Damian McNamara

BOCA RATON, FLA. — When it comes to treatment options, palliative care, and decision making for patients with end-stage heart failure, cardiologists, internists, family physicians, and geriatricians are similarly lacking in awareness, according to a national pilot survey.

The American College of Cardiology and the American Heart Association's recommendations for the care of heart failure patients include a call for cardiologists to counsel patients about end-of-life issues.

However, most of the care of heart failure patients is done by noncardiologist physicians, and there is still uncertainty about which physicians should address end-of-life concerns with end-stage heart failure patients.

“The question is, who is going to have 'the talk'?” Dr. Paul J. Hauptman said in an interview.

“More and more patients have heart failure, and more and more patients are going to die from heart failure. What are we going to do with this burgeoning population of patients with heart failure?” asked Dr. Hauptman, professor of medicine, division of cardiology, and director of heart failure/transplantation at St. Louis (Mo.) University.

In an attempt to answer that question, Dr. Hauptman and his associates surveyed cardiologists, family physicians, internists, and geriatricians about the management of patients with end-stage heart failure. The investigators randomly selected physicians from the American Medical Association Master File.

The administration of the 51-question survey is ongoing, with the goal of garnering opinions from 1,450 physicians. Preliminary results from 76 responses were given in a poster presentation at the annual meeting of the Heart Failure Society of America.

The survey indicates a similar lack of awareness about published guidelines for heart failure (44% of cardiologists, 47% of noncardiologists), a similar belief in left-ventricular pacing as a life-extending measure (44% of cardiologists, 41% of noncardiologists), and a similar level of uncertainty about when to refer a patient to hospice care (52% of cardiologists, 53% of noncardiologists).

Almost 85% of the noncardiologists who responded to the survey said they believed that they, and not cardiologists, should initiate end-of-life discussions with their patients. “The noncardiologists really thought they were better [at that] than the cardiologists,” Dr. Hauptman commented.

However, he added, most of the generalists reported that they had never had such a discussion with a patient or a patient's family.

“Cardiologists have an acute-care perspective. We don't really know about what is going on at the end of life,” Dr. Hauptman said. “It's going to take education and discussions at national meetings [to understand that].”

The majority of respondents (91% of cardiologists, 67% of noncardiologists) do not use standard quality of life measurements for patients with end-stage heart failure.

“This would be kind of shocking” if confirmed by the full survey, he said.

Most of the cardiologists who were surveyed (65%) said that they have discussed implantable cardioverter defibrillator deactivation with an end-stage patient or family member, compared with 35% of noncardiologists.

With the increasing prevalence of heart failure, Dr. Hauptman asserted, “more patients are going to show up with a device. Do you turn them off or [do you] not turn them off?”

Dr. Hauptman said that he hoped the final results of the survey would provide even more insight about physicians' attitudes toward end-stage heart failure and that the information will be able to be used to design effective interventions in the future.

BOCA RATON, FLA. — When it comes to treatment options, palliative care, and decision making for patients with end-stage heart failure, cardiologists, internists, family physicians, and geriatricians are similarly lacking in awareness, according to a national pilot survey.

The American College of Cardiology and the American Heart Association's recommendations for the care of heart failure patients include a call for cardiologists to counsel patients about end-of-life issues.

However, most of the care of heart failure patients is done by noncardiologist physicians, and there is still uncertainty about which physicians should address end-of-life concerns with end-stage heart failure patients.

“The question is, who is going to have 'the talk'?” Dr. Paul J. Hauptman said in an interview.

“More and more patients have heart failure, and more and more patients are going to die from heart failure. What are we going to do with this burgeoning population of patients with heart failure?” asked Dr. Hauptman, professor of medicine, division of cardiology, and director of heart failure/transplantation at St. Louis (Mo.) University.

In an attempt to answer that question, Dr. Hauptman and his associates surveyed cardiologists, family physicians, internists, and geriatricians about the management of patients with end-stage heart failure. The investigators randomly selected physicians from the American Medical Association Master File.

The administration of the 51-question survey is ongoing, with the goal of garnering opinions from 1,450 physicians. Preliminary results from 76 responses were given in a poster presentation at the annual meeting of the Heart Failure Society of America.

The survey indicates a similar lack of awareness about published guidelines for heart failure (44% of cardiologists, 47% of noncardiologists), a similar belief in left-ventricular pacing as a life-extending measure (44% of cardiologists, 41% of noncardiologists), and a similar level of uncertainty about when to refer a patient to hospice care (52% of cardiologists, 53% of noncardiologists).

Almost 85% of the noncardiologists who responded to the survey said they believed that they, and not cardiologists, should initiate end-of-life discussions with their patients. “The noncardiologists really thought they were better [at that] than the cardiologists,” Dr. Hauptman commented.

However, he added, most of the generalists reported that they had never had such a discussion with a patient or a patient's family.

“Cardiologists have an acute-care perspective. We don't really know about what is going on at the end of life,” Dr. Hauptman said. “It's going to take education and discussions at national meetings [to understand that].”

The majority of respondents (91% of cardiologists, 67% of noncardiologists) do not use standard quality of life measurements for patients with end-stage heart failure.

“This would be kind of shocking” if confirmed by the full survey, he said.

Most of the cardiologists who were surveyed (65%) said that they have discussed implantable cardioverter defibrillator deactivation with an end-stage patient or family member, compared with 35% of noncardiologists.

With the increasing prevalence of heart failure, Dr. Hauptman asserted, “more patients are going to show up with a device. Do you turn them off or [do you] not turn them off?”

Dr. Hauptman said that he hoped the final results of the survey would provide even more insight about physicians' attitudes toward end-stage heart failure and that the information will be able to be used to design effective interventions in the future.

BOCA RATON, FLA. — When it comes to treatment options, palliative care, and decision making for patients with end-stage heart failure, cardiologists, internists, family physicians, and geriatricians are similarly lacking in awareness, according to a national pilot survey.

The American College of Cardiology and the American Heart Association's recommendations for the care of heart failure patients include a call for cardiologists to counsel patients about end-of-life issues.

However, most of the care of heart failure patients is done by noncardiologist physicians, and there is still uncertainty about which physicians should address end-of-life concerns with end-stage heart failure patients.

“The question is, who is going to have 'the talk'?” Dr. Paul J. Hauptman said in an interview.

“More and more patients have heart failure, and more and more patients are going to die from heart failure. What are we going to do with this burgeoning population of patients with heart failure?” asked Dr. Hauptman, professor of medicine, division of cardiology, and director of heart failure/transplantation at St. Louis (Mo.) University.

In an attempt to answer that question, Dr. Hauptman and his associates surveyed cardiologists, family physicians, internists, and geriatricians about the management of patients with end-stage heart failure. The investigators randomly selected physicians from the American Medical Association Master File.

The administration of the 51-question survey is ongoing, with the goal of garnering opinions from 1,450 physicians. Preliminary results from 76 responses were given in a poster presentation at the annual meeting of the Heart Failure Society of America.

The survey indicates a similar lack of awareness about published guidelines for heart failure (44% of cardiologists, 47% of noncardiologists), a similar belief in left-ventricular pacing as a life-extending measure (44% of cardiologists, 41% of noncardiologists), and a similar level of uncertainty about when to refer a patient to hospice care (52% of cardiologists, 53% of noncardiologists).

Almost 85% of the noncardiologists who responded to the survey said they believed that they, and not cardiologists, should initiate end-of-life discussions with their patients. “The noncardiologists really thought they were better [at that] than the cardiologists,” Dr. Hauptman commented.

However, he added, most of the generalists reported that they had never had such a discussion with a patient or a patient's family.

“Cardiologists have an acute-care perspective. We don't really know about what is going on at the end of life,” Dr. Hauptman said. “It's going to take education and discussions at national meetings [to understand that].”

The majority of respondents (91% of cardiologists, 67% of noncardiologists) do not use standard quality of life measurements for patients with end-stage heart failure.

“This would be kind of shocking” if confirmed by the full survey, he said.

Most of the cardiologists who were surveyed (65%) said that they have discussed implantable cardioverter defibrillator deactivation with an end-stage patient or family member, compared with 35% of noncardiologists.

With the increasing prevalence of heart failure, Dr. Hauptman asserted, “more patients are going to show up with a device. Do you turn them off or [do you] not turn them off?”

Dr. Hauptman said that he hoped the final results of the survey would provide even more insight about physicians' attitudes toward end-stage heart failure and that the information will be able to be used to design effective interventions in the future.

BOCA RATON, FLA. — Automated home monitoring improved short-term outcomes for patients with heart failure, compared with standard disease management alone, in a multicenter, randomized study, Dr. Andrew R. Weintraub reported at the annual meeting of the Heart Failure Society of America.

