Michele G. Sullivan

The rates of new acute hepatitis A and B infections in the United States have plummeted to the lowest levels since their respective peaks in 1971 and 1985, according to a recent report by the Centers for Disease Control and Prevention.

The incidence of hepatitis A for 2005—the latest year for which full data are available—was a historic low of 1.5/100,000 U.S. population, based on a total of 4,488 confirmed cases as reported to the National Notifiable Diseases Surveillance System each year, according to the CDC report (MMWR 2007;56:[No. SS-3]).

This is an 88% drop from 1995, when the disease's incidence was 12.0/100,000 with 31,582 new cases. That year, effective vaccines against hepatitis A first became available in the United States. The highest incidence of new hepatitis A infections ever recorded was 28.9/100,000, based on 59,606 cases in 1971; the 2005 rate is a 95% decline from that peak.

Similarly, the 2005 incidence of hepatitis B was 1.8/100,000 (5,494 cases), an 84% drop from the peak hepatitis B year of 1985, when the rate was 11.5/100,000 (26,654 cases).

“The trend has been very impressive,” Dr. Emmet B. Keeffe, professor of medicine and chief of hepatology at Stanford (Calif.) University Medical Center, said in an interview. “We are having a significant impact on this disease in the United States, and we could see its eradication.”

Dr. Hua Chen, of the University of Houston, agreed. “I'm very optimistic about it. I really believe these diseases could be eliminated within 10 or 20 years,” said Dr. Chen, an expert on hepatitis vaccine research.

CDC epidemiologist Annemarie Wasley, Sc.D., the report's lead author, expressed a more cautious outlook, but said the numbers illustrate the beneficial impact of a national vaccine strategy aimed at eradicating hepatitis.

“We feel that if we keep applying these recommendations, strengthening them where they are weak, and reaching out to high-risk groups, we can continue this downward trend to an even lower incidence of new infection,” she said in an interview.

The decrease in new infections is related directly to recent expansions in the recommendations for routine hepatitis A vaccination in young children and to ongoing hepatitis B vaccination strategies, according to Dr. Wasley.

Since the hepatitis A incidence of 12.0/100,000 in 1995, the annual rate has declined steadily, reflecting a 1996 recommendation to vaccinate those at increased risk of infection (international travelers, men who have sex with men, drug users, and children living in communities with high rates of disease).

A 1999 recommendation to implement routine vaccination for children in 11 states with high infection rates contributed to the effect: The national hepatitis A new-cases rate dropped 47% from 1995 (12.0/100,000) to 1999 (6.3/100,000); from 1999 to 2005, the decrease accelerated to 74%.

The 2005 recommendation to include hepatitis A as part of the routine childhood vaccination schedule will “provide the foundation for eventual consideration of elimination of indigenous hepatitis A virus transmission in the U.S.,” the report noted.

The similarly dramatic decline in new cases of hepatitis B is associated with the 1991 launch of a national four-step program to eliminate its transmission, the CDC noted. The key elements of that program were universal vaccination of newborns, routine screening of all pregnant women with prenatal treatment of those infected, routine vaccination of all unvaccinated children and adolescents, and vaccination of all at-risk adults. The national hepatitis B new-cases rate had dropped 38% from 1985 (11.5) to 1991 (7.1/100,000); from 1991 to 2005, the decrease accelerated to 75%.

In addition to the dramatic declines in hepatitis A and B, the report notes a similar significant decline in hepatitis C. This finding is probably because of risk-reduction behaviors and the decline in needle sharing among injectable drug users, Dr. Wasley said.

Hepatitis C continued the decline it has shown since its peak, also in 1985, when a 1.8/100,000 incidence (4,192 new cases) was recorded. In 2005, the rate fell to just 0.2/100,000 (671 cases), an 89% decrease and also a historic low for the nation.

But despite the good news, challenges remain. Unfortunately, Dr. Wasley said, rates of hepatitis B among 24- to 44-year-olds remain unacceptably high.

Most of the occurrences in this age group are associated with high-risk behaviors, including intravenous drug use, male/male sex, and multiple sexual partners. “The vaccine has always been recommended for people with these risk factors, but the challenge is getting it to them—and that's one of the things we need to focus on in the future.”

The problem is not vaccine availability, Dr. Chen said, but instead it is an issue of education and accessibility. “Adults with sexually transmitted disease and illegal drug users are the two biggest populations at risk right now. These are precisely the adults who don't self-identify as a high-risk population. They remain unaware of their risk and do not communicate this with their physicians—if they even have a physician. It's a huge challenge to public health to effectively reach them and get them vaccinated.”

Her recent review of more than 6,000 respondents to the National Health and Nutrition Examination Survey examined factors affecting hepatitis vaccination rates (Curr. Med. Res. Opin. 2006;22:2489–96). Among those with high-risk behaviors, being single, male, and uninsured had significant negative associations with hepatitis vaccination. “The people who need it most are the ones who don't have it,” Dr. Chen said.

Dr. Keeffe agreed. “These are hard populations to penetrate and elicit compliance from. Doctors who work in these environments, such as STD clinics or inner cities with large indigent populations, need to try and increase the delivery of vaccine to these patients.”

But even if new hepatitis infections become a relic of the past, Dr. Wasley warned, physicians will be dealing with the existing chronic infections for years to come. “There are more than 3 million people in this country who have chronic hepatitis, and that is an enormous health care burden,” she said.

ELSEVIER GLOBAL MEDICAL NEWS

The rates of new acute hepatitis A and B infections in the United States have plummeted to the lowest levels since their respective peaks in 1971 and 1985, according to a recent report by the Centers for Disease Control and Prevention.

The incidence of hepatitis A for 2005—the latest year for which full data are available—was a historic low of 1.5/100,000 U.S. population, based on a total of 4,488 confirmed cases as reported to the National Notifiable Diseases Surveillance System each year, according to the CDC report (MMWR 2007;56:[No. SS-3]).

This is an 88% drop from 1995, when the disease's incidence was 12.0/100,000 with 31,582 new cases. That year, effective vaccines against hepatitis A first became available in the United States. The highest incidence of new hepatitis A infections ever recorded was 28.9/100,000, based on 59,606 cases in 1971; the 2005 rate is a 95% decline from that peak.

Similarly, the 2005 incidence of hepatitis B was 1.8/100,000 (5,494 cases), an 84% drop from the peak hepatitis B year of 1985, when the rate was 11.5/100,000 (26,654 cases).

“The trend has been very impressive,” Dr. Emmet B. Keeffe, professor of medicine and chief of hepatology at Stanford (Calif.) University Medical Center, said in an interview. “We are having a significant impact on this disease in the United States, and we could see its eradication.”

Dr. Hua Chen, of the University of Houston, agreed. “I'm very optimistic about it. I really believe these diseases could be eliminated within 10 or 20 years,” said Dr. Chen, an expert on hepatitis vaccine research.

CDC epidemiologist Annemarie Wasley, Sc.D., the report's lead author, expressed a more cautious outlook, but said the numbers illustrate the beneficial impact of a national vaccine strategy aimed at eradicating hepatitis.

“We feel that if we keep applying these recommendations, strengthening them where they are weak, and reaching out to high-risk groups, we can continue this downward trend to an even lower incidence of new infection,” she said in an interview.

The decrease in new infections is related directly to recent expansions in the recommendations for routine hepatitis A vaccination in young children and to ongoing hepatitis B vaccination strategies, according to Dr. Wasley.

Since the hepatitis A incidence of 12.0/100,000 in 1995, the annual rate has declined steadily, reflecting a 1996 recommendation to vaccinate those at increased risk of infection (international travelers, men who have sex with men, drug users, and children living in communities with high rates of disease).

A 1999 recommendation to implement routine vaccination for children in 11 states with high infection rates contributed to the effect: The national hepatitis A new-cases rate dropped 47% from 1995 (12.0/100,000) to 1999 (6.3/100,000); from 1999 to 2005, the decrease accelerated to 74%.

The 2005 recommendation to include hepatitis A as part of the routine childhood vaccination schedule will “provide the foundation for eventual consideration of elimination of indigenous hepatitis A virus transmission in the U.S.,” the report noted.

The similarly dramatic decline in new cases of hepatitis B is associated with the 1991 launch of a national four-step program to eliminate its transmission, the CDC noted. The key elements of that program were universal vaccination of newborns, routine screening of all pregnant women with prenatal treatment of those infected, routine vaccination of all unvaccinated children and adolescents, and vaccination of all at-risk adults. The national hepatitis B new-cases rate had dropped 38% from 1985 (11.5) to 1991 (7.1/100,000); from 1991 to 2005, the decrease accelerated to 75%.

In addition to the dramatic declines in hepatitis A and B, the report notes a similar significant decline in hepatitis C. This finding is probably because of risk-reduction behaviors and the decline in needle sharing among injectable drug users, Dr. Wasley said.

Hepatitis C continued the decline it has shown since its peak, also in 1985, when a 1.8/100,000 incidence (4,192 new cases) was recorded. In 2005, the rate fell to just 0.2/100,000 (671 cases), an 89% decrease and also a historic low for the nation.

But despite the good news, challenges remain. Unfortunately, Dr. Wasley said, rates of hepatitis B among 24- to 44-year-olds remain unacceptably high.

Most of the occurrences in this age group are associated with high-risk behaviors, including intravenous drug use, male/male sex, and multiple sexual partners. “The vaccine has always been recommended for people with these risk factors, but the challenge is getting it to them—and that's one of the things we need to focus on in the future.”

The problem is not vaccine availability, Dr. Chen said, but instead it is an issue of education and accessibility. “Adults with sexually transmitted disease and illegal drug users are the two biggest populations at risk right now. These are precisely the adults who don't self-identify as a high-risk population. They remain unaware of their risk and do not communicate this with their physicians—if they even have a physician. It's a huge challenge to public health to effectively reach them and get them vaccinated.”

