One Minute, Shared Decision-Making Aid Reduces Unnecessary Hospitalization

Posted on by Kurt Jensen

Additional cardiac imaging often unnecessary

Last week, Mayo Clinic researchers showed that using a shared decision-making aid to involve more patients in care decisions can prevent both unnecessary hospitalization and more advanced cardiac tests for patients with low-risk chest pain.

The "Chest Pain Choice" shared decision-making aid is one of the latest evidence-based practices built on high-sensitivity troponin rule-out of acute coronary syndrome for ED patients reporting acute chest pain. After the one-hour test, an additional "one minute" discussion to educate patients about their risk and reach a shared decision can prevent further unnecessary and costly testing.

ACVP Blog has discussed decision-making for acute chest pain before, suggesting that the fact the cardiac biomarker test can safely and accurately rule-out acute coronary syndrome within one hour "challenges [the] need" for commonly-used noninvasive imaging prior to patient discharge.

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Two common ways you might misinterpret medical research

Posted on by Kurt Jensen

Sophisticated statistics in medical research can be hard to translate to layman's terms, and when they are, these common misinterpretations can be downright misleading.

1. Odds ratios don't express relative risk.

In 1999, media reports resulting from a study published in the New England Journal of Medicine wrongly suggested that black patients and women were 40 percent less likely than white patients and men, respectively, to undergo cardiac catheterization.

The study's authors had used odds ratios to describe the significance of their findings—a common practice among statistically sophisticated researchers—which showed that black patients and women were definitely less likely to be referred for invasive procedures than white patients and men, but not how much less likely.

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Study finds risky drug interaction between two common statins and anti-clotting drug for stroke

Posted on by Kurt Jensen

If simvastatin or lovastatin are combined with dabigatran—brand name Pradaxa, an anti-clotting drug—hemorrhage risk increases.

A study published today in the Canadian Medical Association Journal found that within a cohort of almost 46,000 patients treated with dabigatran, the use of simvastatin or lovastatin, relative to other statins, increased the risk of a major hemorrhage by approximately 42 percent.*

Administrative data supported the authors' hypothesis that these two commonly-prescribed, cholesterol-lowering statins would "increase the amount of dabigatran absorbed by the body," reads the St. Michael's Hospital press release, "something other statins would not be expected to do." A higher concentration of dabigatran, in turn, would result in higher bleeding risk.

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Video: researchers use light to defibrillate arrhythmias in mice

Posted on by Kurt Jensen

Scientists from Johns Hopkins University and the University of Bonn in Germany have applied advances in optogenetics to terminate arrhythmias in mice.

In a new study published online yesterday in the Journal of Clinical Investigation, authors prove the concept of optogenetic defibrillation, where epicardial illumination can effectively terminate ventricular tachycardia—a potential alternative to implantable defibrillators.

"Strong electrical shocks can damage the heart and cause severe pain," write the authors. "Our results... could potentially be translated into humans to achieve nondamaging and pain-free termination of ventricular arrhythmia."

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