Previously, the benefit of disease management for heart failure patients was shown, but the studies were nonrandomized, single-center, or assessed nonspecialized teams. Then the prospective, randomized Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) study demonstrated significant hospitalization reductions from heart failure and cardiovascular disease, as well as a shorter length of stay with disease management (Circulation 2004;110:1450–5), said Dr. Weintraub, director of the Coronary Care Unit at the Tufts-New England Medical Center, Boston.

Dr. Weintraub and his associates randomized 93 patients to a control group of disease management and another 95 to an intervention group with home monitoring.

The control patients received the same disease management as in the SPAN-CHF study, which included an initial nurse home visit, weekly or biweekly telephone monitoring, and the availability of a nurse manager 24 hours a day via pager. Intervention patients received the same services, but also weighed themselves on an interactive scale, measured their blood pressure, and took their pulse daily using an automated home monitor (Philips Medical Systems, Bothell, Wash.). Intervention patients answered health status and compliance questions daily via text messaging (Health Hero Network, Mountain View, Calif.).

The investigators enrolled patients within 2 weeks of discharge after their first episode of heart failure. All had a measurement of left ventricular function within 6 months (mean 30%). There was a high incidence of ACE inhibitor, angiotensin receptor blocker, and β-blocker use. Patient demographics were similar. Both groups had a wide range in baseline ejection fractions, said Dr. Weintraub.

“We detected a trend in reduction with intervention of heart failure hospitalized days, cardiac hospitalized days, and all-cause hospitalized days,” said Dr. Weintraub, who received research support from GlaxoSmithKline Inc., Agilent Technologies/Philips Medical Systems, and the Health Hero Network.

The number of hospitalizations for heart failure more than 90 days in the intervention group was a mean 0.5, compared with 1.8 for the control group. Hospitalizations for all cardiac causes were 0.8 in the intervention group, compared with 2.2 in the control group. There were no significant differences between groups in all-cause hospitalizations.

There were no differences in hospitalization rates according to gender, age, left ventricular ejection fraction, New York Heart Association classification, or hypertension. However, “our patients with diabetes at baseline were significantly more likely to be hospitalized for heart failure,” he added (odds ratio 4.3).

BOCA RATON, FLA. — Automated home monitoring improved short-term outcomes for patients with heart failure, compared with standard disease management alone, in a multicenter, randomized study, Dr. Andrew R. Weintraub reported at the annual meeting of the Heart Failure Society of America.

Previously, the benefit of disease management for heart failure patients was shown, but the studies were nonrandomized, single-center, or assessed nonspecialized teams. Then the prospective, randomized Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) study demonstrated significant hospitalization reductions from heart failure and cardiovascular disease, as well as a shorter length of stay with disease management (Circulation 2004;110:1450–5), said Dr. Weintraub, director of the Coronary Care Unit at the Tufts-New England Medical Center, Boston.

Dr. Weintraub and his associates randomized 93 patients to a control group of disease management and another 95 to an intervention group with home monitoring.

The control patients received the same disease management as in the SPAN-CHF study, which included an initial nurse home visit, weekly or biweekly telephone monitoring, and the availability of a nurse manager 24 hours a day via pager. Intervention patients received the same services, but also weighed themselves on an interactive scale, measured their blood pressure, and took their pulse daily using an automated home monitor (Philips Medical Systems, Bothell, Wash.). Intervention patients answered health status and compliance questions daily via text messaging (Health Hero Network, Mountain View, Calif.).

The investigators enrolled patients within 2 weeks of discharge after their first episode of heart failure. All had a measurement of left ventricular function within 6 months (mean 30%). There was a high incidence of ACE inhibitor, angiotensin receptor blocker, and β-blocker use. Patient demographics were similar. Both groups had a wide range in baseline ejection fractions, said Dr. Weintraub.

“We detected a trend in reduction with intervention of heart failure hospitalized days, cardiac hospitalized days, and all-cause hospitalized days,” said Dr. Weintraub, who received research support from GlaxoSmithKline Inc., Agilent Technologies/Philips Medical Systems, and the Health Hero Network.

The number of hospitalizations for heart failure more than 90 days in the intervention group was a mean 0.5, compared with 1.8 for the control group. Hospitalizations for all cardiac causes were 0.8 in the intervention group, compared with 2.2 in the control group. There were no significant differences between groups in all-cause hospitalizations.

There were no differences in hospitalization rates according to gender, age, left ventricular ejection fraction, New York Heart Association classification, or hypertension. However, “our patients with diabetes at baseline were significantly more likely to be hospitalized for heart failure,” he added (odds ratio 4.3).

BOCA RATON, FLA. — Automated home monitoring improved short-term outcomes for patients with heart failure, compared with standard disease management alone, in a multicenter, randomized study, Dr. Andrew R. Weintraub reported at the annual meeting of the Heart Failure Society of America.

Previously, the benefit of disease management for heart failure patients was shown, but the studies were nonrandomized, single-center, or assessed nonspecialized teams. Then the prospective, randomized Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) study demonstrated significant hospitalization reductions from heart failure and cardiovascular disease, as well as a shorter length of stay with disease management (Circulation 2004;110:1450–5), said Dr. Weintraub, director of the Coronary Care Unit at the Tufts-New England Medical Center, Boston.

Dr. Weintraub and his associates randomized 93 patients to a control group of disease management and another 95 to an intervention group with home monitoring.

The control patients received the same disease management as in the SPAN-CHF study, which included an initial nurse home visit, weekly or biweekly telephone monitoring, and the availability of a nurse manager 24 hours a day via pager. Intervention patients received the same services, but also weighed themselves on an interactive scale, measured their blood pressure, and took their pulse daily using an automated home monitor (Philips Medical Systems, Bothell, Wash.). Intervention patients answered health status and compliance questions daily via text messaging (Health Hero Network, Mountain View, Calif.).

The investigators enrolled patients within 2 weeks of discharge after their first episode of heart failure. All had a measurement of left ventricular function within 6 months (mean 30%). There was a high incidence of ACE inhibitor, angiotensin receptor blocker, and β-blocker use. Patient demographics were similar. Both groups had a wide range in baseline ejection fractions, said Dr. Weintraub.

“We detected a trend in reduction with intervention of heart failure hospitalized days, cardiac hospitalized days, and all-cause hospitalized days,” said Dr. Weintraub, who received research support from GlaxoSmithKline Inc., Agilent Technologies/Philips Medical Systems, and the Health Hero Network.

The number of hospitalizations for heart failure more than 90 days in the intervention group was a mean 0.5, compared with 1.8 for the control group. Hospitalizations for all cardiac causes were 0.8 in the intervention group, compared with 2.2 in the control group. There were no significant differences between groups in all-cause hospitalizations.

There were no differences in hospitalization rates according to gender, age, left ventricular ejection fraction, New York Heart Association classification, or hypertension. However, “our patients with diabetes at baseline were significantly more likely to be hospitalized for heart failure,” he added (odds ratio 4.3).

ORLANDO — Superobese males and patients with anastomotic leak have a fourfold increased risk of pulmonary embolism after gastric bypass surgery, according to a study presented at the annual meeting of the American Society for Bariatric Surgery.

Pulmonary embolism (PE) remains a leading cause of death following gastric bypass surgery, occurring with a 1% incidence in these patients (Arch. Surg. 2003;138:957–61). Extending prophylaxis after discharge, including the use of prophylactic inferior vena cava (IVC) filters, is gaining wide acceptance for high-risk patients, Dr. Fadi Abou-Nukta said.

Dr. Abou-Nukta and his associates studied 1,225 patients who had open Roux-en-Y gastric bypass at the Hospital of Saint Raphael in New Haven, Conn. All procedures were performed between 1998 and 2003. A total of 78% of these morbidly obese participants were female. Age and body mass index (BMI) for the morbidly obese group were compared with those of a randomly selected group of open gastric bypass patients.

The researchers diagnosed PE using computed tomography, ventilation-perfusion scanning, or autopsy. There were 11 patients with a PE, 6 male (2.3% incidence) and 5 female (0.5% incidence).

Prophylaxis consisted of heparin 5,000 IU, which was administered preoperatively, and intermittent use of pneumatic compression stockings in the operating room. Patients received enoxaparin (Lovenox) 40 mg, every 12 hours, until discharge, and early postoperative ambulation was encouraged.

Nine of the 11 patients developed a PE after discharge from the hospital, all within 30 days of undergoing gastric bypass surgery. The average BMI of 61 kg/m

However, superobese males—those with a BMI of 50 or more—and those with an anastomotic leak had the greatest incidence of PE (4% in each group).