Her recent review of more than 6,000 respondents to the National Health and Nutrition Examination Survey examined factors affecting hepatitis vaccination rates (Curr. Med. Res. Opin. 2006;22:2489–96). Among those with high-risk behaviors, being single, male, and uninsured had significant negative associations with hepatitis vaccination. “The people who need it most are the ones who don't have it,” Dr. Chen said.

Dr. Keeffe agreed. “These are hard populations to penetrate and elicit compliance from. Doctors who work in these environments, such as STD clinics or inner cities with large indigent populations, need to try and increase the delivery of vaccine to these patients.”

But even if new hepatitis infections become a relic of the past, Dr. Wasley warned, physicians will be dealing with the existing chronic infections for years to come. “There are more than 3 million people in this country who have chronic hepatitis, and that is an enormous health care burden,” she said.

ELSEVIER GLOBAL MEDICAL NEWS

The rates of new acute hepatitis A and B infections in the United States have plummeted to the lowest levels since their respective peaks in 1971 and 1985, according to a recent report by the Centers for Disease Control and Prevention.

The incidence of hepatitis A for 2005—the latest year for which full data are available—was a historic low of 1.5/100,000 U.S. population, based on a total of 4,488 confirmed cases as reported to the National Notifiable Diseases Surveillance System each year, according to the CDC report (MMWR 2007;56:[No. SS-3]).

This is an 88% drop from 1995, when the disease's incidence was 12.0/100,000 with 31,582 new cases. That year, effective vaccines against hepatitis A first became available in the United States. The highest incidence of new hepatitis A infections ever recorded was 28.9/100,000, based on 59,606 cases in 1971; the 2005 rate is a 95% decline from that peak.

Similarly, the 2005 incidence of hepatitis B was 1.8/100,000 (5,494 cases), an 84% drop from the peak hepatitis B year of 1985, when the rate was 11.5/100,000 (26,654 cases).

“The trend has been very impressive,” Dr. Emmet B. Keeffe, professor of medicine and chief of hepatology at Stanford (Calif.) University Medical Center, said in an interview. “We are having a significant impact on this disease in the United States, and we could see its eradication.”

Dr. Hua Chen, of the University of Houston, agreed. “I'm very optimistic about it. I really believe these diseases could be eliminated within 10 or 20 years,” said Dr. Chen, an expert on hepatitis vaccine research.

CDC epidemiologist Annemarie Wasley, Sc.D., the report's lead author, expressed a more cautious outlook, but said the numbers illustrate the beneficial impact of a national vaccine strategy aimed at eradicating hepatitis.

“We feel that if we keep applying these recommendations, strengthening them where they are weak, and reaching out to high-risk groups, we can continue this downward trend to an even lower incidence of new infection,” she said in an interview.

The decrease in new infections is related directly to recent expansions in the recommendations for routine hepatitis A vaccination in young children and to ongoing hepatitis B vaccination strategies, according to Dr. Wasley.

Since the hepatitis A incidence of 12.0/100,000 in 1995, the annual rate has declined steadily, reflecting a 1996 recommendation to vaccinate those at increased risk of infection (international travelers, men who have sex with men, drug users, and children living in communities with high rates of disease).

A 1999 recommendation to implement routine vaccination for children in 11 states with high infection rates contributed to the effect: The national hepatitis A new-cases rate dropped 47% from 1995 (12.0/100,000) to 1999 (6.3/100,000); from 1999 to 2005, the decrease accelerated to 74%.

The 2005 recommendation to include hepatitis A as part of the routine childhood vaccination schedule will “provide the foundation for eventual consideration of elimination of indigenous hepatitis A virus transmission in the U.S.,” the report noted.

The similarly dramatic decline in new cases of hepatitis B is associated with the 1991 launch of a national four-step program to eliminate its transmission, the CDC noted. The key elements of that program were universal vaccination of newborns, routine screening of all pregnant women with prenatal treatment of those infected, routine vaccination of all unvaccinated children and adolescents, and vaccination of all at-risk adults. The national hepatitis B new-cases rate had dropped 38% from 1985 (11.5) to 1991 (7.1/100,000); from 1991 to 2005, the decrease accelerated to 75%.

In addition to the dramatic declines in hepatitis A and B, the report notes a similar significant decline in hepatitis C. This finding is probably because of risk-reduction behaviors and the decline in needle sharing among injectable drug users, Dr. Wasley said.

Hepatitis C continued the decline it has shown since its peak, also in 1985, when a 1.8/100,000 incidence (4,192 new cases) was recorded. In 2005, the rate fell to just 0.2/100,000 (671 cases), an 89% decrease and also a historic low for the nation.

But despite the good news, challenges remain. Unfortunately, Dr. Wasley said, rates of hepatitis B among 24- to 44-year-olds remain unacceptably high.

Most of the occurrences in this age group are associated with high-risk behaviors, including intravenous drug use, male/male sex, and multiple sexual partners. “The vaccine has always been recommended for people with these risk factors, but the challenge is getting it to them—and that's one of the things we need to focus on in the future.”

The problem is not vaccine availability, Dr. Chen said, but instead it is an issue of education and accessibility. “Adults with sexually transmitted disease and illegal drug users are the two biggest populations at risk right now. These are precisely the adults who don't self-identify as a high-risk population. They remain unaware of their risk and do not communicate this with their physicians—if they even have a physician. It's a huge challenge to public health to effectively reach them and get them vaccinated.”

Her recent review of more than 6,000 respondents to the National Health and Nutrition Examination Survey examined factors affecting hepatitis vaccination rates (Curr. Med. Res. Opin. 2006;22:2489–96). Among those with high-risk behaviors, being single, male, and uninsured had significant negative associations with hepatitis vaccination. “The people who need it most are the ones who don't have it,” Dr. Chen said.

Dr. Keeffe agreed. “These are hard populations to penetrate and elicit compliance from. Doctors who work in these environments, such as STD clinics or inner cities with large indigent populations, need to try and increase the delivery of vaccine to these patients.”

But even if new hepatitis infections become a relic of the past, Dr. Wasley warned, physicians will be dealing with the existing chronic infections for years to come. “There are more than 3 million people in this country who have chronic hepatitis, and that is an enormous health care burden,” she said.

ELSEVIER GLOBAL MEDICAL NEWS

WASHINGTON — Long-term clopidogrel use appears to improve outcomes—including all-cause mortality and recurrent myocardial infarction—after either bare-metal or drug-eluting stent placement for acute coronary syndrome, Dr. Michael Ho reported at a conference sponsored by the American Heart Association.

His retrospective study found a 60% reduced risk of death in stent patients who continued taking the drug for up to 2 years, compared with those who did not. There were also significantly reduced risks of hospitalization for acute myocardial infarction and the combined end point of death and acute MI, Dr. Ho said in an interview.

“These findings are hypothesis generating because of the observational nature of the study, and they suggest the urgent need for a randomized clinical trial to assess the efficacy of extended clopidogrel use among ACS patients receiving stents,” said Dr. Ho, a cardiologist at the Denver Veterans Affairs Medical Center.

The findings are particularly intriguing “given the broader concerns of late events in drug-eluting stent patients,” he said.

Data were extracted from a national sample of 1,455 acute coronary syndrome patients admitted to 127 VA medical centers during 2003–2004. The patients' mean age was 64 years. Twenty-one percent had previously experienced an MI; 19% had diabetes. Cerebrovascular disease was present in 5%, and 24% had reduced left ejection fraction.

All presented with acute MI or unstable angina and underwent percutaneous coronary intervention with the placement of a bare-metal or drug-eluting stent.

All of the patients were prescribed clopidogrel at discharge. Dr. Ho compared mortality and MI hospitalization rates between those who were still taking the drug and those who were not, using pharmacy records with a median follow-up of 18 months.

Overall, there was a 60% reduced risk of all-cause mortality in those who continued to take the drug, with both stent groups reaping a similar benefit (bare-metal stent, hazard ratio 0.36; drug-eluting stent, HR 0.48).

There was also a significantly reduced overall risk of another acute MI (HR 0.55) and the combined end point of all-cause mortality and acute MI (HR 0.51).

The magnitude of association between clopidogrel use and reduced mortality was consistent throughout the entire 18 months, Dr. Ho said. In the first 6 months, the reduced risk was 0.36; at 7–12 months, it was 0.43; and at 13–18 months, it was 0.37.

“This theory should be tested immediately in a randomized clinical trial,” he said.

“Observational studies like this really raise the question of whether we should be giving these patients clopidogrel for longer periods than current guidelines recommend.”

WASHINGTON — Long-term clopidogrel use appears to improve outcomes—including all-cause mortality and recurrent myocardial infarction—after either bare-metal or drug-eluting stent placement for acute coronary syndrome, Dr. Michael Ho reported at a conference sponsored by the American Heart Association.

His retrospective study found a 60% reduced risk of death in stent patients who continued taking the drug for up to 2 years, compared with those who did not. There were also significantly reduced risks of hospitalization for acute myocardial infarction and the combined end point of death and acute MI, Dr. Ho said in an interview.

“These findings are hypothesis generating because of the observational nature of the study, and they suggest the urgent need for a randomized clinical trial to assess the efficacy of extended clopidogrel use among ACS patients receiving stents,” said Dr. Ho, a cardiologist at the Denver Veterans Affairs Medical Center.

The findings are particularly intriguing “given the broader concerns of late events in drug-eluting stent patients,” he said.

Data were extracted from a national sample of 1,455 acute coronary syndrome patients admitted to 127 VA medical centers during 2003–2004. The patients' mean age was 64 years. Twenty-one percent had previously experienced an MI; 19% had diabetes. Cerebrovascular disease was present in 5%, and 24% had reduced left ejection fraction.

All presented with acute MI or unstable angina and underwent percutaneous coronary intervention with the placement of a bare-metal or drug-eluting stent.

All of the patients were prescribed clopidogrel at discharge. Dr. Ho compared mortality and MI hospitalization rates between those who were still taking the drug and those who were not, using pharmacy records with a median follow-up of 18 months.

