Angina Blog on Angina.com

If you have stable cardiovascular disease, it is more than likely that you can safely engage in sexual activity, according to an American Heart Association scientific statement.

The statement, published online in Circulation: Journal of the American Heart Association, contains recommendations by experts from various fields, including heart disease, exercise physiology and sexual counseling.

“Sexual activity is a major quality of life issue for men and women with cardiovascular disease and their partners,” said Glenn N. Levine, M.D., lead author of the statement and a professor of medicine at Baylor College of Medicine in Houston, Texas. “Unfortunately, discussions about sexual activity rarely take place in the clinical context.”

The recommendations include:

• After a diagnosis of cardiovascular disease, it is reasonable for patients to be evaluated by their physician or healthcare provider before resuming sexual activity.
• Cardiac rehabilitation and regular physical activity can reduce the risk of cardiovascular complications related to sexual activity in people who have had heart failure or a heart attack.
• Women with cardiovascular disease should be counseled on the safety and advisability of contraceptive methods and pregnancy based on their patient profile.
• Patients with severe heart disease who have symptoms with minimal activity or while at rest should not be sexually active until their cardiovascular disease symptoms are stabilized with appropriate treatment.
• Patients should be assessed to see if their sexual dysfunction is related to underlying vascular or cardiac disease, anxiety, depression or other factors.
• Drugs that can improve cardiovascular symptoms or survival should not be withheld due to concerns that such drugs may impact sexual function.
• Drugs to treat erectile dysfunction are generally safe for men who have stable cardiovascular disease. These drugs should not be used in patients receiving nitrate therapy for chest pains due to coronary artery disease (blockages in the arteries that supply the heart with blood), and nitrates should not be administered to patients within 24-48 hours of using an erectile dysfunction drug (depending on the drug used).
• It is reasonable for post-menopausal women with cardiovascular disease to use estrogen that’s topically or vaginally inserted for the treatment of painful intercourse.

Decreased sexual activity and function — common in men and women with cardiovascular diseases — is often related to anxiety and depression.

The absolute rate of cardiovascular events during sexual activity, such as heart attacks or chest pain caused by heart disease, is miniscule because sexual activity is usually for a short time.

“Some patients will postpone sexual activity when it is actually relatively safe for them to engage in it,” said Levine, who is also director of the Cardiac Care Unit at the Michael E. DeBakey Medical Center in Houston. “On the other hand, there are some patients for whom it may be reasonable to defer sexual activity until they’re assessed and stabilized.”

Co-writers are Elaine E. Steinke, R.N., Ph.D.; Faisal G. Bakaeen, M.D.; Biykem Bozkurt, M.D., Ph.D.; Melvin D. Cheitlin, M.D.; Jamie Beth Conti, M.D.; Elyse Foster, M.D.; Tiny Jaarsma, R.N., Ph.D.; Robert A. Kloner, M.D., Ph.D.; Richard A. Lange, M.D., M.B.A.; Stacy Lindau, M.D.; Barry J. Maron, M.D.; Debra K. Moser, D.N.Sc., R.N.; E. Magnus Ohman, M.D.; Allen D. Seftel, M.D.; and William J. Stewart, M.D.

Source: Eurekalert

Preventing heart disease before it starts is a good long-term investment in the nation’s health, according to a new policy statement from the American Heart Association.

The policy statement, published in Circulation: Journal of the American Heart Association, summarizes years of research on the value of investing in prevention, particularly through community-based changes to make it easier to live a healthy lifestyle:

• Every dollar spent on building trails for walking or biking saves $3 in medical costs.
• Companies that invest in workers’ health with comprehensive worksite wellness programs and health work environments have less absenteeism, greater productivity and lower healthcare costs.
• Initiating a nationwide plan to drastically cut the amount of salt in the food supply to support an average intake of 1500 mg per day may reduce high blood pressure in the country by 25 percent, saving $26 billion in healthcare costs annually.

As a call to action, the statement puts an equal amount of responsibility on individuals and on society — specifically federal, state and local policy-makers.

“People often don’t realize the power to stay healthy is in their own hands,” said William S. Weintraub, M.D., lead author of the statement and the John H. Ammon chair of cardiology and cardiology section chief at Christiana Care Health System in Newark, Del. “But it’s not something many individuals or families can do alone. It takes fundamental changes from society as a whole.”

It’s more difficult to make healthy choices in some neighborhoods because it’s hard to find a safe place to bike or a nearby store with fresh vegetables at an affordable price, he said.