Most of the 11 patients presented with multiple risk factors for PE, Dr. Abou-Nukta said. “Sixty percent of patients who experienced this complication had three or more risk factors.” Risk factors include male gender, a BMI over 50, venous stasis disease, truncal obesity, sleep apnea, and immobility.

Patients are considered at high risk preoperatively if they have sepsis or two or more of these risk factors, Dr. Abou-Nukta said.

“For these patients, we extend the chemical prophylaxis to several weeks after discharge. Very high risk patients also get an [inferior vena cava] filter,” he added.

ORLANDO — Superobese males and patients with anastomotic leak have a fourfold increased risk of pulmonary embolism after gastric bypass surgery, according to a study presented at the annual meeting of the American Society for Bariatric Surgery.

Pulmonary embolism (PE) remains a leading cause of death following gastric bypass surgery, occurring with a 1% incidence in these patients (Arch. Surg. 2003;138:957–61). Extending prophylaxis after discharge, including the use of prophylactic inferior vena cava (IVC) filters, is gaining wide acceptance for high-risk patients, Dr. Fadi Abou-Nukta said.

Dr. Abou-Nukta and his associates studied 1,225 patients who had open Roux-en-Y gastric bypass at the Hospital of Saint Raphael in New Haven, Conn. All procedures were performed between 1998 and 2003. A total of 78% of these morbidly obese participants were female. Age and body mass index (BMI) for the morbidly obese group were compared with those of a randomly selected group of open gastric bypass patients.

The researchers diagnosed PE using computed tomography, ventilation-perfusion scanning, or autopsy. There were 11 patients with a PE, 6 male (2.3% incidence) and 5 female (0.5% incidence).

Prophylaxis consisted of heparin 5,000 IU, which was administered preoperatively, and intermittent use of pneumatic compression stockings in the operating room. Patients received enoxaparin (Lovenox) 40 mg, every 12 hours, until discharge, and early postoperative ambulation was encouraged.

Nine of the 11 patients developed a PE after discharge from the hospital, all within 30 days of undergoing gastric bypass surgery. The average BMI of 61 kg/m

However, superobese males—those with a BMI of 50 or more—and those with an anastomotic leak had the greatest incidence of PE (4% in each group).

Most of the 11 patients presented with multiple risk factors for PE, Dr. Abou-Nukta said. “Sixty percent of patients who experienced this complication had three or more risk factors.” Risk factors include male gender, a BMI over 50, venous stasis disease, truncal obesity, sleep apnea, and immobility.

Patients are considered at high risk preoperatively if they have sepsis or two or more of these risk factors, Dr. Abou-Nukta said.

“For these patients, we extend the chemical prophylaxis to several weeks after discharge. Very high risk patients also get an [inferior vena cava] filter,” he added.

ORLANDO — Superobese males and patients with anastomotic leak have a fourfold increased risk of pulmonary embolism after gastric bypass surgery, according to a study presented at the annual meeting of the American Society for Bariatric Surgery.

Pulmonary embolism (PE) remains a leading cause of death following gastric bypass surgery, occurring with a 1% incidence in these patients (Arch. Surg. 2003;138:957–61). Extending prophylaxis after discharge, including the use of prophylactic inferior vena cava (IVC) filters, is gaining wide acceptance for high-risk patients, Dr. Fadi Abou-Nukta said.

Dr. Abou-Nukta and his associates studied 1,225 patients who had open Roux-en-Y gastric bypass at the Hospital of Saint Raphael in New Haven, Conn. All procedures were performed between 1998 and 2003. A total of 78% of these morbidly obese participants were female. Age and body mass index (BMI) for the morbidly obese group were compared with those of a randomly selected group of open gastric bypass patients.

The researchers diagnosed PE using computed tomography, ventilation-perfusion scanning, or autopsy. There were 11 patients with a PE, 6 male (2.3% incidence) and 5 female (0.5% incidence).

Prophylaxis consisted of heparin 5,000 IU, which was administered preoperatively, and intermittent use of pneumatic compression stockings in the operating room. Patients received enoxaparin (Lovenox) 40 mg, every 12 hours, until discharge, and early postoperative ambulation was encouraged.

Nine of the 11 patients developed a PE after discharge from the hospital, all within 30 days of undergoing gastric bypass surgery. The average BMI of 61 kg/m

However, superobese males—those with a BMI of 50 or more—and those with an anastomotic leak had the greatest incidence of PE (4% in each group).

Most of the 11 patients presented with multiple risk factors for PE, Dr. Abou-Nukta said. “Sixty percent of patients who experienced this complication had three or more risk factors.” Risk factors include male gender, a BMI over 50, venous stasis disease, truncal obesity, sleep apnea, and immobility.

Patients are considered at high risk preoperatively if they have sepsis or two or more of these risk factors, Dr. Abou-Nukta said.

“For these patients, we extend the chemical prophylaxis to several weeks after discharge. Very high risk patients also get an [inferior vena cava] filter,” he added.

BOCA RATON, FLA. — Automated home monitoring improved short-term outcomes for patients with heart failure, compared with standard disease management alone, in a multicenter, randomized study, Dr. Andrew R. Weintraub reported at the annual meeting of the Heart Failure Society of America.

Previously, researchers showed the benefit of disease management for heart failure patients, but the studies were nonrandomized, single-center, or assessed nonspecialized teams. Then the prospective, randomized Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) study demonstrated a significant reduction in hospitalizations from heart failure and cardiovascular disease, as well as a shorter length of stay with disease management (Circulation 2004;110:1450–5), said Dr. Weintraub, director of the Coronary Care Unit at the Tufts-New England Medical Center, Boston.

To determine whether the addition of automated home monitoring would further reduce hospitalization and resource use for patients enrolled in the disease management program, Dr. Weintraub and his associates randomized 93 patients to a control group of disease management and another 95 to an intervention group with home monitoring.

The control patients received the same disease management as in the SPAN-CHF study, which included an initial nurse home visit, weekly or biweekly telephone monitoring, and the availability of a nurse manager 24 hours a day via pager. Intervention patients received the same services, but also weighed themselves on an interactive scale, measured their blood pressure, and took their pulse daily using an automated home monitor (Philips Medical Systems, Bothell, Wash.). They also answered health status and compliance questions daily via text messaging (Health Hero Network, Mountain View, Calif.).

The investigators enrolled patients within 2 weeks of discharge after their first episode of heart failure. All had a measurement of left ventricular function within 6 months (mean 30%). They were aged 18–90 years. There was a high incidence of ACE inhibitor, angiotensin receptor blocker, and β-blocker use. Patient demographics were similar. Both groups had a wide range in baseline ejection fractions, said Dr. Weintraub.

“We detected a trend in reduction with intervention of heart failure hospitalized days, cardiac hospitalized days, and all-cause hospitalized days,” he said.

The number of hospitalizations for heart failure more than 90 days in the intervention group was a mean 0.5, compared with 1.8 for the control group (relative risk 0.28). Hospitalizations for all cardiac causes were 0.8 in the intervention group, compared with 2.2 in the control group (RR 0.37). There were no significant differences between groups in all-cause hospitalizations.

There were no differences in hospitalization rates according to gender, age, left ventricular ejection fraction, New York Heart Association classification, or hypertension. However, “our patients with diabetes at baseline were significantly more likely to be hospitalized for heart failure,” Dr. Weintraub added (odds ratio 4.3).

“We documented the 90-day benefit of adding an automated-home-monitoring system to a previously validated telephonic disease management program,” said Dr. Weintraub, who received research support from GlaxoSmithKline Inc., Agilent Technologies/Philips Medical Systems, and the Health Hero Network. “The addition … produced further improvement in the short-term, heart failure-related clinical outcomes in patients recently hospitalized for heart failure.”

An attendee asked whether the benefits were a result of self-management or the increase in nurse-patient interaction. Nurse managers reported spending 15%–20% above the normal standard care time with automated-home-monitoring patients, Dr. Weintraub said. But the benefit was from self- management and “the nurses facilitated that benefit,” he asserted.

BOCA RATON, FLA. — Automated home monitoring improved short-term outcomes for patients with heart failure, compared with standard disease management alone, in a multicenter, randomized study, Dr. Andrew R. Weintraub reported at the annual meeting of the Heart Failure Society of America.

Previously, researchers showed the benefit of disease management for heart failure patients, but the studies were nonrandomized, single-center, or assessed nonspecialized teams. Then the prospective, randomized Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) study demonstrated a significant reduction in hospitalizations from heart failure and cardiovascular disease, as well as a shorter length of stay with disease management (Circulation 2004;110:1450–5), said Dr. Weintraub, director of the Coronary Care Unit at the Tufts-New England Medical Center, Boston.