Overall, there was a 60% reduced risk of all-cause mortality in those who continued to take the drug, with both stent groups reaping a similar benefit (bare-metal stent, hazard ratio 0.36; drug-eluting stent, HR 0.48).

There was also a significantly reduced overall risk of another acute MI (HR 0.55) and the combined end point of all-cause mortality and acute MI (HR 0.51).

The magnitude of association between clopidogrel use and reduced mortality was consistent throughout the entire 18 months, Dr. Ho said. In the first 6 months, the reduced risk was 0.36; at 7–12 months, it was 0.43; and at 13–18 months, it was 0.37.

“This theory should be tested immediately in a randomized clinical trial,” he said.

“Observational studies like this really raise the question of whether we should be giving these patients clopidogrel for longer periods than current guidelines recommend.”

WASHINGTON — Long-term clopidogrel use appears to improve outcomes—including all-cause mortality and recurrent myocardial infarction—after either bare-metal or drug-eluting stent placement for acute coronary syndrome, Dr. Michael Ho reported at a conference sponsored by the American Heart Association.

His retrospective study found a 60% reduced risk of death in stent patients who continued taking the drug for up to 2 years, compared with those who did not. There were also significantly reduced risks of hospitalization for acute myocardial infarction and the combined end point of death and acute MI, Dr. Ho said in an interview.

“These findings are hypothesis generating because of the observational nature of the study, and they suggest the urgent need for a randomized clinical trial to assess the efficacy of extended clopidogrel use among ACS patients receiving stents,” said Dr. Ho, a cardiologist at the Denver Veterans Affairs Medical Center.

The findings are particularly intriguing “given the broader concerns of late events in drug-eluting stent patients,” he said.

Data were extracted from a national sample of 1,455 acute coronary syndrome patients admitted to 127 VA medical centers during 2003–2004. The patients' mean age was 64 years. Twenty-one percent had previously experienced an MI; 19% had diabetes. Cerebrovascular disease was present in 5%, and 24% had reduced left ejection fraction.

All presented with acute MI or unstable angina and underwent percutaneous coronary intervention with the placement of a bare-metal or drug-eluting stent.

All of the patients were prescribed clopidogrel at discharge. Dr. Ho compared mortality and MI hospitalization rates between those who were still taking the drug and those who were not, using pharmacy records with a median follow-up of 18 months.

Overall, there was a 60% reduced risk of all-cause mortality in those who continued to take the drug, with both stent groups reaping a similar benefit (bare-metal stent, hazard ratio 0.36; drug-eluting stent, HR 0.48).

There was also a significantly reduced overall risk of another acute MI (HR 0.55) and the combined end point of all-cause mortality and acute MI (HR 0.51).

The magnitude of association between clopidogrel use and reduced mortality was consistent throughout the entire 18 months, Dr. Ho said. In the first 6 months, the reduced risk was 0.36; at 7–12 months, it was 0.43; and at 13–18 months, it was 0.37.

“This theory should be tested immediately in a randomized clinical trial,” he said.

“Observational studies like this really raise the question of whether we should be giving these patients clopidogrel for longer periods than current guidelines recommend.”

CHICAGO – A history of heavy drinking cuts the life span by up to 25 years across all major chronic diseases, Hsiao-ye Yi, Ph.D., reported at the annual meeting of the Research Society on Alcoholism.

The effect seems particularly pronounced in women drinkers, who lose their survival advantage over men at an early age, wrote Dr. Yi, an epidemiologist with the National Institute on Alcohol Abuse and Alcoholism, and his coauthors.

“When no heavy alcohol use is involved, women have a lower cumulative probability of death from all major chronic diseases from age 40 and throughout the rest of life. However, when heavy alcohol use is involved, the cumulative probability of death for women does not diverge significantly from that for men until close to age 55, suggesting an undue effect of alcohol on women,” they wrote.

The researchers examined death records from 1999 to 2004 from the Multiple Causes of Death database, maintained by the National Center for Health Statistics. The database contained information on more than 14.5 million deaths in the United States over that time period. Each death record contained one underlying cause of death and up to 20 contributing causes, all identified by International Classification of Diseases (ICD) codes.

They divided chronic diseases into five categories: malignant neoplasms, diabetes mellitus, neuropsychiatric conditions, cardiovascular disease, and digestive disease, each with detailed subcategories.

The death records did not contain direct drinking measures, so the researchers presumed heavy drinking when they saw any of 12 ICD-10 codes for alcohol-induced medical conditions (Cushing's syndrome; mental/behavioral disorders; degeneration of nervous system; alcohol in blood; alcohol poisoning, accidental or undetermined; and alcoholic polyneuropathy, myopathy, gastritis, liver disease, or chronic pancreatitis).

They then compared the cumulative probability of death by age and the mean age at death between the drinking and nondrinking groups within each of the disease categories. “The analysis of all deaths from major chronic diseases showed that heavy alcohol use is associated with a higher cumulative probability of death beginning as early as age 35,” they reported. “The gap between heavy alcohol use and no heavy alcohol use in the cumulative probability of death from major chronic diseases becomes increasingly wider throughout life until around age 70.”

The average years of life lost due to heavy drinking varied by disease, ranging from 25 years for neuropsychiatric conditions to 7 years for malignant neoplasms, and was generally much greater in women than in men.

Heavy drinkers with neuropsychiatric conditions lost the most years of life, compared with similar patients who didn't drink heavily. Those with cardiovascular disease died a mean of 17 years earlier, and those with digestive diseases, a mean of 15 years earlier. Diabetics who drank heavily lost a mean of 16 years, compared with those without heavy drinking. Heavy alcohol use also shortened the life spans of those with cancer by more than 7 years.

CHICAGO – A history of heavy drinking cuts the life span by up to 25 years across all major chronic diseases, Hsiao-ye Yi, Ph.D., reported at the annual meeting of the Research Society on Alcoholism.

The effect seems particularly pronounced in women drinkers, who lose their survival advantage over men at an early age, wrote Dr. Yi, an epidemiologist with the National Institute on Alcohol Abuse and Alcoholism, and his coauthors.

“When no heavy alcohol use is involved, women have a lower cumulative probability of death from all major chronic diseases from age 40 and throughout the rest of life. However, when heavy alcohol use is involved, the cumulative probability of death for women does not diverge significantly from that for men until close to age 55, suggesting an undue effect of alcohol on women,” they wrote.

The researchers examined death records from 1999 to 2004 from the Multiple Causes of Death database, maintained by the National Center for Health Statistics. The database contained information on more than 14.5 million deaths in the United States over that time period. Each death record contained one underlying cause of death and up to 20 contributing causes, all identified by International Classification of Diseases (ICD) codes.

They divided chronic diseases into five categories: malignant neoplasms, diabetes mellitus, neuropsychiatric conditions, cardiovascular disease, and digestive disease, each with detailed subcategories.

The death records did not contain direct drinking measures, so the researchers presumed heavy drinking when they saw any of 12 ICD-10 codes for alcohol-induced medical conditions (Cushing's syndrome; mental/behavioral disorders; degeneration of nervous system; alcohol in blood; alcohol poisoning, accidental or undetermined; and alcoholic polyneuropathy, myopathy, gastritis, liver disease, or chronic pancreatitis).

They then compared the cumulative probability of death by age and the mean age at death between the drinking and nondrinking groups within each of the disease categories. “The analysis of all deaths from major chronic diseases showed that heavy alcohol use is associated with a higher cumulative probability of death beginning as early as age 35,” they reported. “The gap between heavy alcohol use and no heavy alcohol use in the cumulative probability of death from major chronic diseases becomes increasingly wider throughout life until around age 70.”

The average years of life lost due to heavy drinking varied by disease, ranging from 25 years for neuropsychiatric conditions to 7 years for malignant neoplasms, and was generally much greater in women than in men.

Heavy drinkers with neuropsychiatric conditions lost the most years of life, compared with similar patients who didn't drink heavily. Those with cardiovascular disease died a mean of 17 years earlier, and those with digestive diseases, a mean of 15 years earlier. Diabetics who drank heavily lost a mean of 16 years, compared with those without heavy drinking. Heavy alcohol use also shortened the life spans of those with cancer by more than 7 years.

CHICAGO – A history of heavy drinking cuts the life span by up to 25 years across all major chronic diseases, Hsiao-ye Yi, Ph.D., reported at the annual meeting of the Research Society on Alcoholism.

The effect seems particularly pronounced in women drinkers, who lose their survival advantage over men at an early age, wrote Dr. Yi, an epidemiologist with the National Institute on Alcohol Abuse and Alcoholism, and his coauthors.

“When no heavy alcohol use is involved, women have a lower cumulative probability of death from all major chronic diseases from age 40 and throughout the rest of life. However, when heavy alcohol use is involved, the cumulative probability of death for women does not diverge significantly from that for men until close to age 55, suggesting an undue effect of alcohol on women,” they wrote.

The researchers examined death records from 1999 to 2004 from the Multiple Causes of Death database, maintained by the National Center for Health Statistics. The database contained information on more than 14.5 million deaths in the United States over that time period. Each death record contained one underlying cause of death and up to 20 contributing causes, all identified by International Classification of Diseases (ICD) codes.

They divided chronic diseases into five categories: malignant neoplasms, diabetes mellitus, neuropsychiatric conditions, cardiovascular disease, and digestive disease, each with detailed subcategories.

The death records did not contain direct drinking measures, so the researchers presumed heavy drinking when they saw any of 12 ICD-10 codes for alcohol-induced medical conditions (Cushing's syndrome; mental/behavioral disorders; degeneration of nervous system; alcohol in blood; alcohol poisoning, accidental or undetermined; and alcoholic polyneuropathy, myopathy, gastritis, liver disease, or chronic pancreatitis).

They then compared the cumulative probability of death by age and the mean age at death between the drinking and nondrinking groups within each of the disease categories. “The analysis of all deaths from major chronic diseases showed that heavy alcohol use is associated with a higher cumulative probability of death beginning as early as age 35,” they reported. “The gap between heavy alcohol use and no heavy alcohol use in the cumulative probability of death from major chronic diseases becomes increasingly wider throughout life until around age 70.”