“But, given the high cost of treating acute and chronic disease, prevention offers the potential of improving health and cutting costs,” said Weintraub, a professor of medicine at Thomas Jefferson University in Philadelphia, Penn. “What we spend on cardiovascular disease is not sustainable. But we can afford to prevent it. Ultimately, we can’t afford not to.”

“Individual responsibility is a crucial first step, but environmental and policy changes are the most impactful ways to improve health,” said Gordon Tomaselli, M.D., American Heart Association president. In the statement, the American Heart Association calls for policy-makers to ensure that:

• Schools include quality physical education and opportunities for physical activity in the curriculum every day.
• School lunches include more fresh vegetables and fruits and less salt and sugar.
• Communities are built with exercise in mind and include sidewalks and bike trails.
• Less added sugars, salt and trans fats are included in foods.
• Neighborhood stores — particularly those in lower income areas — carry affordable, fresh vegetables and fruits.
• Smoking isn’t allowed in restaurants, the workplace and other indoor spaces.
• Additional taxes are added to tobacco products to further discourage use.
• Smoking cessation programs are adequately funded.
• Increased funding is directed toward programs that eliminate health disparities.

Medical care and indirect costs of heart disease in the United States rose to $450 billion last year, and are projected to be more than $1 trillion by 2030, according to the American Heart Association.

“Heart disease is largely preventable, yet most of the funding for and the focus on heart disease are on the back end, related to acute and chronic care — after the damage is done,” said Tomaselli, professor and director of the Division of Cardiology at the Johns Hopkins University School of Medicine in Baltimore, Md. “We need to get society away from thinking we’ll take care of the disease in the future.”

Deaths from cardiovascular diseases have fallen by more than 50 percent since peaking in the 1960s. More than half of that decrease has been attributed to prevention, due to improved management of cholesterol, blood pressure and tobacco use.

“Prevention will pay for itself,” Tomaselli said. “Not just monetarily, but also by lengthening and improving the quality of life people can enjoy. More importantly, these changes won’t just affect us today — they’ll have a positive impact on generations to come.”

Co-authors are Stephen Daniels, M.D., Ph.D.; Lora E. Burke, Ph.D., M.P.H.; Barry Franklin, Ph.D.; David C. Goff, Jr., M.D., Ph.D.; Laura L Hayman, Ph.D., R.N.; Donald Lloyd-Jones, M.D. ; Dilip K. Pandey, M.B.B.S., Ph.D.; Eduardo Sanchez, M.D., M.P.H.; Andrea Parsons Schram, D.N.P., C.R.N.P.; and Laurie P. Whitsel, Ph.D. Author disclosures are on the manuscript.

American Heart Association Rapid Access Journal Report

Study Highlights:

• Transporting a specialist to a patient having a severe heart attack (STEMI) can reduce delays in the patient receiving primary angioplasty, compared with transferring the patient to a specialist.

• Of patients in the specialist-transfer group, 21 percent received angioplasty within the recommended 90 minutes vs. 7.7 percent of patients in the patient-transfer group.

DALLAS, April 26, 2011 — In a large, traffic-congested city in China, severe heart attack patients received treatment faster and had better long-term results when interventional physicians were taken to them, according to a study in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.

The REVERSE-STEMI study involved 334 patients who had suffered a ST elevation myocardial infarction (STEMI), a severe form of heart attack.

The patients were initially brought to one of five hospitals, all in Shanghai, China, that didn’t have specialists who could perform primary percutaneous coronary infusion (PPCI) or primary angioplasty, but had cardiac catheterization laboratories.

During PPCI, the recommended treatment for acute STEMI patients, a balloon on the end of a long tube, or catheter, is guided through one of a patient’s arteries to the blockage causing the heart attack. Then, the balloon is inflated to place a stent to open the artery.

In the study, about half the patients were transferred, as is routine, to a sixth Shanghai hospital capable of performing PPCI. The other patients were subject to an “interventionalist-transfer strategy,” in which the patients stayed at the hospital where their condition was diagnosed and an interventional cardiologist was dispatched from a PPCI-capable hospital.

The study tracked “door-to-balloon time,” the period between a STEMI patient’s arrival at a hospital to when the balloon was inflated. The goal is a door-to-balloon time of 90 minutes or less.

About 21 percent of the patients in the interventionalist-transfer group had PPCI performed within the 90-minute time frame, compared with just 7.7 percent of those in the patient-transfer group, the researchers found.

The interventionalist-transfer strategy is feasible and effective in reducing door-to-balloon time, said Qi Zhang, author of the study and a cardiologist at Ruijin Hospital in Shanghai, China.