To determine whether the addition of automated home monitoring would further reduce hospitalization and resource use for patients enrolled in the disease management program, Dr. Weintraub and his associates randomized 93 patients to a control group of disease management and another 95 to an intervention group with home monitoring.

The control patients received the same disease management as in the SPAN-CHF study, which included an initial nurse home visit, weekly or biweekly telephone monitoring, and the availability of a nurse manager 24 hours a day via pager. Intervention patients received the same services, but also weighed themselves on an interactive scale, measured their blood pressure, and took their pulse daily using an automated home monitor (Philips Medical Systems, Bothell, Wash.). They also answered health status and compliance questions daily via text messaging (Health Hero Network, Mountain View, Calif.).

The investigators enrolled patients within 2 weeks of discharge after their first episode of heart failure. All had a measurement of left ventricular function within 6 months (mean 30%). They were aged 18–90 years. There was a high incidence of ACE inhibitor, angiotensin receptor blocker, and β-blocker use. Patient demographics were similar. Both groups had a wide range in baseline ejection fractions, said Dr. Weintraub.

“We detected a trend in reduction with intervention of heart failure hospitalized days, cardiac hospitalized days, and all-cause hospitalized days,” he said.

The number of hospitalizations for heart failure more than 90 days in the intervention group was a mean 0.5, compared with 1.8 for the control group (relative risk 0.28). Hospitalizations for all cardiac causes were 0.8 in the intervention group, compared with 2.2 in the control group (RR 0.37). There were no significant differences between groups in all-cause hospitalizations.

There were no differences in hospitalization rates according to gender, age, left ventricular ejection fraction, New York Heart Association classification, or hypertension. However, “our patients with diabetes at baseline were significantly more likely to be hospitalized for heart failure,” Dr. Weintraub added (odds ratio 4.3).

“We documented the 90-day benefit of adding an automated-home-monitoring system to a previously validated telephonic disease management program,” said Dr. Weintraub, who received research support from GlaxoSmithKline Inc., Agilent Technologies/Philips Medical Systems, and the Health Hero Network. “The addition … produced further improvement in the short-term, heart failure-related clinical outcomes in patients recently hospitalized for heart failure.”

An attendee asked whether the benefits were a result of self-management or the increase in nurse-patient interaction. Nurse managers reported spending 15%–20% above the normal standard care time with automated-home-monitoring patients, Dr. Weintraub said. But the benefit was from self- management and “the nurses facilitated that benefit,” he asserted.

BOCA RATON, FLA. — Automated home monitoring improved short-term outcomes for patients with heart failure, compared with standard disease management alone, in a multicenter, randomized study, Dr. Andrew R. Weintraub reported at the annual meeting of the Heart Failure Society of America.

Previously, researchers showed the benefit of disease management for heart failure patients, but the studies were nonrandomized, single-center, or assessed nonspecialized teams. Then the prospective, randomized Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) study demonstrated a significant reduction in hospitalizations from heart failure and cardiovascular disease, as well as a shorter length of stay with disease management (Circulation 2004;110:1450–5), said Dr. Weintraub, director of the Coronary Care Unit at the Tufts-New England Medical Center, Boston.

To determine whether the addition of automated home monitoring would further reduce hospitalization and resource use for patients enrolled in the disease management program, Dr. Weintraub and his associates randomized 93 patients to a control group of disease management and another 95 to an intervention group with home monitoring.

The control patients received the same disease management as in the SPAN-CHF study, which included an initial nurse home visit, weekly or biweekly telephone monitoring, and the availability of a nurse manager 24 hours a day via pager. Intervention patients received the same services, but also weighed themselves on an interactive scale, measured their blood pressure, and took their pulse daily using an automated home monitor (Philips Medical Systems, Bothell, Wash.). They also answered health status and compliance questions daily via text messaging (Health Hero Network, Mountain View, Calif.).

The investigators enrolled patients within 2 weeks of discharge after their first episode of heart failure. All had a measurement of left ventricular function within 6 months (mean 30%). They were aged 18–90 years. There was a high incidence of ACE inhibitor, angiotensin receptor blocker, and β-blocker use. Patient demographics were similar. Both groups had a wide range in baseline ejection fractions, said Dr. Weintraub.

“We detected a trend in reduction with intervention of heart failure hospitalized days, cardiac hospitalized days, and all-cause hospitalized days,” he said.

The number of hospitalizations for heart failure more than 90 days in the intervention group was a mean 0.5, compared with 1.8 for the control group (relative risk 0.28). Hospitalizations for all cardiac causes were 0.8 in the intervention group, compared with 2.2 in the control group (RR 0.37). There were no significant differences between groups in all-cause hospitalizations.

There were no differences in hospitalization rates according to gender, age, left ventricular ejection fraction, New York Heart Association classification, or hypertension. However, “our patients with diabetes at baseline were significantly more likely to be hospitalized for heart failure,” Dr. Weintraub added (odds ratio 4.3).

“We documented the 90-day benefit of adding an automated-home-monitoring system to a previously validated telephonic disease management program,” said Dr. Weintraub, who received research support from GlaxoSmithKline Inc., Agilent Technologies/Philips Medical Systems, and the Health Hero Network. “The addition … produced further improvement in the short-term, heart failure-related clinical outcomes in patients recently hospitalized for heart failure.”

An attendee asked whether the benefits were a result of self-management or the increase in nurse-patient interaction. Nurse managers reported spending 15%–20% above the normal standard care time with automated-home-monitoring patients, Dr. Weintraub said. But the benefit was from self- management and “the nurses facilitated that benefit,” he asserted.

BOCA RATON, FLA. — A new and smaller left ventricular assist device now in clinical trials is appropriate for most women and provides similar outcomes, compared with a larger device already used for patients with heart failure, according to a poster presentation at the annual meeting of the Heart Failure Society of America.

The large size of the original HeartMate XVE Left Ventricular Assist System (Thoratec Corp., Pleasanton, Calif.), which is currently approved as a bridge-to-transplant as well as a destination therapy, precluded its use in many women, Dr. Leway Chen said. Only about 9%-16% of women with heart failure received a HeartMate XVE in published studies, according to Dr. Chen, director of the heart failure and transplantation program at Strong Memorial Hospital, University of Rochester (N.Y.). Dr. Chen also is an investigator for Thoratec.

In this study, Dr. Chen and his associates assessed 34 patients—including 15 women—with advanced New York Heart Association class IV heart failure at 10 medical centers. All received the HeartMate II, a continuous-flow left ventricular assist device with one-third the mass of a typical implanted electric pulsatile device. Median age was 49 years for women and 55 years for men. There was one transient ischemic attack and one stroke in a patient who fully recovered prior to implantation among the women; neither of these events occurred in men.

There were no device failures but minor malfunctions occurred in both groups. “The adverse event numbers are too small to make a conclusion,” he said. Six women received a transplant and five had ongoing therapy after a median of 96 days with the device. Three men received a transplant and 10 continued therapy with the device after a median of 117 days.

BOCA RATON, FLA. — A new and smaller left ventricular assist device now in clinical trials is appropriate for most women and provides similar outcomes, compared with a larger device already used for patients with heart failure, according to a poster presentation at the annual meeting of the Heart Failure Society of America.

The large size of the original HeartMate XVE Left Ventricular Assist System (Thoratec Corp., Pleasanton, Calif.), which is currently approved as a bridge-to-transplant as well as a destination therapy, precluded its use in many women, Dr. Leway Chen said. Only about 9%-16% of women with heart failure received a HeartMate XVE in published studies, according to Dr. Chen, director of the heart failure and transplantation program at Strong Memorial Hospital, University of Rochester (N.Y.). Dr. Chen also is an investigator for Thoratec.

In this study, Dr. Chen and his associates assessed 34 patients—including 15 women—with advanced New York Heart Association class IV heart failure at 10 medical centers. All received the HeartMate II, a continuous-flow left ventricular assist device with one-third the mass of a typical implanted electric pulsatile device. Median age was 49 years for women and 55 years for men. There was one transient ischemic attack and one stroke in a patient who fully recovered prior to implantation among the women; neither of these events occurred in men.

There were no device failures but minor malfunctions occurred in both groups. “The adverse event numbers are too small to make a conclusion,” he said. Six women received a transplant and five had ongoing therapy after a median of 96 days with the device. Three men received a transplant and 10 continued therapy with the device after a median of 117 days.