The average years of life lost due to heavy drinking varied by disease, ranging from 25 years for neuropsychiatric conditions to 7 years for malignant neoplasms, and was generally much greater in women than in men.

Heavy drinkers with neuropsychiatric conditions lost the most years of life, compared with similar patients who didn't drink heavily. Those with cardiovascular disease died a mean of 17 years earlier, and those with digestive diseases, a mean of 15 years earlier. Diabetics who drank heavily lost a mean of 16 years, compared with those without heavy drinking. Heavy alcohol use also shortened the life spans of those with cancer by more than 7 years.

CHICAGO – Alcohol may actually protect the cognitive health of some patients who sustain a head injury while intoxicated, Rael Lange, Ph.D., said at the annual meeting of the Research Society of Alcoholism.

His conclusion stands in stark contrast to the extant literature, which almost universally finds poorer cognitive outcomes in intoxicated patients with traumatic brain injury. But this study contains a critical difference from every other examination of this issue, said Dr. Lange of the University of British Columbia, Vancouver: It excluded patients with a prior history of excessive alcohol use.

“Many patients who are intoxicated at the time of injury have a significant history of chronic alcoholism,” he said in an interview. “The exclusion of patients with preinjury alcohol use ensured that what we were studying was the effect of day-of-injury alcohol intoxication, rather than day-of-injury alcohol intoxication complicated by the effects of long-term alcohol misuse.”

His retrospective study included 36 patients treated for traumatic brain injury (TBI) at a single hospital; 18 of them were intoxicated at the time of the injury, with a blood alcohol level of at least 100 mg/dL. These patients were matched with 18 others with similar baseline characteristic and similar injuries, but who had no alcohol in their system at the time of injury. Chart review and a neuropsychiatric interview ensured that none of the study group had any significant history of preinjury alcohol use.

This was no easy task, Dr. Lange noted. “It's difficult to study the effects of day-of-injury alcohol intoxication free from the influence of preinjury alcohol intoxication because there is a low prevalence of patients who are intoxicated at the time of injury who do not have a significant history of alcohol abuse. It takes a long time to collect enough participants in this important experimental group. We were fortunate to have access to a large database of trauma patients that were seen over a 7-year period.”

The patients' mean age was 27 years; 70% were male. Their average educational level was 12 years. Motor vehicle accident without seat belt was the most common method of injury (42%), followed by motor vehicle accident with seat belt (11%), and pedestrian struck by motor vehicle (11%). Falls, blows to the head, and assault caused the remainder of the injuries.

One-third of the group sustained a mild TBI with skull fracture; one-third, a complicated mild TBI; and one-third, a severe TBI. Most (70%) had a Glasgow coma score of 13–15; the GCS for the remaining patients was 3–8. Loss of consciousness occurred in 70%, did not occur in 11%, and was unknown in the rest.

All patients underwent a battery of 13 cognitive tests within 9 days of their injury. Whether for raw scores, percentiles, or scores that excluded the lowest and highest percentile, intoxicated patients scored significantly better on more of the tests than did sober patients.

With the 10th percentile as cutoff, low scores on one or more items occurred in 33% of the intoxicated patients and 78% of sober patients. Low scores on two or more items occurred in 17% of the intoxicated and 31% of the sober patients; and low scores on three or more items, 11% of the intoxicated and 39% of the sober patients.

For raw scores, intoxicated patients scored significantly better on 6 of the 13 measures (those measuring delayed verbal memory, delayed visual memory, and executive functioning), and better–but not significantly so–on 4 other tests (those measuring immediate verbal and visual memory, immediate attention span, and verbal fluency).

Several factors may explain the findings, Dr. Lange said. Most studies have focused on long-term, rather than short-term, cognitive outcomes, and there may be a long-term recovery trajectory that his study did not capture. Also, studies that have not controlled for preinjury alcohol abuse may be drawing biased conclusions about the effect of day-of-injury intoxication.

However, he pointed out, the possibility that acute intoxication protects the brain from injury cannot be excluded. Some animal research has found that small to moderate doses of alcohol (1–2.5 g/kg) may have a neuroprotective effect on the brain at the time of injury because of the inhibition of N-methyl-D-aspartate-mediated excitotoxicity. In humans, some studies have suggested that moderate doses of alcohol are associated with reduced mortality.

Dr. Lange said one explanation for the findings the investigators were unable to discount was the “neuroprotection” hypothesis. However, he said, the neurophysiologic processes that may be altered at the time of injury because of moderate alcohol intoxication are not understood. “We must consider this explanation of our findings to be speculative at best,” he said.

CHICAGO – Alcohol may actually protect the cognitive health of some patients who sustain a head injury while intoxicated, Rael Lange, Ph.D., said at the annual meeting of the Research Society of Alcoholism.

His conclusion stands in stark contrast to the extant literature, which almost universally finds poorer cognitive outcomes in intoxicated patients with traumatic brain injury. But this study contains a critical difference from every other examination of this issue, said Dr. Lange of the University of British Columbia, Vancouver: It excluded patients with a prior history of excessive alcohol use.

“Many patients who are intoxicated at the time of injury have a significant history of chronic alcoholism,” he said in an interview. “The exclusion of patients with preinjury alcohol use ensured that what we were studying was the effect of day-of-injury alcohol intoxication, rather than day-of-injury alcohol intoxication complicated by the effects of long-term alcohol misuse.”

His retrospective study included 36 patients treated for traumatic brain injury (TBI) at a single hospital; 18 of them were intoxicated at the time of the injury, with a blood alcohol level of at least 100 mg/dL. These patients were matched with 18 others with similar baseline characteristic and similar injuries, but who had no alcohol in their system at the time of injury. Chart review and a neuropsychiatric interview ensured that none of the study group had any significant history of preinjury alcohol use.

This was no easy task, Dr. Lange noted. “It's difficult to study the effects of day-of-injury alcohol intoxication free from the influence of preinjury alcohol intoxication because there is a low prevalence of patients who are intoxicated at the time of injury who do not have a significant history of alcohol abuse. It takes a long time to collect enough participants in this important experimental group. We were fortunate to have access to a large database of trauma patients that were seen over a 7-year period.”

The patients' mean age was 27 years; 70% were male. Their average educational level was 12 years. Motor vehicle accident without seat belt was the most common method of injury (42%), followed by motor vehicle accident with seat belt (11%), and pedestrian struck by motor vehicle (11%). Falls, blows to the head, and assault caused the remainder of the injuries.

One-third of the group sustained a mild TBI with skull fracture; one-third, a complicated mild TBI; and one-third, a severe TBI. Most (70%) had a Glasgow coma score of 13–15; the GCS for the remaining patients was 3–8. Loss of consciousness occurred in 70%, did not occur in 11%, and was unknown in the rest.

All patients underwent a battery of 13 cognitive tests within 9 days of their injury. Whether for raw scores, percentiles, or scores that excluded the lowest and highest percentile, intoxicated patients scored significantly better on more of the tests than did sober patients.

With the 10th percentile as cutoff, low scores on one or more items occurred in 33% of the intoxicated patients and 78% of sober patients. Low scores on two or more items occurred in 17% of the intoxicated and 31% of the sober patients; and low scores on three or more items, 11% of the intoxicated and 39% of the sober patients.

For raw scores, intoxicated patients scored significantly better on 6 of the 13 measures (those measuring delayed verbal memory, delayed visual memory, and executive functioning), and better–but not significantly so–on 4 other tests (those measuring immediate verbal and visual memory, immediate attention span, and verbal fluency).

Several factors may explain the findings, Dr. Lange said. Most studies have focused on long-term, rather than short-term, cognitive outcomes, and there may be a long-term recovery trajectory that his study did not capture. Also, studies that have not controlled for preinjury alcohol abuse may be drawing biased conclusions about the effect of day-of-injury intoxication.

However, he pointed out, the possibility that acute intoxication protects the brain from injury cannot be excluded. Some animal research has found that small to moderate doses of alcohol (1–2.5 g/kg) may have a neuroprotective effect on the brain at the time of injury because of the inhibition of N-methyl-D-aspartate-mediated excitotoxicity. In humans, some studies have suggested that moderate doses of alcohol are associated with reduced mortality.

Dr. Lange said one explanation for the findings the investigators were unable to discount was the “neuroprotection” hypothesis. However, he said, the neurophysiologic processes that may be altered at the time of injury because of moderate alcohol intoxication are not understood. “We must consider this explanation of our findings to be speculative at best,” he said.

CHICAGO – Alcohol may actually protect the cognitive health of some patients who sustain a head injury while intoxicated, Rael Lange, Ph.D., said at the annual meeting of the Research Society of Alcoholism.

His conclusion stands in stark contrast to the extant literature, which almost universally finds poorer cognitive outcomes in intoxicated patients with traumatic brain injury. But this study contains a critical difference from every other examination of this issue, said Dr. Lange of the University of British Columbia, Vancouver: It excluded patients with a prior history of excessive alcohol use.

“Many patients who are intoxicated at the time of injury have a significant history of chronic alcoholism,” he said in an interview. “The exclusion of patients with preinjury alcohol use ensured that what we were studying was the effect of day-of-injury alcohol intoxication, rather than day-of-injury alcohol intoxication complicated by the effects of long-term alcohol misuse.”

His retrospective study included 36 patients treated for traumatic brain injury (TBI) at a single hospital; 18 of them were intoxicated at the time of the injury, with a blood alcohol level of at least 100 mg/dL. These patients were matched with 18 others with similar baseline characteristic and similar injuries, but who had no alcohol in their system at the time of injury. Chart review and a neuropsychiatric interview ensured that none of the study group had any significant history of preinjury alcohol use.

