“’There must be some kind of way out of here’, said the joker to the thief. ‘There’s too much confusion, I can’t get no relief,'” sang Bob Dylan. Like the song, understanding the most optimal approach for certain at-risk cardiac patients can be tricky; however, with new research, multi-society documents and advances in care, a more clear path to patient care may be coming into focus.
In fact, a multi-society document published earlier this week attempted to outline recommendations for the proper use of combining proton-pump inhibitors (PPIs) and dual-antiplatelet therapy when treating heart disease patients. While dual-antiplatelet therapy in combination with aspirin has been shown to reduce major cardiovascular events (MACE), it also may produce recurrent bleeds in patients with GI bleeding—PPIs or H2RAs can reduce this potential risk.
The authors drew several conclusions to best use this combination of medications and suggested that PPIs be used in patients with a history of GI bleeding, but not in patients with a low risk of GI bleeding.
Additionally, researchers found that using an automated safety surveillance system of a clinical outcomes registry for CVD may identify devices that cause higher risk for patients. The system evaluated seven devices and performed 21 safety analyses such as risk of post-procedural MI and risk of MACE, among others. The authors found that of the seven devices, the Taxus Express2 (Boston Scientific) was associated with an increased in MI within 30 days of PCI procedures. They also found increased vascular complications associated with the Angio-Seal STS vascular closure device (St. Jude Medical).
Although still a work in progress, these surveillance systems could assist in the reporting and identifying of post-market safety risks, ultimately improving the care of heart patients.
Lastly, an analysis published in Circulation found that using a collaborative approach to heart failure care—with a cardiologist and primary care physician—improves outcomes. Compared with patients who visited only their primary care physician within 30 days of discharge, those who underwent collaborative care saw reduced rates of mortality by nearly 50 percent.
Care for heart patients is a mixed-bag. With multiple treatment approaches, devices and medical therapy available, cardiologists must strive to find the model of care that offers the least amount of confusion and provides the best relief. Which models of care do you find work best?
Let us know your thoughts.