BOCA RATON, FLA. — A new and smaller left ventricular assist device now in clinical trials is appropriate for most women and provides similar outcomes, compared with a larger device already used for patients with heart failure, according to a poster presentation at the annual meeting of the Heart Failure Society of America.

The large size of the original HeartMate XVE Left Ventricular Assist System (Thoratec Corp., Pleasanton, Calif.), which is currently approved as a bridge-to-transplant as well as a destination therapy, precluded its use in many women, Dr. Leway Chen said. Only about 9%-16% of women with heart failure received a HeartMate XVE in published studies, according to Dr. Chen, director of the heart failure and transplantation program at Strong Memorial Hospital, University of Rochester (N.Y.). Dr. Chen also is an investigator for Thoratec.

In this study, Dr. Chen and his associates assessed 34 patients—including 15 women—with advanced New York Heart Association class IV heart failure at 10 medical centers. All received the HeartMate II, a continuous-flow left ventricular assist device with one-third the mass of a typical implanted electric pulsatile device. Median age was 49 years for women and 55 years for men. There was one transient ischemic attack and one stroke in a patient who fully recovered prior to implantation among the women; neither of these events occurred in men.

There were no device failures but minor malfunctions occurred in both groups. “The adverse event numbers are too small to make a conclusion,” he said. Six women received a transplant and five had ongoing therapy after a median of 96 days with the device. Three men received a transplant and 10 continued therapy with the device after a median of 117 days.

BOCA RATON, FLA. — Heart failure patients with atrial fibrillation who receive cardiac resynchronization devices experience benefits similar to those in patients without the condition, according to data presented at the annual meeting of the Heart Failure Society of America.

Major cardiac resynchronization therapy trials typically exclude patients with atrial fibrillation. However, the diagnosis is common in patients with heart failure.

“It's an important question to ask—a lot of our patients have atrial fibrillation. We don't know if they benefit from resynchronization,” Dr. Jooyoung Julia Shin, said in an interview during a poster session.

Dr. Shin and her associates compared New York Heart Association (NYHA) classifications before and 6 months after device placement for patients with and without atrial fibrillation. They assessed data for 1,017 people with heart failure who were enrolled in the InSync Registry and InSync ICD (Implantable Cardioverter Defibrillator) Registry (Medtronic Inc.). Of these registrants, 389 (38%) with an NYHA classification at 6 months had a history of atrial fibrillation before implantation.

Such patients were not included in the clinical trials, said Dr. Shin, a researcher in the division of cardiology at Emory University, Atlanta. The study's principal investigator was Dr. Andrew L. Smith.

The overall mean NYHA classification was 3.0 before device implantation and 2.3 at 6 months. At 6 months, the mean improvement in NYHA classification was the same in both groups: 59%. This indicates that patients with a history of atrial fibrillation can benefit from cardiac resynchronization therapy, Dr. Shin said.

The researchers plan to continue following participants up to 3 years.

BOCA RATON, FLA. — Heart failure patients with atrial fibrillation who receive cardiac resynchronization devices experience benefits similar to those in patients without the condition, according to data presented at the annual meeting of the Heart Failure Society of America.

Major cardiac resynchronization therapy trials typically exclude patients with atrial fibrillation. However, the diagnosis is common in patients with heart failure.

“It's an important question to ask—a lot of our patients have atrial fibrillation. We don't know if they benefit from resynchronization,” Dr. Jooyoung Julia Shin, said in an interview during a poster session.

Dr. Shin and her associates compared New York Heart Association (NYHA) classifications before and 6 months after device placement for patients with and without atrial fibrillation. They assessed data for 1,017 people with heart failure who were enrolled in the InSync Registry and InSync ICD (Implantable Cardioverter Defibrillator) Registry (Medtronic Inc.). Of these registrants, 389 (38%) with an NYHA classification at 6 months had a history of atrial fibrillation before implantation.

Such patients were not included in the clinical trials, said Dr. Shin, a researcher in the division of cardiology at Emory University, Atlanta. The study's principal investigator was Dr. Andrew L. Smith.

The overall mean NYHA classification was 3.0 before device implantation and 2.3 at 6 months. At 6 months, the mean improvement in NYHA classification was the same in both groups: 59%. This indicates that patients with a history of atrial fibrillation can benefit from cardiac resynchronization therapy, Dr. Shin said.

The researchers plan to continue following participants up to 3 years.

BOCA RATON, FLA. — Heart failure patients with atrial fibrillation who receive cardiac resynchronization devices experience benefits similar to those in patients without the condition, according to data presented at the annual meeting of the Heart Failure Society of America.

Major cardiac resynchronization therapy trials typically exclude patients with atrial fibrillation. However, the diagnosis is common in patients with heart failure.

“It's an important question to ask—a lot of our patients have atrial fibrillation. We don't know if they benefit from resynchronization,” Dr. Jooyoung Julia Shin, said in an interview during a poster session.

Dr. Shin and her associates compared New York Heart Association (NYHA) classifications before and 6 months after device placement for patients with and without atrial fibrillation. They assessed data for 1,017 people with heart failure who were enrolled in the InSync Registry and InSync ICD (Implantable Cardioverter Defibrillator) Registry (Medtronic Inc.). Of these registrants, 389 (38%) with an NYHA classification at 6 months had a history of atrial fibrillation before implantation.

Such patients were not included in the clinical trials, said Dr. Shin, a researcher in the division of cardiology at Emory University, Atlanta. The study's principal investigator was Dr. Andrew L. Smith.

The overall mean NYHA classification was 3.0 before device implantation and 2.3 at 6 months. At 6 months, the mean improvement in NYHA classification was the same in both groups: 59%. This indicates that patients with a history of atrial fibrillation can benefit from cardiac resynchronization therapy, Dr. Shin said.

The researchers plan to continue following participants up to 3 years.

BOCA RATON, FLA. — The brain natriuretic peptide, nesiritide, which is used to treat acute heart failure symptoms, did not facilitate diuresis or protect renal function in a small study of stable hospitalized patients.

Many clinicians believe that nesiritide (Natrecor, Scios Inc.) facilitates furosemide diuresis and prevents renal dysfunction, Dr. Margaret M. Redfield, said in an interview. However, a recent metaanalysis indicated that the agent might actually increase the risk of renal dysfunction (Circulation 2005;111:1487-91).

In a poster presented at the annual meeting of the Heart Failure Society of America, Dr. Redfield and associates studied 65 patients hospitalized for decompensated heart failure and who were treated with a standard dose of nesiritide for relief of their heart failure symptoms. They were randomized to nesiritide as a 2-mcg/kg bolus at admission and a 0.01-mcg/kg per minute infusion at 48 hours (34 patients) or to standard therapy (31 patients).

The participants also received 40-mg b.i.d. intravenous furosemide if they had mild renal dysfunction at baseline, defined as a creatinine clearance of 40-60 mL/min. They received 80-mg b.i.d. intravenous furosemide if they had moderate renal dysfunction, or a creatinine clearance of 20-39 mL/min, said Dr. Redfield, professor of medicine, Mayo Clinic College of Medicine, Rochester, Minn.

Mean baseline creatinine was 1.8 mg/dL in the nesiritide group and 1.7 mg/dL in the standard therapy group; by 48 hours, the mean changes were increases of 0.12 mg/dL and 0.07 mg/dL, respectively. Mean baseline brain natriuretic peptide level was 640 pg/mL for the nesiritide group and 538 pg/mL for the standard therapy group; by 48 hours, the mean changes were a 474-pg/mL increase in the nesiritide group and a 59-pg/mL decrease in the control group. Total furosemide use was 272 mg in the nesiritide group and 255 mg in the standard treatment group at 48 hours.

“Nesiritide causes no harm, but has no significant benefit,” Dr. Redfield said. “Nesiritide did not enhance the response to furosemide.”

Systolic blood pressure was lower in the nesiritide group at 24 hours, but not significantly different between groups by 48 hours.

BOCA RATON, FLA. — The brain natriuretic peptide, nesiritide, which is used to treat acute heart failure symptoms, did not facilitate diuresis or protect renal function in a small study of stable hospitalized patients.

Many clinicians believe that nesiritide (Natrecor, Scios Inc.) facilitates furosemide diuresis and prevents renal dysfunction, Dr. Margaret M. Redfield, said in an interview. However, a recent metaanalysis indicated that the agent might actually increase the risk of renal dysfunction (Circulation 2005;111:1487-91).

In a poster presented at the annual meeting of the Heart Failure Society of America, Dr. Redfield and associates studied 65 patients hospitalized for decompensated heart failure and who were treated with a standard dose of nesiritide for relief of their heart failure symptoms. They were randomized to nesiritide as a 2-mcg/kg bolus at admission and a 0.01-mcg/kg per minute infusion at 48 hours (34 patients) or to standard therapy (31 patients).

