

In January 2009, Mayo Clinic Rochester expanded cardiac catheterization service availability (CSA) to Saturdays with the "goal of timely access with improved efficiency of care," write the authors.

Despite succeeding in greatly reducing length of stay—a statistically significant, adjusted average of 1.73 days—total costs of care were similar prior to CSA expansion.

Continue reading Routine Cardiac Catheterization Expanding to Saturdays?

A new cardiac imaging paradigm for acute chest pain?

Posted on by Kurt Jensen

In the "high-sensitivity cardiac troponin era," will the role of cardiac imaging in the ED change?

As high-sensitivity cardiac troponin (hs-cTn) assays become more and more common, cardiac imaging becomes less necessary for ruling out acute myocardial infarction (AMI) in ED patients with acute chest pain, but might be useful to prevent unnecessary or aggressive treatments write experts in July's volume of the American Heart Journal.

ACVP blog has covered the groundbreaking research on the high-sensitivity cardiac troponin tests since early last year, when we reported a new strategy that could rule out acute myocardial infarction within one hour, and rule it in with 75 percent accuracy. In June, two studies publishes in JAMA Cardiology lent further support to one-hour algorithms.

The speed and safe, accurate "rule out" of acute myocardial infarction through these cardiac biomarker tests "challenges [the] need" for noninvasive imaging prior to patient discharge when troponin values are normal, write the authors of the American Heart Journal article.

Continue reading A new cardiac imaging paradigm for acute chest pain?

Medical Mystery Monday: Why is Heart Disease In Decline? Part Two

Posted on by Kurt Jensen

Last week, ACVP blog's analysis of heart disease as a medical mystery left our readers with a few big questions.

Despite all the research and measurement into heart disease on a national and global scale - are we any closer to satisfying answers about how best to continue to decrease heart disease mortality rates?

The history of the heart disease decline - and all the research that came out of it - still might leave us (surprisingly) lost for hard answers.

Attribution of causes, historically, a murky process

In 2013, medical historians David S. Jones, MD, PhD of Harvard Medical School and Jeremy A. Greene, MD, PhD of Johns Hopkins School of Medicine published a history of the decline of heart disease mortality in the American Journal of Public Health.

Following their peak in the early 1960s, heart disease mortality rates shockingly declined 20 percent between 1968 and 1978---a decline so large and without simple explanation that a conference was called to determine whether the decline was "real." (It was.)

"Quite simply, the problem was that too many things had changed," write Jones and Greene.

Continue reading Medical Mystery Monday: Why is Heart Disease In Decline? Part Two