This was no easy task, Dr. Lange noted. “It's difficult to study the effects of day-of-injury alcohol intoxication free from the influence of preinjury alcohol intoxication because there is a low prevalence of patients who are intoxicated at the time of injury who do not have a significant history of alcohol abuse. It takes a long time to collect enough participants in this important experimental group. We were fortunate to have access to a large database of trauma patients that were seen over a 7-year period.”

The patients' mean age was 27 years; 70% were male. Their average educational level was 12 years. Motor vehicle accident without seat belt was the most common method of injury (42%), followed by motor vehicle accident with seat belt (11%), and pedestrian struck by motor vehicle (11%). Falls, blows to the head, and assault caused the remainder of the injuries.

One-third of the group sustained a mild TBI with skull fracture; one-third, a complicated mild TBI; and one-third, a severe TBI. Most (70%) had a Glasgow coma score of 13–15; the GCS for the remaining patients was 3–8. Loss of consciousness occurred in 70%, did not occur in 11%, and was unknown in the rest.

All patients underwent a battery of 13 cognitive tests within 9 days of their injury. Whether for raw scores, percentiles, or scores that excluded the lowest and highest percentile, intoxicated patients scored significantly better on more of the tests than did sober patients.

With the 10th percentile as cutoff, low scores on one or more items occurred in 33% of the intoxicated patients and 78% of sober patients. Low scores on two or more items occurred in 17% of the intoxicated and 31% of the sober patients; and low scores on three or more items, 11% of the intoxicated and 39% of the sober patients.

For raw scores, intoxicated patients scored significantly better on 6 of the 13 measures (those measuring delayed verbal memory, delayed visual memory, and executive functioning), and better–but not significantly so–on 4 other tests (those measuring immediate verbal and visual memory, immediate attention span, and verbal fluency).

Several factors may explain the findings, Dr. Lange said. Most studies have focused on long-term, rather than short-term, cognitive outcomes, and there may be a long-term recovery trajectory that his study did not capture. Also, studies that have not controlled for preinjury alcohol abuse may be drawing biased conclusions about the effect of day-of-injury intoxication.

However, he pointed out, the possibility that acute intoxication protects the brain from injury cannot be excluded. Some animal research has found that small to moderate doses of alcohol (1–2.5 g/kg) may have a neuroprotective effect on the brain at the time of injury because of the inhibition of N-methyl-D-aspartate-mediated excitotoxicity. In humans, some studies have suggested that moderate doses of alcohol are associated with reduced mortality.

Dr. Lange said one explanation for the findings the investigators were unable to discount was the “neuroprotection” hypothesis. However, he said, the neurophysiologic processes that may be altered at the time of injury because of moderate alcohol intoxication are not understood. “We must consider this explanation of our findings to be speculative at best,” he said.

A community-based push to create standardized response systems could decrease mortality and streamline acute care for patients suffering an ST-elevation myocardial infarction.

The American Heart Association's ambitious “Mission: Lifeline” program will go far beyond past efforts at improving treatment times through public outreach and education, Dr. Alice Jacobs said during a press conference. “Regrettably, prior public awareness campaigns and community-based interventions have not yet been effective in reducing the time from symptom onset to first medical contact, or in increasing the number of patients who use emergency medical services [EMS] to get to hospitals where they can receive the appropriate care. We must have a system in place that will do this.”

The need for systematic reform, beginning with patient education and continuing through emergency response and hospital systems, is sadly obvious, she said. “Despite the proven benefits of quickly restoring blood flow to the heart muscle during a heart attack, 30% of STEMI patients do not receive any reperfusion therapy,” neither fibrinolytics nor primary percutaneous coronary intervention (PCI), said Dr. Jacobs, director of the cardiac catheterization lab at Boston Medical Center. “And only 50% of those who get fibrinolytics and 40% of those who undergo PCI do so within the recommended time frames.”

Last year, the AHA convened a conference to devise an organized method of addressing these issues. The group's recommendations are published in the journal Circulation (DOI:10.1161/CIRCULATIONAHA.107.184043).

The ideal system would combine several key elements, she said.

▸ Public education. “We must start with patient education,” Dr. Jacobs said. “People need to understand the signs and symptoms of a heart attack, and the importance of activating the EMS system as quickly as possible.” Half of STEMI patients drive themselves to the hospital or get a ride from family or friends, “resulting in a delay of the treatment that EMS could provide.

▸ Improving EMS diagnosis of STEMI. “In the ideal scenario, the cath lab would be activated by EMS from the field, or by the emergency physician from the hospital, and the patient would be brought directly to the cath lab without wasting time in the emergency room,” Dr. Jacobs said. “If EMS systems have the personnel, training, and appropriate resources, they can acquire, interpret, and transmit 12-lead electrocardiograms that can show the patient is having a STEMI heart attack.”

▸ Quick, efficient transfer to hospitals equipped with cardiac catheterization teams. The majority of STEMI patients go to hospitals without on-site primary PCI capabilities, Dr. Jacobs said. Unfortunately, transfer delays are all too common. “Transfers are often a matter of the patient waiting for the next available ambulance. Under this system, patients transported to a non-PCI-capable hospital would remain on the stretcher with EMS personnel in attendance until the decision is made about whether to transport to a PCI-capable receiving hospital, which is always available and never on diversion, 24 hours a day, and 7 days a week.”

▸ Hospital incentives and certification. “We will be working with payers and policy makers to ensure that mechanisms are in place for appropriate reimbursement,” Dr. Jacobs said. This may eventually translate into one treatment fee that is split between the transporting, referring, and receiving organizations. A STEMI Center Certification program will establish treatment and accountability protocols for both referring and receiving hospitals.

Achieving these goals won't be quick or easy, said Dr. Raymond Gibbons, president of the American Heart Association. Stakeholders on every level—from patients in the community to local hospitals, legislators, insurance companies, and the federal government—will have to cooperate before Mission: Lifeline can become a reality.

The AHA will play a pivotal role in bringing these parties together, Dr. Gibbons said, beginning with an assessment of EMS effectiveness for STEMI patients. The AHA will use this information to construct a basic response system that can be tailored to different regions. The group will also convene meetings at the state and local levels to identify ways to implement the system, and to evaluate pilot programs.

Funding these systems, Dr. Gibbons said, will be largely left to localities. AHA will provide support in seeking the money necessary for implementation—industry grants, for example—but the group won't be contributing financially to any individual project.

“As an example, there may be a need to purchase the 12-lead equipment and train EMS staff,” Dr. Gibbons said. “The AHA can look for mechanisms to support that. In the past, we have placed automatic external defibrillators with first-responder units by advocating for state grants or donor support. We're confident that similar tactics can be employed with Mission: Lifeline.”

A few AHA-led pilot programs are already underway, Dr. Gibbons noted. A 2004 grant from The Annenberg Foundation made it possible for Los Angeles to create a response system that relies on 12-lead ECG readings by EMS providers. The AHA Greater Southeast Affiliate has convened a state-level STEMI task force and helped introduce a legislative bill to develop emergency angioplasty centers for STEMI patients. And in Texas, a task force met in January to discuss ways to more effectively manage STEMI patients.

Although establishing such a response system is an enormous challenge, the payoff is just as big, said Dr. Tim Henry, interventional cardiologist and director of research at the Minneapolis Heart Institute. Four years ago, the facility instituted a two-pronged standardized care system for STEMI patients based on their distance from a regional PCI-capable facility.

Outcomes have been very good, he said. “The in-hospital mortality for these patients is now 4%, even with 15% of them being older than 80 years. And close to 98% are getting appropriate adjunctive medication, which increases long-term survival. … It proves that you can indeed develop these regional systems that will improve outcomes.”

A community-based push to create standardized response systems could decrease mortality and streamline acute care for patients suffering an ST-elevation myocardial infarction.

The American Heart Association's ambitious “Mission: Lifeline” program will go far beyond past efforts at improving treatment times through public outreach and education, Dr. Alice Jacobs said during a press conference. “Regrettably, prior public awareness campaigns and community-based interventions have not yet been effective in reducing the time from symptom onset to first medical contact, or in increasing the number of patients who use emergency medical services [EMS] to get to hospitals where they can receive the appropriate care. We must have a system in place that will do this.”

The need for systematic reform, beginning with patient education and continuing through emergency response and hospital systems, is sadly obvious, she said. “Despite the proven benefits of quickly restoring blood flow to the heart muscle during a heart attack, 30% of STEMI patients do not receive any reperfusion therapy,” neither fibrinolytics nor primary percutaneous coronary intervention (PCI), said Dr. Jacobs, director of the cardiac catheterization lab at Boston Medical Center. “And only 50% of those who get fibrinolytics and 40% of those who undergo PCI do so within the recommended time frames.”

Last year, the AHA convened a conference to devise an organized method of addressing these issues. The group's recommendations are published in the journal Circulation (DOI:10.1161/CIRCULATIONAHA.107.184043).

The ideal system would combine several key elements, she said.

▸ Public education. “We must start with patient education,” Dr. Jacobs said. “People need to understand the signs and symptoms of a heart attack, and the importance of activating the EMS system as quickly as possible.” Half of STEMI patients drive themselves to the hospital or get a ride from family or friends, “resulting in a delay of the treatment that EMS could provide.

▸ Improving EMS diagnosis of STEMI. “In the ideal scenario, the cath lab would be activated by EMS from the field, or by the emergency physician from the hospital, and the patient would be brought directly to the cath lab without wasting time in the emergency room,” Dr. Jacobs said. “If EMS systems have the personnel, training, and appropriate resources, they can acquire, interpret, and transmit 12-lead electrocardiograms that can show the patient is having a STEMI heart attack.”

▸ Quick, efficient transfer to hospitals equipped with cardiac catheterization teams. The majority of STEMI patients go to hospitals without on-site primary PCI capabilities, Dr. Jacobs said. Unfortunately, transfer delays are all too common. “Transfers are often a matter of the patient waiting for the next available ambulance. Under this system, patients transported to a non-PCI-capable hospital would remain on the stretcher with EMS personnel in attendance until the decision is made about whether to transport to a PCI-capable receiving hospital, which is always available and never on diversion, 24 hours a day, and 7 days a week.”