The participants also received 40-mg b.i.d. intravenous furosemide if they had mild renal dysfunction at baseline, defined as a creatinine clearance of 40-60 mL/min. They received 80-mg b.i.d. intravenous furosemide if they had moderate renal dysfunction, or a creatinine clearance of 20-39 mL/min, said Dr. Redfield, professor of medicine, Mayo Clinic College of Medicine, Rochester, Minn.

Mean baseline creatinine was 1.8 mg/dL in the nesiritide group and 1.7 mg/dL in the standard therapy group; by 48 hours, the mean changes were increases of 0.12 mg/dL and 0.07 mg/dL, respectively. Mean baseline brain natriuretic peptide level was 640 pg/mL for the nesiritide group and 538 pg/mL for the standard therapy group; by 48 hours, the mean changes were a 474-pg/mL increase in the nesiritide group and a 59-pg/mL decrease in the control group. Total furosemide use was 272 mg in the nesiritide group and 255 mg in the standard treatment group at 48 hours.

“Nesiritide causes no harm, but has no significant benefit,” Dr. Redfield said. “Nesiritide did not enhance the response to furosemide.”

Systolic blood pressure was lower in the nesiritide group at 24 hours, but not significantly different between groups by 48 hours.

BOCA RATON, FLA. — The brain natriuretic peptide, nesiritide, which is used to treat acute heart failure symptoms, did not facilitate diuresis or protect renal function in a small study of stable hospitalized patients.

Many clinicians believe that nesiritide (Natrecor, Scios Inc.) facilitates furosemide diuresis and prevents renal dysfunction, Dr. Margaret M. Redfield, said in an interview. However, a recent metaanalysis indicated that the agent might actually increase the risk of renal dysfunction (Circulation 2005;111:1487-91).

In a poster presented at the annual meeting of the Heart Failure Society of America, Dr. Redfield and associates studied 65 patients hospitalized for decompensated heart failure and who were treated with a standard dose of nesiritide for relief of their heart failure symptoms. They were randomized to nesiritide as a 2-mcg/kg bolus at admission and a 0.01-mcg/kg per minute infusion at 48 hours (34 patients) or to standard therapy (31 patients).

The participants also received 40-mg b.i.d. intravenous furosemide if they had mild renal dysfunction at baseline, defined as a creatinine clearance of 40-60 mL/min. They received 80-mg b.i.d. intravenous furosemide if they had moderate renal dysfunction, or a creatinine clearance of 20-39 mL/min, said Dr. Redfield, professor of medicine, Mayo Clinic College of Medicine, Rochester, Minn.

Mean baseline creatinine was 1.8 mg/dL in the nesiritide group and 1.7 mg/dL in the standard therapy group; by 48 hours, the mean changes were increases of 0.12 mg/dL and 0.07 mg/dL, respectively. Mean baseline brain natriuretic peptide level was 640 pg/mL for the nesiritide group and 538 pg/mL for the standard therapy group; by 48 hours, the mean changes were a 474-pg/mL increase in the nesiritide group and a 59-pg/mL decrease in the control group. Total furosemide use was 272 mg in the nesiritide group and 255 mg in the standard treatment group at 48 hours.

“Nesiritide causes no harm, but has no significant benefit,” Dr. Redfield said. “Nesiritide did not enhance the response to furosemide.”

Systolic blood pressure was lower in the nesiritide group at 24 hours, but not significantly different between groups by 48 hours.

ORLANDO – Psychiatric conditions are more common among patients who seek bariatric surgery than among the general population, according to preliminary results from a study reported by Melissa A. Kalarchian, Ph.D., at the annual meeting of the American Society for Bariatric Surgery.

Dr. Kalarchian and her colleagues screened bariatric surgery candidates with the Structured Clinical Interview for the DSM-IV to determine current and lifetime history of psychiatric disorders.

Preliminary results included 200 surgical candidates. Their average age was 46 years; 89% were white; 85% were female; and their average body mass index (kg/m2) was 53. They eventually had the procedures performed at hospitals of the University of Pittsburgh Medical Center.

The surgical candidates had higher rates of lifetime psychopathology than those reported for individuals in the community in the baseline National Comorbidity Survey (NCS), said Dr. Kalarchian of the Western Psychiatric Institute and Clinic in Pittsburgh. (See graph.)

Anxiety disorders included generalized anxiety, posttraumatic stress disorder, and obsessive-compulsive disorder. A complete list of the anxiety disorders would also include agoraphobia, panic disorder, social phobia, and specific phobia.

Prevalence of major depressive disorder (MDD) varied by gender. A total of 10% of female and 13% of male surgery candidates met criteria for MDD at study entry. In addition, 45% of female and 33% of male surgical candidates reported a lifetime history of MDD. In the NCS, 21% of women and 13% of men reported such a history.

The researchers also assessed binge eating. Among the surgical candidates in the study, 34% reported a lifetime history of binge eating and 18% reported current binge eating.

“It's really important to wait for prospective studies before saying binge eating is a contraindication to surgery,” Dr. Kalarchian said. “Binge eating can be treated, and I don't think it would be grounds to deny or delay surgery,” she said.

“Binge eating is strongly associated with depression and obesity,” she added. “There is controversy about whether binge eating disorder is a distinct syndrome or a marker of another psychiatric disorder.”

The findings of the study suggest a need to monitor patients for onset or recurrent psychiatric symptoms, she said.

An inability to determine a cause-and-effect relationship between psychiatric morbidity and being severely obese in our culture was a limitation of the study, Dr. Kalarchian said. “Prospective studies really need to determine how psychosocial factors are related to surgical outcomes, and to identify those who are vulnerable to poor outcomes.”

To encourage subjects in the study who had psychological problems to seek help, Dr. Kalarchian and her associates did not report the results to the surgical team. “The confidential nature might encourage patients to discuss their mental health issues,” she said.

A meeting attendee asked Dr. Kalarchian if she would inform surgeons if a patient had a major psychiatric concern. “It would be a rare instance where we would identify something we would need to inform the surgical team about, for example, suicidality.”

Although previous research indicated that bariatric surgery patients might have higher rates of psychopathology, the studies were limited methodologically, Dr. Kalarchian said.

ORLANDO – Psychiatric conditions are more common among patients who seek bariatric surgery than among the general population, according to preliminary results from a study reported by Melissa A. Kalarchian, Ph.D., at the annual meeting of the American Society for Bariatric Surgery.

Dr. Kalarchian and her colleagues screened bariatric surgery candidates with the Structured Clinical Interview for the DSM-IV to determine current and lifetime history of psychiatric disorders.

Preliminary results included 200 surgical candidates. Their average age was 46 years; 89% were white; 85% were female; and their average body mass index (kg/m2) was 53. They eventually had the procedures performed at hospitals of the University of Pittsburgh Medical Center.

The surgical candidates had higher rates of lifetime psychopathology than those reported for individuals in the community in the baseline National Comorbidity Survey (NCS), said Dr. Kalarchian of the Western Psychiatric Institute and Clinic in Pittsburgh. (See graph.)

Anxiety disorders included generalized anxiety, posttraumatic stress disorder, and obsessive-compulsive disorder. A complete list of the anxiety disorders would also include agoraphobia, panic disorder, social phobia, and specific phobia.

Prevalence of major depressive disorder (MDD) varied by gender. A total of 10% of female and 13% of male surgery candidates met criteria for MDD at study entry. In addition, 45% of female and 33% of male surgical candidates reported a lifetime history of MDD. In the NCS, 21% of women and 13% of men reported such a history.

The researchers also assessed binge eating. Among the surgical candidates in the study, 34% reported a lifetime history of binge eating and 18% reported current binge eating.

“It's really important to wait for prospective studies before saying binge eating is a contraindication to surgery,” Dr. Kalarchian said. “Binge eating can be treated, and I don't think it would be grounds to deny or delay surgery,” she said.

“Binge eating is strongly associated with depression and obesity,” she added. “There is controversy about whether binge eating disorder is a distinct syndrome or a marker of another psychiatric disorder.”

The findings of the study suggest a need to monitor patients for onset or recurrent psychiatric symptoms, she said.

An inability to determine a cause-and-effect relationship between psychiatric morbidity and being severely obese in our culture was a limitation of the study, Dr. Kalarchian said. “Prospective studies really need to determine how psychosocial factors are related to surgical outcomes, and to identify those who are vulnerable to poor outcomes.”

To encourage subjects in the study who had psychological problems to seek help, Dr. Kalarchian and her associates did not report the results to the surgical team. “The confidential nature might encourage patients to discuss their mental health issues,” she said.