A year later, nearly 85 percent of the patients whose specialist was taken to them survived and had not experienced any other major cardiac events, such as another heart attack, compared to nearly 75 percent of the patient transfer group. Also a year later, the left ventricular ejection fraction of patients in the interventionalist-transfer group (60.1 percent) was significantly higher than that of the patient-transfer group (56.9 percent). Left ventricular ejection fraction is a measure of the heart’s pumping ability.

Traffic increased the door-to-balloon times for transferred patients by delaying the arrival of the ambulance at the first hospital and then delaying the patient’s transfer to the second hospital. The risk of cardiac complications also increased during patient transfer. The average transfer distance was 17.5 kilometers (almost 11 miles).

The interventionalist-transfer strategy could be an important tool in metropolitan areas of China or elsewhere if resources such as ambulances and emergency staff are in short supply, leading to delays in transferring patients, researchers said. Until emergency infrastructure in some cities can be improved, “we believe this strategy is a good interim option,” Zhang said.

Co-authors are Rui Yan Zhang, M.D.; Jian Ping Qiu, M.D.; Jun Feng Zhang, M.D.; Xiao Long Wang, M.D.; Li Jiang, M.D.; Min Lei Liao, M.D.; Jian Sheng Zhang, M.D.; Jian Hu, M.D.; Zheng Kun Yang, M.D. and Wei Feng Shen, M.D., Ph.D. Author disclosures are on the manuscript.

The Shanghai Science and Technology Foundation and the National Nature Science Foundation of China funded the study.

(Media-Newswire.com) – HOUSTON — ( April 5, 2011 ) — New guidelines for the management of patients with unstable angina and non-ST-elevation myocardial infarction ( termed acute coronary syndromes ) have been released by the American College of Cardiology and the American Heart Association. The guidelines were created by a consortium of national experts including a cardiologist from Baylor College of Medicine.

“This important document is an update of the 2007 ACC/AHA guidelines. We examined past recommendations, reviewed the clinical data that accrued since then, and created the most updated set of recommendations that can provide guidance for physician in their patient care,” said Dr. Hani Jneid, assistant professor of medicine and interventional cardiologist at Baylor College of Medicine and the Michael E. DeBakey VA Medical Center. Dr. Jneid was part of the 15-member writing group, led by Dr. R. Scott Wright, professor of medicine at the Mayo Clinic.

Leading cause of death
Unstable angina occurs when the heart doesn’t get enough blood flow and oxygen, as a result of blockage in one or more of the coronary arteries. This results in chest discomfort, and when prolonged beyond a 20-30 minute period, may progress into myocardial infarction ( or a heart attack ) with death of heart muscle cells. Those guidelines therefore address one of the most commonly encountered clinical conditions and a leading cause of death and morbidity in the United States and the Western World.

Jneid indicated that the guidelines have been updated with a plethora of new recommendations. These include, but are not limited to, recommendations pertinent to early hospital care, such as the timing of cardiac catheterization after an acute coronary syndrome, the use of intravenous anti-platelet and anticoagulant medications, and especially the clinical application of prasugrel, a novel oral anti-platelet drug. New recommendations pertinent to patients with diabetes and chronic kidney disease, as well as recommendations for quality of care and outcome monitoring after an acute coronary syndrome have also been proposed.

Clinically relevant changes
“Our multifaceted group worked tirelessly to review the literature and dissect clinical studies and experimental evidence to come up with the meticulous and clinically relevant changes,” Jneid said. “This process of periodically updating Guidelines is very important to patient care, especially in the dynamic and rapidly evolving field of cardiovascular medicine. The careful revisions and scrutiny of the document and the choice of unbiased and balanced team of experts are all a testimony of the high standards set by the ACC and AHA in constructing these guidelines, as supported by report of the Institutes of Medicine last month.”

In addition to Drs. Scott and Jneid, the national expert panel is made up of Drs. Jeffrey Anderson, Cynthia Adams, Charles Bridges, A. Michael Lincoff, Donald Casey, Eric Peterson, Steven Ettinger, George Philippides, Francis M Fesmire, Pierre Theroux, Theodore Ganiats, Nanette Wenger and James Zidar. Of note, this guidelines update was created in collaboration with prominent medical organizations, including the American Academy of Family Physicians, the American College of Emergency Physicians, the Society for Cardiac Angiography and Interventions, and the Society of Thoracic Surgeons.

The 2011 focused update will be published in the Journal of the American College of Cardiology and Circulation: Journal of the American Heart Association. It has been released online ahead of print on the ACC and AHA web sites.