▸ Hospital incentives and certification. “We will be working with payers and policy makers to ensure that mechanisms are in place for appropriate reimbursement,” Dr. Jacobs said. This may eventually translate into one treatment fee that is split between the transporting, referring, and receiving organizations. A STEMI Center Certification program will establish treatment and accountability protocols for both referring and receiving hospitals.

Achieving these goals won't be quick or easy, said Dr. Raymond Gibbons, president of the American Heart Association. Stakeholders on every level—from patients in the community to local hospitals, legislators, insurance companies, and the federal government—will have to cooperate before Mission: Lifeline can become a reality.

The AHA will play a pivotal role in bringing these parties together, Dr. Gibbons said, beginning with an assessment of EMS effectiveness for STEMI patients. The AHA will use this information to construct a basic response system that can be tailored to different regions. The group will also convene meetings at the state and local levels to identify ways to implement the system, and to evaluate pilot programs.

Funding these systems, Dr. Gibbons said, will be largely left to localities. AHA will provide support in seeking the money necessary for implementation—industry grants, for example—but the group won't be contributing financially to any individual project.

“As an example, there may be a need to purchase the 12-lead equipment and train EMS staff,” Dr. Gibbons said. “The AHA can look for mechanisms to support that. In the past, we have placed automatic external defibrillators with first-responder units by advocating for state grants or donor support. We're confident that similar tactics can be employed with Mission: Lifeline.”

A few AHA-led pilot programs are already underway, Dr. Gibbons noted. A 2004 grant from The Annenberg Foundation made it possible for Los Angeles to create a response system that relies on 12-lead ECG readings by EMS providers. The AHA Greater Southeast Affiliate has convened a state-level STEMI task force and helped introduce a legislative bill to develop emergency angioplasty centers for STEMI patients. And in Texas, a task force met in January to discuss ways to more effectively manage STEMI patients.

Although establishing such a response system is an enormous challenge, the payoff is just as big, said Dr. Tim Henry, interventional cardiologist and director of research at the Minneapolis Heart Institute. Four years ago, the facility instituted a two-pronged standardized care system for STEMI patients based on their distance from a regional PCI-capable facility.

Outcomes have been very good, he said. “The in-hospital mortality for these patients is now 4%, even with 15% of them being older than 80 years. And close to 98% are getting appropriate adjunctive medication, which increases long-term survival. … It proves that you can indeed develop these regional systems that will improve outcomes.”

A community-based push to create standardized response systems could decrease mortality and streamline acute care for patients suffering an ST-elevation myocardial infarction.

The American Heart Association's ambitious “Mission: Lifeline” program will go far beyond past efforts at improving treatment times through public outreach and education, Dr. Alice Jacobs said during a press conference. “Regrettably, prior public awareness campaigns and community-based interventions have not yet been effective in reducing the time from symptom onset to first medical contact, or in increasing the number of patients who use emergency medical services [EMS] to get to hospitals where they can receive the appropriate care. We must have a system in place that will do this.”

The need for systematic reform, beginning with patient education and continuing through emergency response and hospital systems, is sadly obvious, she said. “Despite the proven benefits of quickly restoring blood flow to the heart muscle during a heart attack, 30% of STEMI patients do not receive any reperfusion therapy,” neither fibrinolytics nor primary percutaneous coronary intervention (PCI), said Dr. Jacobs, director of the cardiac catheterization lab at Boston Medical Center. “And only 50% of those who get fibrinolytics and 40% of those who undergo PCI do so within the recommended time frames.”

Last year, the AHA convened a conference to devise an organized method of addressing these issues. The group's recommendations are published in the journal Circulation (DOI:10.1161/CIRCULATIONAHA.107.184043).

The ideal system would combine several key elements, she said.

▸ Public education. “We must start with patient education,” Dr. Jacobs said. “People need to understand the signs and symptoms of a heart attack, and the importance of activating the EMS system as quickly as possible.” Half of STEMI patients drive themselves to the hospital or get a ride from family or friends, “resulting in a delay of the treatment that EMS could provide.

▸ Improving EMS diagnosis of STEMI. “In the ideal scenario, the cath lab would be activated by EMS from the field, or by the emergency physician from the hospital, and the patient would be brought directly to the cath lab without wasting time in the emergency room,” Dr. Jacobs said. “If EMS systems have the personnel, training, and appropriate resources, they can acquire, interpret, and transmit 12-lead electrocardiograms that can show the patient is having a STEMI heart attack.”

▸ Quick, efficient transfer to hospitals equipped with cardiac catheterization teams. The majority of STEMI patients go to hospitals without on-site primary PCI capabilities, Dr. Jacobs said. Unfortunately, transfer delays are all too common. “Transfers are often a matter of the patient waiting for the next available ambulance. Under this system, patients transported to a non-PCI-capable hospital would remain on the stretcher with EMS personnel in attendance until the decision is made about whether to transport to a PCI-capable receiving hospital, which is always available and never on diversion, 24 hours a day, and 7 days a week.”

▸ Hospital incentives and certification. “We will be working with payers and policy makers to ensure that mechanisms are in place for appropriate reimbursement,” Dr. Jacobs said. This may eventually translate into one treatment fee that is split between the transporting, referring, and receiving organizations. A STEMI Center Certification program will establish treatment and accountability protocols for both referring and receiving hospitals.

Achieving these goals won't be quick or easy, said Dr. Raymond Gibbons, president of the American Heart Association. Stakeholders on every level—from patients in the community to local hospitals, legislators, insurance companies, and the federal government—will have to cooperate before Mission: Lifeline can become a reality.

The AHA will play a pivotal role in bringing these parties together, Dr. Gibbons said, beginning with an assessment of EMS effectiveness for STEMI patients. The AHA will use this information to construct a basic response system that can be tailored to different regions. The group will also convene meetings at the state and local levels to identify ways to implement the system, and to evaluate pilot programs.

Funding these systems, Dr. Gibbons said, will be largely left to localities. AHA will provide support in seeking the money necessary for implementation—industry grants, for example—but the group won't be contributing financially to any individual project.

“As an example, there may be a need to purchase the 12-lead equipment and train EMS staff,” Dr. Gibbons said. “The AHA can look for mechanisms to support that. In the past, we have placed automatic external defibrillators with first-responder units by advocating for state grants or donor support. We're confident that similar tactics can be employed with Mission: Lifeline.”

A few AHA-led pilot programs are already underway, Dr. Gibbons noted. A 2004 grant from The Annenberg Foundation made it possible for Los Angeles to create a response system that relies on 12-lead ECG readings by EMS providers. The AHA Greater Southeast Affiliate has convened a state-level STEMI task force and helped introduce a legislative bill to develop emergency angioplasty centers for STEMI patients. And in Texas, a task force met in January to discuss ways to more effectively manage STEMI patients.

Although establishing such a response system is an enormous challenge, the payoff is just as big, said Dr. Tim Henry, interventional cardiologist and director of research at the Minneapolis Heart Institute. Four years ago, the facility instituted a two-pronged standardized care system for STEMI patients based on their distance from a regional PCI-capable facility.

Outcomes have been very good, he said. “The in-hospital mortality for these patients is now 4%, even with 15% of them being older than 80 years. And close to 98% are getting appropriate adjunctive medication, which increases long-term survival. … It proves that you can indeed develop these regional systems that will improve outcomes.”

A community-based push to create standardized response systems could decrease mortality and streamline acute care for patients suffering an ST-elevation myocandial infection.

The American Heart Association's ambitious “Mission: Lifeline” program will go far beyond past efforts at improving treatment times through public outreach and education, Dr. Alice Jacobs said at a press briefing. “Regrettably, prior public awareness campaigns and community-based interventions have not yet been effective in reducing the time from symptom onset to first medical contact, or in increasing the number of patients who use emergency medical services [EMS] to get to hospitals where they can receive the appropriate care. We must have a system in place that will do this.”

The need for systematic reform, beginning with patient education and continuing through emergency response and hospital systems, is sadly obvious, she said. “Despite the proven benefits of quickly restoring blood flow to the heart muscle during a heart attack, 30% of STEMI patients do not receive any reperfusion therapy,” neither fibrinolytics nor primary percutaneous coronary intervention (PCI), said Dr. Jacobs, director of the cardiac catheterization lab at Boston Medical Center. “And only 50% of those who get fibrinolytics and 40% of those who undergo PCI do so within the recommended time frames.”

Last year, the AHA convened a conference to devise an organized method of addressing these issues. The group's recommendations have been published in the journal Circulation (DOI:10.1161/CIRCULATIONAHA.107.184043).

The ideal system would combine several key elements, she said.

▸ Public education. “We must start with patient education,” Dr. Jacobs said. “People need to understand the signs and symptoms of a heart attack, and the importance of activating the EMS system as quickly as possible.” Half of STEMI patients drive themselves to the hospital or get a ride from family or friends, “resulting in a delay of the treatment that EMS could provide.

▸ Improving EMS diagnosis of STEMI. “In the ideal scenario, the cath lab would be activated by EMS from the field, or by the emergency physician from the hospital, and the patient would be brought directly to the cath lab without wasting time in the emergency room,” Dr. Jacobs said. “If EMS systems have the personnel, training, and appropriate resources, they can acquire, interpret, and transmit 12-lead electrocardiograms that can show the patient is having a STEMI heart attack.”

▸ Quick, efficient transfer to hospitals equipped with cardiac catheterization teams. The majority of STEMI patients go to hospitals without on-site primary PCI capabilities, Dr. Jacobs said. Unfortunately, transfer delays are all too common. “Transfers are often a matter of the patient waiting for the next available ambulance. Under this system, patients transported to a non-PCI-capable hospital would remain on the stretcher with EMS personnel in attendance until the decision is made about whether to transport to a PCI-capable receiving hospital, which is always available and never on diversion, 24 hours a day, and 7 days a week.”