A meeting attendee asked Dr. Kalarchian if she would inform surgeons if a patient had a major psychiatric concern. “It would be a rare instance where we would identify something we would need to inform the surgical team about, for example, suicidality.”

Although previous research indicated that bariatric surgery patients might have higher rates of psychopathology, the studies were limited methodologically, Dr. Kalarchian said.

ORLANDO – Psychiatric conditions are more common among patients who seek bariatric surgery than among the general population, according to preliminary results from a study reported by Melissa A. Kalarchian, Ph.D., at the annual meeting of the American Society for Bariatric Surgery.

Dr. Kalarchian and her colleagues screened bariatric surgery candidates with the Structured Clinical Interview for the DSM-IV to determine current and lifetime history of psychiatric disorders.

Preliminary results included 200 surgical candidates. Their average age was 46 years; 89% were white; 85% were female; and their average body mass index (kg/m2) was 53. They eventually had the procedures performed at hospitals of the University of Pittsburgh Medical Center.

The surgical candidates had higher rates of lifetime psychopathology than those reported for individuals in the community in the baseline National Comorbidity Survey (NCS), said Dr. Kalarchian of the Western Psychiatric Institute and Clinic in Pittsburgh. (See graph.)

Anxiety disorders included generalized anxiety, posttraumatic stress disorder, and obsessive-compulsive disorder. A complete list of the anxiety disorders would also include agoraphobia, panic disorder, social phobia, and specific phobia.

Prevalence of major depressive disorder (MDD) varied by gender. A total of 10% of female and 13% of male surgery candidates met criteria for MDD at study entry. In addition, 45% of female and 33% of male surgical candidates reported a lifetime history of MDD. In the NCS, 21% of women and 13% of men reported such a history.

The researchers also assessed binge eating. Among the surgical candidates in the study, 34% reported a lifetime history of binge eating and 18% reported current binge eating.

“It's really important to wait for prospective studies before saying binge eating is a contraindication to surgery,” Dr. Kalarchian said. “Binge eating can be treated, and I don't think it would be grounds to deny or delay surgery,” she said.

“Binge eating is strongly associated with depression and obesity,” she added. “There is controversy about whether binge eating disorder is a distinct syndrome or a marker of another psychiatric disorder.”

The findings of the study suggest a need to monitor patients for onset or recurrent psychiatric symptoms, she said.

An inability to determine a cause-and-effect relationship between psychiatric morbidity and being severely obese in our culture was a limitation of the study, Dr. Kalarchian said. “Prospective studies really need to determine how psychosocial factors are related to surgical outcomes, and to identify those who are vulnerable to poor outcomes.”

To encourage subjects in the study who had psychological problems to seek help, Dr. Kalarchian and her associates did not report the results to the surgical team. “The confidential nature might encourage patients to discuss their mental health issues,” she said.

A meeting attendee asked Dr. Kalarchian if she would inform surgeons if a patient had a major psychiatric concern. “It would be a rare instance where we would identify something we would need to inform the surgical team about, for example, suicidality.”

Although previous research indicated that bariatric surgery patients might have higher rates of psychopathology, the studies were limited methodologically, Dr. Kalarchian said.

BOCA RATON, FLA. – When it comes to treatment options, palliative care, and decision making for patients with end-stage heart failure, cardiologists, internists, family physicians, and geriatricians are similarly lacking in awareness, according to a national pilot survey.

The American College of Cardiology and the American Heart Association's recommendations for care of heart failure patients include a call for cardiologists to counsel patients about end-of-life issues. However, most of the care of heart failure patients is by noncardiologist physicians, and there is still uncertainty about which physicians should address end-of-life concerns with end-stage heart failure patients.

“The question is, who is going to have 'the talk'?” Dr. Paul J. Hauptman said in an interview.

“More and more patients have heart failure, and more and more patients are going to die from heart failure. What are we going to do with this burgeoning population of patients with heart failure?” asked Dr. Hauptman, professor of medicine, division of cardiology, and director of heart failure/transplantation at St. Louis (Mo.) University.

In an attempt to answer that question, Dr. Hauptman and his associates surveyed cardiologists, family physicians, internists, and geriatricians about the management of patients with end-stage heart failure. The investigators randomly selected physicians from the American Medical Association Master File.

The administration of the 51-question survey is ongoing, with the goal of garnering opinions from 1,450 physicians. Preliminary results from 76 responses were given in a poster presentation at the annual meeting of the Heart Failure Society of America.

The survey indicates a similar lack of awareness about published guidelines for heart failure (44% of cardiologists, 47% of noncardiologists), a similar belief in left ventricular pacing as a life-extending measure (44% of cardiologists, 41% of noncardiologists), and a similar level of uncertainty about when to refer a patient to hospice care (52% of cardiologists, 53% of noncardiologists).

Almost 85% of the noncardiologists believed that they, and not cardiologists, should initiate end-of-life discussions. “The noncardiologists really thought they were better [at that] than the cardiologists,” Dr. Hauptman said. However, he added, most of the generalists reported they had never had such a discussion with a patient or a patient's family.

“Cardiologists have an acute-care perspective. We don't really know about what is going on at the end of life,” Dr. Hauptman said. “It's going to take education and discussions at national meetings [to understand that].”

The majority of respondents (91% of cardiologists, 67% of noncardiologists) do not use standard quality of life measurements for patients with end-stage heart failure. “This would be kind of shocking” if confirmed by the full survey, he said.

Most of the cardiologists surveyed (65%) have discussed implantable cardioverter defibrillator deactivation with an end-stage patient or family member, compared with 35% of noncardiologists. With the increasing prevalence of heart failure, Dr. Hauptman said, “more patients are going to show up with a device. Do you turn them off or not turn them off?”

Dr. Hauptman said he hopes that the final results of the survey will provide even more insight about physician attitudes toward end-stage heart failure and that the information can be used to design effective interventions in the future.

BOCA RATON, FLA. – When it comes to treatment options, palliative care, and decision making for patients with end-stage heart failure, cardiologists, internists, family physicians, and geriatricians are similarly lacking in awareness, according to a national pilot survey.

The American College of Cardiology and the American Heart Association's recommendations for care of heart failure patients include a call for cardiologists to counsel patients about end-of-life issues. However, most of the care of heart failure patients is by noncardiologist physicians, and there is still uncertainty about which physicians should address end-of-life concerns with end-stage heart failure patients.

“The question is, who is going to have 'the talk'?” Dr. Paul J. Hauptman said in an interview.

“More and more patients have heart failure, and more and more patients are going to die from heart failure. What are we going to do with this burgeoning population of patients with heart failure?” asked Dr. Hauptman, professor of medicine, division of cardiology, and director of heart failure/transplantation at St. Louis (Mo.) University.

In an attempt to answer that question, Dr. Hauptman and his associates surveyed cardiologists, family physicians, internists, and geriatricians about the management of patients with end-stage heart failure. The investigators randomly selected physicians from the American Medical Association Master File.

The administration of the 51-question survey is ongoing, with the goal of garnering opinions from 1,450 physicians. Preliminary results from 76 responses were given in a poster presentation at the annual meeting of the Heart Failure Society of America.

The survey indicates a similar lack of awareness about published guidelines for heart failure (44% of cardiologists, 47% of noncardiologists), a similar belief in left ventricular pacing as a life-extending measure (44% of cardiologists, 41% of noncardiologists), and a similar level of uncertainty about when to refer a patient to hospice care (52% of cardiologists, 53% of noncardiologists).

Almost 85% of the noncardiologists believed that they, and not cardiologists, should initiate end-of-life discussions. “The noncardiologists really thought they were better [at that] than the cardiologists,” Dr. Hauptman said. However, he added, most of the generalists reported they had never had such a discussion with a patient or a patient's family.

“Cardiologists have an acute-care perspective. We don't really know about what is going on at the end of life,” Dr. Hauptman said. “It's going to take education and discussions at national meetings [to understand that].”

The majority of respondents (91% of cardiologists, 67% of noncardiologists) do not use standard quality of life measurements for patients with end-stage heart failure. “This would be kind of shocking” if confirmed by the full survey, he said.

Most of the cardiologists surveyed (65%) have discussed implantable cardioverter defibrillator deactivation with an end-stage patient or family member, compared with 35% of noncardiologists. With the increasing prevalence of heart failure, Dr. Hauptman said, “more patients are going to show up with a device. Do you turn them off or not turn them off?”

Dr. Hauptman said he hopes that the final results of the survey will provide even more insight about physician attitudes toward end-stage heart failure and that the information can be used to design effective interventions in the future.