Study Highlights:

– Twelve weeks in a low-intensity collaborative care program improved depression symptoms and reduced anxiety in heart disease patients.

– A collaborative care program for depression uses a non-physician care manager to coordinate treatment among the patient, primary doctor and a psychiatrist.

– The study is the first to begin the collaborative care program in the hospital and the first to target a wide range of cardiac conditions.

DALLAS, March 8, 2011 /PRNewswire-USNewswire/ — Participants in the first hospital-initiated, low-intensity collaborative care program to treat depression in heart patients showed significant improvements in their depression, anxiety and emotional quality of life after 6 and 12 weeks, researchers report in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

Collaborative care depression management programs use a non-physician care manager to coordinate depression evaluation and treatment among the patient, primary medical physician and a psychiatrist.

In their trial, researchers randomized 175 depressed heart patients (mostly Caucasian and about half women) to either “usual care” (a recommendation for depressive treatment) or “collaborative care,” which includes receiving written and verbal education about depression and its impact on cardiac disease, scheduling pleasurable leisure activities post-discharge, receiving detailed treatment options (medicines or counseling referral), and coordinating follow-up care after discharge.

“Collaborative care depression-management programs have been used in the outpatient setting, but such a program had never been initiated in the hospital or used for patients with a wide range of cardiac illnesses,” said Jeff C. Huffman, M.D., lead author of the study, assistant professor of psychiatry at Harvard Medical School and director of the Cardiac Psychiatry Research Program at Massachusetts General Hospital in Boston.

“In the real world this program would be applied on cardiac floors and would be much more easily applied to a large group of patients rather than a small subset or single diagnosis,” said Huffman. “This kind of economy of scale may make it much more feasible from a resource and cost standpoint.”

Six weeks after leaving the hospital, nearly twice as many of the collaborative care patients reported their depression symptoms were cut by half or more, compared to those receiving usual care (59.7 percent vs 33.7 percent). The differences at 12 weeks were also improved with a 51.5 percent depression response rate for collaborative care patients versus 34.4 percent for patients receiving usual care.

Those effects decreased once the intervention ended at 12 weeks and between-group differences lost their statistical significance by the six-month follow-up call, which came three months after the patients’ last contact with the researchers.

Although rehospitalization rates were similar between groups, the collaborative care patients self-reported significantly fewer and less severe cardiac symptoms and better adherence to healthy activities like diet and exercise at six months compared to the usual care group. “These improvements are relevant medical outcomes in themselves, and suggest this type of program may have broad effects on overall health,” Huffman said.

Those in the collaborative care group got only a little more attention — three phone calls at most and stronger recommendations from their doctors — than those in the usual care group, which is a less intense follow-up.

The study is a first-step for hospital-initiated collaborative care, Huffman said. “While improved mental health is a start, a program may require more intensity to see improved medical outcomes, and larger studies will be needed to see results in a more diverse patient population.”

“Patients with heart disease who have depression are more likely to be rehospitalized, have poorer quality of life and are more likely to die from their heart disease than are people without depression. If an efficient program like this one can be used to identify, treat and monitor depression in heart disease patients, this might lead to lower rates of rehospitalization or death in these patients, though this remains to be proven.”

The American Heart Association recommends that CVD patients be screened for depression and receive coordinated follow-up care for heart disease and depression if they have both conditions.

Co-authors are: Carol A. Mastromauro, LICSW; Gillian Sowden, B.A.; Gregory L. Fricchione, M.D.; Brian C. Healy, Ph.D.; and James L. Januzzi, M.D. Author disclosures are on the manuscript.

The study was partly funded by an American Heart Association Scientist Development Grant.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position.  The association makes no representation or guarantee as to their accuracy or reliability.  The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

SOURCE American Heart Association

Cost to treat heart disease in United States will triple by 2030 American Heart Association Policy Statement
Study Highlights:

• The cost of treating heart disease in the United States will triple by 2030, according to new projections from the American Heart Association.

• The $545 billion increase is due in part to an aging population.

  Read more on Angina.com

The American Heart Association recommends a population wide reduction in sodium intake to no more than 1500 mg/day.

The American Heart Association’s 2020 impact goals – to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent – include a population-wide reduction of sodium consumption to less than 1,500 mg/daily as one of the ways the association will measure the nation’s cardiovascular health.

The American Heart Association is part of the National Salt Reduction Initiative, which is working with the food industry to reduce sodium content in packaged and restaurant food.

Read the Press Release