Archive for November, 2019

Heart Disease: Invasive Treatment is Not Necessarily Better

Saturday, November 30, 2019 // Uncategorized

There have been some studies showing that in patients with stable heart disease caused by narrowing of the coronary arteries, stents and bypass surgery don’t necessarily improve mortality.  The following is the last salvo in that debate.  This is a summary from Physician’s First Watch

 

ISCHEMIA: Invasive Treatment Not Better Than Meds in Patients with Stable Ischemic Heart Disease

By Amy Orciari Herman

In patients with stable ischemic heart disease, invasive treatment appears no better than optimal medical therapy for preventing cardiovascular (CV) events, according to the international ISCHEMIA trial. The findings were presented on Saturday at the American Heart Association’s annual meeting in Philadelphia.

Nearly 5200 adults with stable ischemic heart disease and moderate-to-severe ischemia (usually diagnosed by stress imaging) were randomized to invasive or conservative management. In the invasive group, patients underwent cardiac catheterization followed by percutaneous coronary intervention (PCI) or coronary artery bypass grafting, when feasible; they also received optimal medical therapy. The conservative group received optimal medical therapy alone. Of note, patients with left main disease were excluded.

At 4 years, incidence of the primary endpoint — a composite of CV death, myocardial infarction (MI), resuscitated cardiac arrest, hospitalization for unstable angina, or heart failure — did not differ significantly between the invasive and conservative groups (13.3% and 15.5%, respectively). A major secondary endpoint comprising CV death or MI also did not differ significantly (11.7% and 13.9%).

Dr. Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology, offered his take: “The ISCHEMIA study is a lot to digest — and the results haven’t yet been published in a peer-reviewed journal. Yet, what seems clear is that patients with stable ischemic disease are safe with medical therapy, which is consistent with many other studies. A side question is whether stress myocardial perfusion studies are providing much value for these patients.”

Why We Chose This as Our Top Story

André Sofair, MD, MPH: Similar results have been described in other studies. I think that this is another case where less may be more for our patients. I think Dr. Krumholz’s comment is an important one — whether we should be performing stress tests on these patients is still an unanswered question.

William E. Chavey, MD, MS: As we digest the results of this trial, the take-home message for primary care may not be about who deserves PCI — but may be about the importance of ensuring that our patients get appropriate guideline-directed therapy.

 

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There Is Something Going Around

Monday, November 18, 2019 // Uncategorized

According to flu surveillance, there is an increase in Influenza Like Illness or ILI (formerly known as FLI) around the state.  Most of it isn’t the flu.  It’s a respiratory virus with flu-like symptoms.  We treat the symptoms with rest and acetaminophen or ibuprofen.  Anti viral medication like Tamiflu are ineffective against this virus.  The following is the summary from  the Center for Disease Control.

 

Texas Influenza Surveillance Report

2019-2020 Season/2019 MMWR Week 45

(November 3, 2019 – November 9, 2019)

Report produced on 11/15/2019

Summary

Influenza activity is increasing and has exceeded the Texas-specific ILI baseline for the first time this season. The percentage of patient visits due to influenza-like illness (ILI) has increased. One influenza-associated pediatric death was reported. One influenza-associated institutional outbreak was reported.

x Due to technical issues with the National Respiratory and Enteric Virus Surveillance System (NREVSS) reporting platform, clinical laboratory data are not available for week 45. This affects data for Table 1, Table 2, Table 4, and Figure 1. An update to previous weeks is included in Table 2. Reporting of this data will resume once the technical issues have been resolved.

Table 1: Summary of Texas Influenza (Flu) and Influenza-like Illness (ILI) Activity for the Current Week Texas Surveillance Component Change from Previous Week Current Week Previous Week Page of Report
Statewide influenza activity level reported to CDC (geographic spread of influenza) Increase Regional Local
Statewide ILINet Activity Indicator assigned by CDC (intensity of influenza-like illness) Increase Moderate Low
Percentage of specimens positive for influenza by hospital laboratories x 5.32% 1
Percentage of visits due to ILI (ILINet) ▲1.17% 4.91% 3.74% 4
Number of regions reporting increased flu/ILI activity ▲2 7 5 5
Number of regions reporting decreased flu/ILI activity No change 1 1 5
Number of variant/novel influenza infections No cases reported 0 0 5
Number of ILI/influenza outbreaks No change 1 1 5
Number of pediatric influenza deaths ▲1 1 0 6
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