BOCA RATON, FLA. – When it comes to treatment options, palliative care, and decision making for patients with end-stage heart failure, cardiologists, internists, family physicians, and geriatricians are similarly lacking in awareness, according to a national pilot survey.

The American College of Cardiology and the American Heart Association's recommendations for care of heart failure patients include a call for cardiologists to counsel patients about end-of-life issues. However, most of the care of heart failure patients is by noncardiologist physicians, and there is still uncertainty about which physicians should address end-of-life concerns with end-stage heart failure patients.

“The question is, who is going to have 'the talk'?” Dr. Paul J. Hauptman said in an interview.

“More and more patients have heart failure, and more and more patients are going to die from heart failure. What are we going to do with this burgeoning population of patients with heart failure?” asked Dr. Hauptman, professor of medicine, division of cardiology, and director of heart failure/transplantation at St. Louis (Mo.) University.

In an attempt to answer that question, Dr. Hauptman and his associates surveyed cardiologists, family physicians, internists, and geriatricians about the management of patients with end-stage heart failure. The investigators randomly selected physicians from the American Medical Association Master File.

The administration of the 51-question survey is ongoing, with the goal of garnering opinions from 1,450 physicians. Preliminary results from 76 responses were given in a poster presentation at the annual meeting of the Heart Failure Society of America.

The survey indicates a similar lack of awareness about published guidelines for heart failure (44% of cardiologists, 47% of noncardiologists), a similar belief in left ventricular pacing as a life-extending measure (44% of cardiologists, 41% of noncardiologists), and a similar level of uncertainty about when to refer a patient to hospice care (52% of cardiologists, 53% of noncardiologists).

Almost 85% of the noncardiologists believed that they, and not cardiologists, should initiate end-of-life discussions. “The noncardiologists really thought they were better [at that] than the cardiologists,” Dr. Hauptman said. However, he added, most of the generalists reported they had never had such a discussion with a patient or a patient's family.

“Cardiologists have an acute-care perspective. We don't really know about what is going on at the end of life,” Dr. Hauptman said. “It's going to take education and discussions at national meetings [to understand that].”

The majority of respondents (91% of cardiologists, 67% of noncardiologists) do not use standard quality of life measurements for patients with end-stage heart failure. “This would be kind of shocking” if confirmed by the full survey, he said.

Most of the cardiologists surveyed (65%) have discussed implantable cardioverter defibrillator deactivation with an end-stage patient or family member, compared with 35% of noncardiologists. With the increasing prevalence of heart failure, Dr. Hauptman said, “more patients are going to show up with a device. Do you turn them off or not turn them off?”

Dr. Hauptman said he hopes that the final results of the survey will provide even more insight about physician attitudes toward end-stage heart failure and that the information can be used to design effective interventions in the future.

BOCA RATON, FLA. – A new and smaller left ventricular assist device now in clinical trials is appropriate for most women and provides similar outcomes, compared with a larger device already used for patients with heart failure, according to a poster presentation at the annual meeting of the Heart Failure Society of America.

The large size of the original HeartMate XVE Left Ventricular Assist System (Thoratec Corp., Pleasanton, Calif.), which is currently approved as a bridge-to-transplant as well as a destination therapy, precluded its use in many women.

“The old device would not fit everyone,” Dr. Leway Chen said in an interview.

Only about 9%-16% of women with heart failure received a HeartMate XVE in published studies, said Dr. Chen, director of the heart failure and transplantation program at Strong Memorial Hospital, University of Rochester (N.Y.). Dr. Chen also is an investigator for Thoratec.

In this study, Dr. Chen and his associates assessed 34 patients–including 15 women–with advanced New York Heart Association class IV heart failure at 10 medical centers. All received the HeartMate II, a continuous-flow left ventricular assist device with one-third the mass of a typical implanted electric pulsatile device. The HeartMate II was implanted in each patient as a bridge to cardiac transplantation.

Etiologies of heart failure included ischemic cardiomyopathy, idiopathic cardiomyopathy, myocarditis, and peripartum cardiomyopathy. Median age was 49 years for women and 55 years for men. There was one transient ischemic attack and one stroke in a patient who fully recovered prior to implantation among the women; neither of these events occurred in men.

There were no device failures but minor malfunctions occurred in both groups, Dr. Chen said. “The adverse event numbers are too small to make a conclusion.”

Six women received a transplant and five had ongoing therapy after a median of 96 days with the device. Three men received a transplant and 10 continued therapy with the device after a median of 117 days. The longest duration of HeartMate II therapy was 577 days as of June 10, 2005, he said.

Regarding the HeartMate II, Dr. Chen said, “We really like it and expect good durability. There are other smaller devices, but this is the closest to market.” A phase II-III study of the device is underway, he added.

BOCA RATON, FLA. – A new and smaller left ventricular assist device now in clinical trials is appropriate for most women and provides similar outcomes, compared with a larger device already used for patients with heart failure, according to a poster presentation at the annual meeting of the Heart Failure Society of America.

The large size of the original HeartMate XVE Left Ventricular Assist System (Thoratec Corp., Pleasanton, Calif.), which is currently approved as a bridge-to-transplant as well as a destination therapy, precluded its use in many women.

“The old device would not fit everyone,” Dr. Leway Chen said in an interview.

Only about 9%-16% of women with heart failure received a HeartMate XVE in published studies, said Dr. Chen, director of the heart failure and transplantation program at Strong Memorial Hospital, University of Rochester (N.Y.). Dr. Chen also is an investigator for Thoratec.

In this study, Dr. Chen and his associates assessed 34 patients–including 15 women–with advanced New York Heart Association class IV heart failure at 10 medical centers. All received the HeartMate II, a continuous-flow left ventricular assist device with one-third the mass of a typical implanted electric pulsatile device. The HeartMate II was implanted in each patient as a bridge to cardiac transplantation.

Etiologies of heart failure included ischemic cardiomyopathy, idiopathic cardiomyopathy, myocarditis, and peripartum cardiomyopathy. Median age was 49 years for women and 55 years for men. There was one transient ischemic attack and one stroke in a patient who fully recovered prior to implantation among the women; neither of these events occurred in men.

There were no device failures but minor malfunctions occurred in both groups, Dr. Chen said. “The adverse event numbers are too small to make a conclusion.”

Six women received a transplant and five had ongoing therapy after a median of 96 days with the device. Three men received a transplant and 10 continued therapy with the device after a median of 117 days. The longest duration of HeartMate II therapy was 577 days as of June 10, 2005, he said.

Regarding the HeartMate II, Dr. Chen said, “We really like it and expect good durability. There are other smaller devices, but this is the closest to market.” A phase II-III study of the device is underway, he added.

BOCA RATON, FLA. – A new and smaller left ventricular assist device now in clinical trials is appropriate for most women and provides similar outcomes, compared with a larger device already used for patients with heart failure, according to a poster presentation at the annual meeting of the Heart Failure Society of America.

The large size of the original HeartMate XVE Left Ventricular Assist System (Thoratec Corp., Pleasanton, Calif.), which is currently approved as a bridge-to-transplant as well as a destination therapy, precluded its use in many women.

“The old device would not fit everyone,” Dr. Leway Chen said in an interview.

Only about 9%-16% of women with heart failure received a HeartMate XVE in published studies, said Dr. Chen, director of the heart failure and transplantation program at Strong Memorial Hospital, University of Rochester (N.Y.). Dr. Chen also is an investigator for Thoratec.

In this study, Dr. Chen and his associates assessed 34 patients–including 15 women–with advanced New York Heart Association class IV heart failure at 10 medical centers. All received the HeartMate II, a continuous-flow left ventricular assist device with one-third the mass of a typical implanted electric pulsatile device. The HeartMate II was implanted in each patient as a bridge to cardiac transplantation.

Etiologies of heart failure included ischemic cardiomyopathy, idiopathic cardiomyopathy, myocarditis, and peripartum cardiomyopathy. Median age was 49 years for women and 55 years for men. There was one transient ischemic attack and one stroke in a patient who fully recovered prior to implantation among the women; neither of these events occurred in men.

There were no device failures but minor malfunctions occurred in both groups, Dr. Chen said. “The adverse event numbers are too small to make a conclusion.”

Six women received a transplant and five had ongoing therapy after a median of 96 days with the device. Three men received a transplant and 10 continued therapy with the device after a median of 117 days. The longest duration of HeartMate II therapy was 577 days as of June 10, 2005, he said.

Regarding the HeartMate II, Dr. Chen said, “We really like it and expect good durability. There are other smaller devices, but this is the closest to market.” A phase II-III study of the device is underway, he added.