▸ Hospital incentives and certification. “We will be working with payers and policy makers to ensure that mechanisms are in place for appropriate reimbursement,” Dr. Jacobs said. This may eventually translate into one treatment fee that is split between the transporting, referring, and receiving organizations. A STEMI Center Certification program will establish treatment and accountability protocols for both referring and receiving hospitals.

Achieving these goals won't be quick or easy, said Dr. Raymond Gibbons, president of the American Heart Association. Stakeholders on every level—from patients in the community to local hospitals, legislators, insurance companies, and the federal government—will have to cooperate before Mission: Lifeline can become a reality across the country.

The AHA will play a pivotal role in bringing these parties together, Dr. Gibbons said, beginning with an assessment of EMS effectiveness for STEMI patients. The AHA will use this information to construct a basic response system that can be tailored to different regions. The group will also convene meetings at the state and local levels to identify ways to implement the system, and to evaluate pilot programs.

Funding these systems, Dr. Gibbons said, will be largely left to localities. AHA will provide support in seeking the money necessary for implementation—industry grants, for example—but the group won't be contributing financially to any individual project.

“As an example, there may be a need to purchase the 12-lead equipment and train EMS staff,” Dr. Gibbons said. “The AHA can look for mechanisms to support that. In the past, we have placed automatic external defibrillators with first-responder units by advocating for state grants or donor support. We're confident that similar tactics can be employed with Mission: Lifeline.”

A few AHA-led pilot programs are already underway, Dr. Gibbons noted. A 2004 grant from The Annenberg Foundation made it possible for Los Angeles to create a response system that relies on 12-lead ECG readings by EMS providers. The AHA Greater Southeast Affiliate has convened a state-level STEMI task force and helped introduce a legislative bill to develop emergency angioplasty centers for STEMI patients. And in Texas, a task force met in January to discuss ways to more effectively manage STEMI patients.

Although establishing such a response system is an enormous challenge, the payoff is just as big, said Dr. Tim Henry, interventional cardiologist and director of research at the Minneapolis Heart Institute. Four years ago, the facility instituted a two-pronged standardized care system for STEMI patients based on their distance from a regional PCI-capable facility.

“Our approach involves different protocols for patients who live within either 60 miles [zone 1] or 60–210 miles [zone 2] from these hospitals. Our median time from the STEMI referral hospitals to balloon inflation at the receiving hospital is now 96 minutes for those in zone 1 and 118 minutes in zone 2.”

Outcomes have been very good, he said. “The in-hospital mortality for these patients is now 4%, even with 15% of them being older than 80 years. And close to 98% are getting appropriate adjunctive medication, which increases long-term survival. It's been exceptionally successful and proves that you can indeed develop these regional systems that will improve outcomes.”

A community-based push to create standardized response systems could decrease mortality and streamline acute care for patients suffering an ST-elevation myocandial infection.

The American Heart Association's ambitious “Mission: Lifeline” program will go far beyond past efforts at improving treatment times through public outreach and education, Dr. Alice Jacobs said at a press briefing. “Regrettably, prior public awareness campaigns and community-based interventions have not yet been effective in reducing the time from symptom onset to first medical contact, or in increasing the number of patients who use emergency medical services [EMS] to get to hospitals where they can receive the appropriate care. We must have a system in place that will do this.”

The need for systematic reform, beginning with patient education and continuing through emergency response and hospital systems, is sadly obvious, she said. “Despite the proven benefits of quickly restoring blood flow to the heart muscle during a heart attack, 30% of STEMI patients do not receive any reperfusion therapy,” neither fibrinolytics nor primary percutaneous coronary intervention (PCI), said Dr. Jacobs, director of the cardiac catheterization lab at Boston Medical Center. “And only 50% of those who get fibrinolytics and 40% of those who undergo PCI do so within the recommended time frames.”

Last year, the AHA convened a conference to devise an organized method of addressing these issues. The group's recommendations have been published in the journal Circulation (DOI:10.1161/CIRCULATIONAHA.107.184043).

The ideal system would combine several key elements, she said.

▸ Public education. “We must start with patient education,” Dr. Jacobs said. “People need to understand the signs and symptoms of a heart attack, and the importance of activating the EMS system as quickly as possible.” Half of STEMI patients drive themselves to the hospital or get a ride from family or friends, “resulting in a delay of the treatment that EMS could provide.

▸ Improving EMS diagnosis of STEMI. “In the ideal scenario, the cath lab would be activated by EMS from the field, or by the emergency physician from the hospital, and the patient would be brought directly to the cath lab without wasting time in the emergency room,” Dr. Jacobs said. “If EMS systems have the personnel, training, and appropriate resources, they can acquire, interpret, and transmit 12-lead electrocardiograms that can show the patient is having a STEMI heart attack.”

▸ Quick, efficient transfer to hospitals equipped with cardiac catheterization teams. The majority of STEMI patients go to hospitals without on-site primary PCI capabilities, Dr. Jacobs said. Unfortunately, transfer delays are all too common. “Transfers are often a matter of the patient waiting for the next available ambulance. Under this system, patients transported to a non-PCI-capable hospital would remain on the stretcher with EMS personnel in attendance until the decision is made about whether to transport to a PCI-capable receiving hospital, which is always available and never on diversion, 24 hours a day, and 7 days a week.”

▸ Hospital incentives and certification. “We will be working with payers and policy makers to ensure that mechanisms are in place for appropriate reimbursement,” Dr. Jacobs said. This may eventually translate into one treatment fee that is split between the transporting, referring, and receiving organizations. A STEMI Center Certification program will establish treatment and accountability protocols for both referring and receiving hospitals.

Achieving these goals won't be quick or easy, said Dr. Raymond Gibbons, president of the American Heart Association. Stakeholders on every level—from patients in the community to local hospitals, legislators, insurance companies, and the federal government—will have to cooperate before Mission: Lifeline can become a reality across the country.

The AHA will play a pivotal role in bringing these parties together, Dr. Gibbons said, beginning with an assessment of EMS effectiveness for STEMI patients. The AHA will use this information to construct a basic response system that can be tailored to different regions. The group will also convene meetings at the state and local levels to identify ways to implement the system, and to evaluate pilot programs.

Funding these systems, Dr. Gibbons said, will be largely left to localities. AHA will provide support in seeking the money necessary for implementation—industry grants, for example—but the group won't be contributing financially to any individual project.

“As an example, there may be a need to purchase the 12-lead equipment and train EMS staff,” Dr. Gibbons said. “The AHA can look for mechanisms to support that. In the past, we have placed automatic external defibrillators with first-responder units by advocating for state grants or donor support. We're confident that similar tactics can be employed with Mission: Lifeline.”

A few AHA-led pilot programs are already underway, Dr. Gibbons noted. A 2004 grant from The Annenberg Foundation made it possible for Los Angeles to create a response system that relies on 12-lead ECG readings by EMS providers. The AHA Greater Southeast Affiliate has convened a state-level STEMI task force and helped introduce a legislative bill to develop emergency angioplasty centers for STEMI patients. And in Texas, a task force met in January to discuss ways to more effectively manage STEMI patients.

Although establishing such a response system is an enormous challenge, the payoff is just as big, said Dr. Tim Henry, interventional cardiologist and director of research at the Minneapolis Heart Institute. Four years ago, the facility instituted a two-pronged standardized care system for STEMI patients based on their distance from a regional PCI-capable facility.

“Our approach involves different protocols for patients who live within either 60 miles [zone 1] or 60–210 miles [zone 2] from these hospitals. Our median time from the STEMI referral hospitals to balloon inflation at the receiving hospital is now 96 minutes for those in zone 1 and 118 minutes in zone 2.”

Outcomes have been very good, he said. “The in-hospital mortality for these patients is now 4%, even with 15% of them being older than 80 years. And close to 98% are getting appropriate adjunctive medication, which increases long-term survival. It's been exceptionally successful and proves that you can indeed develop these regional systems that will improve outcomes.”

A community-based push to create standardized response systems could decrease mortality and streamline acute care for patients suffering an ST-elevation myocandial infection.

The American Heart Association's ambitious “Mission: Lifeline” program will go far beyond past efforts at improving treatment times through public outreach and education, Dr. Alice Jacobs said at a press briefing. “Regrettably, prior public awareness campaigns and community-based interventions have not yet been effective in reducing the time from symptom onset to first medical contact, or in increasing the number of patients who use emergency medical services [EMS] to get to hospitals where they can receive the appropriate care. We must have a system in place that will do this.”

The need for systematic reform, beginning with patient education and continuing through emergency response and hospital systems, is sadly obvious, she said. “Despite the proven benefits of quickly restoring blood flow to the heart muscle during a heart attack, 30% of STEMI patients do not receive any reperfusion therapy,” neither fibrinolytics nor primary percutaneous coronary intervention (PCI), said Dr. Jacobs, director of the cardiac catheterization lab at Boston Medical Center. “And only 50% of those who get fibrinolytics and 40% of those who undergo PCI do so within the recommended time frames.”

Last year, the AHA convened a conference to devise an organized method of addressing these issues. The group's recommendations have been published in the journal Circulation (DOI:10.1161/CIRCULATIONAHA.107.184043).

The ideal system would combine several key elements, she said.

▸ Public education. “We must start with patient education,” Dr. Jacobs said. “People need to understand the signs and symptoms of a heart attack, and the importance of activating the EMS system as quickly as possible.” Half of STEMI patients drive themselves to the hospital or get a ride from family or friends, “resulting in a delay of the treatment that EMS could provide.

▸ Improving EMS diagnosis of STEMI. “In the ideal scenario, the cath lab would be activated by EMS from the field, or by the emergency physician from the hospital, and the patient would be brought directly to the cath lab without wasting time in the emergency room,” Dr. Jacobs said. “If EMS systems have the personnel, training, and appropriate resources, they can acquire, interpret, and transmit 12-lead electrocardiograms that can show the patient is having a STEMI heart attack.”

▸ Quick, efficient transfer to hospitals equipped with cardiac catheterization teams. The majority of STEMI patients go to hospitals without on-site primary PCI capabilities, Dr. Jacobs said. Unfortunately, transfer delays are all too common. “Transfers are often a matter of the patient waiting for the next available ambulance. Under this system, patients transported to a non-PCI-capable hospital would remain on the stretcher with EMS personnel in attendance until the decision is made about whether to transport to a PCI-capable receiving hospital, which is always available and never on diversion, 24 hours a day, and 7 days a week.”

▸ Hospital incentives and certification. “We will be working with payers and policy makers to ensure that mechanisms are in place for appropriate reimbursement,” Dr. Jacobs said. This may eventually translate into one treatment fee that is split between the transporting, referring, and receiving organizations. A STEMI Center Certification program will establish treatment and accountability protocols for both referring and receiving hospitals.

Achieving these goals won't be quick or easy, said Dr. Raymond Gibbons, president of the American Heart Association. Stakeholders on every level—from patients in the community to local hospitals, legislators, insurance companies, and the federal government—will have to cooperate before Mission: Lifeline can become a reality across the country.

The AHA will play a pivotal role in bringing these parties together, Dr. Gibbons said, beginning with an assessment of EMS effectiveness for STEMI patients. The AHA will use this information to construct a basic response system that can be tailored to different regions. The group will also convene meetings at the state and local levels to identify ways to implement the system, and to evaluate pilot programs.

Funding these systems, Dr. Gibbons said, will be largely left to localities. AHA will provide support in seeking the money necessary for implementation—industry grants, for example—but the group won't be contributing financially to any individual project.

“As an example, there may be a need to purchase the 12-lead equipment and train EMS staff,” Dr. Gibbons said. “The AHA can look for mechanisms to support that. In the past, we have placed automatic external defibrillators with first-responder units by advocating for state grants or donor support. We're confident that similar tactics can be employed with Mission: Lifeline.”

A few AHA-led pilot programs are already underway, Dr. Gibbons noted. A 2004 grant from The Annenberg Foundation made it possible for Los Angeles to create a response system that relies on 12-lead ECG readings by EMS providers. The AHA Greater Southeast Affiliate has convened a state-level STEMI task force and helped introduce a legislative bill to develop emergency angioplasty centers for STEMI patients. And in Texas, a task force met in January to discuss ways to more effectively manage STEMI patients.

Although establishing such a response system is an enormous challenge, the payoff is just as big, said Dr. Tim Henry, interventional cardiologist and director of research at the Minneapolis Heart Institute. Four years ago, the facility instituted a two-pronged standardized care system for STEMI patients based on their distance from a regional PCI-capable facility.

“Our approach involves different protocols for patients who live within either 60 miles [zone 1] or 60–210 miles [zone 2] from these hospitals. Our median time from the STEMI referral hospitals to balloon inflation at the receiving hospital is now 96 minutes for those in zone 1 and 118 minutes in zone 2.”

Outcomes have been very good, he said. “The in-hospital mortality for these patients is now 4%, even with 15% of them being older than 80 years. And close to 98% are getting appropriate adjunctive medication, which increases long-term survival. It's been exceptionally successful and proves that you can indeed develop these regional systems that will improve outcomes.”

Alzheimer's disease advocates and federal officials are calling for measures to combat what is being called a “looming avalanche” of Alzheimer's disease in the United States.

Alzheimer's disease prevalence in this country is projected to skyrocket in the next 40 years, from 4.5 million to more than 13 million. The national health infrastructure is not equipped for this, said Robert Egge of the Center for Health Transformation.

“Because of our national strategy—or rather the lack of it—we are not on the right footing to get a handle on this before it hits,” Mr. Egge commented in an interview.

The Center for Health Transformation, a health policy think tank founded by former Speaker of the House Newt Gingrich, advocates a national AD strategic plan that would tackle the impending epidemic just as national policy spearheaded the response to HIV/AIDS and the possibility of an avian flu epidemic. That kind of bold commitment is precisely what's long overdue for AD,” said Mr. Egge, director of the center's Alzheimer's disease project.

Such a plan would address two facets of the problem: money and leadership, Mr. Egge said. “We simply don't have anyone at the executive level focused on [AD], and without that, it's hard to imagine how we can get an overall organized approach. Secondly, we need to examine the amount of money we're spending now on treating the disease, compared [with] what we are investing to overcome it.”

The numbers are distressing, he and Mr. Gingrich wrote in a recent commentary. AD is the third most expensive medical condition in the U.S., costing $100 billion annually in Medicare and Medicaid dollars. “Without medical breakthroughs, as the Boomers pass through their elder years, federal spending on AD care will increase to more than $1 trillion per year by 2050, in today's dollars. That is more than 10% of America's current gross domestic product,” they wrote (Alzheimers Dement. 2007;3:239–42).

A national AD strategy would build the case for making substantial national investments in research for both early detection and pharmacotherapy, and urge the Food and Drug Administration to accelerate new drug evaluation, Mr. Gingrich and Mr. Egge wrote. A strategic plan also should help caregivers, perhaps by providing some kind of financial support to those who save Medicare money by keeping a patient at home as long as possible.

The Alzheimer's Association has joined the Center for Health Transformation in taking the first steps toward building a national plan. In mid-July, the two entities announced the formation of a study group cochaired by Mr. Gingrich and former Sen. Bob Kerrey (D-Neb.). The group will consist of nonpartisan, independent health policy experts and is charged with evaluating the nation's efforts to combat the disease and recommend strategies for addressing shortcomings.

The Center for Health Transformation is not the only one nipping at government heels over the Alzheimer's epidemic. Sen. Barbara Mikulski (D-Md.) has introduced two bills to address several of the same issues: shoring up research dollars and assisting families.

The Alzheimer's Breakthrough Act of 2007 (S. 898) would double National Institutes of Health funding for AD research to $1.3 billion in 2008; the Alzheimer's Family Assistance Act (S. 897) would provide a $3,000 annual tax credit for families caring for a member with a chronic condition like AD, and includes a long-term care tax deduction as well. Both bills have a House companion and have been referred to committee.

Sen. Mikulski also has held three hearings on the issue. Dr. Samuel Gandy, chairman of the Alzheimer's Association Medical and Scientific Advisory Council, was among the experts who testified.

With a number of promising drug therapies on the horizon, it's more important than ever to push for increased research money, Dr. Gandy told the committee. “Within the next 3 years, it is all but certain that we will have disease-modifying drugs that will fundamentally change the nature of Alzheimer's. For millions of Americans, a diagnosis will no longer be a death sentence, but [rather be] the beginning of a manageable chronic illness.”

The promises of research are a direct result of federal funding support, he said. But NIH funding for Alzheimer's research has declined every year since 2003, and the proposed fiscal year 2008 federal budget contains yet another cut.

Doubling federal research dollars would improve this situation, said Jennifer Zeitzer, associate director of federal policy for the Alzheimer's Association. “It's a very significant request, but that's what the scientific community believes needs to be done to bring these new drugs to market,” she said in an interview. “This would really speed up the time to when prevention becomes a reality, and to when we can detect and treat symptoms before they become disabling.”

Stephen McConnell, the association's vice president for Advocacy and Public Policy, believes the new bills have a chance this time, especially with growing concern about Medicare dollars. “Elected officials are looking at ways to keep Medicare solvent as the Baby Boomers age,” he said in an interview. “Addressing AD is one way to help that cause.”

The disease is also grabbing a lot of headlines—and politicians view those as a meter of public interest. “Elected officials are tuned into that, especially in an election cycle.”

Alzheimer's disease advocates and federal officials are calling for measures to combat what is being called a “looming avalanche” of Alzheimer's disease in the United States.

Alzheimer's disease prevalence in this country is projected to skyrocket in the next 40 years, from 4.5 million to more than 13 million. The national health infrastructure is not equipped for this, said Robert Egge of the Center for Health Transformation.

“Because of our national strategy—or rather the lack of it—we are not on the right footing to get a handle on this before it hits,” Mr. Egge commented in an interview.

The Center for Health Transformation, a health policy think tank founded by former Speaker of the House Newt Gingrich, advocates a national AD strategic plan that would tackle the impending epidemic just as national policy spearheaded the response to HIV/AIDS and the possibility of an avian flu epidemic. That kind of bold commitment is precisely what's long overdue for AD,” said Mr. Egge, director of the center's Alzheimer's disease project.

Such a plan would address two facets of the problem: money and leadership, Mr. Egge said. “We simply don't have anyone at the executive level focused on [AD], and without that, it's hard to imagine how we can get an overall organized approach. Secondly, we need to examine the amount of money we're spending now on treating the disease, compared [with] what we are investing to overcome it.”

The numbers are distressing, he and Mr. Gingrich wrote in a recent commentary. AD is the third most expensive medical condition in the U.S., costing $100 billion annually in Medicare and Medicaid dollars. “Without medical breakthroughs, as the Boomers pass through their elder years, federal spending on AD care will increase to more than $1 trillion per year by 2050, in today's dollars. That is more than 10% of America's current gross domestic product,” they wrote (Alzheimers Dement. 2007;3:239–42).

A national AD strategy would build the case for making substantial national investments in research for both early detection and pharmacotherapy, and urge the Food and Drug Administration to accelerate new drug evaluation, Mr. Gingrich and Mr. Egge wrote. A strategic plan also should help caregivers, perhaps by providing some kind of financial support to those who save Medicare money by keeping a patient at home as long as possible.

The Alzheimer's Association has joined the Center for Health Transformation in taking the first steps toward building a national plan. In mid-July, the two entities announced the formation of a study group cochaired by Mr. Gingrich and former Sen. Bob Kerrey (D-Neb.). The group will consist of nonpartisan, independent health policy experts and is charged with evaluating the nation's efforts to combat the disease and recommend strategies for addressing shortcomings.

The Center for Health Transformation is not the only one nipping at government heels over the Alzheimer's epidemic. Sen. Barbara Mikulski (D-Md.) has introduced two bills to address several of the same issues: shoring up research dollars and assisting families.

The Alzheimer's Breakthrough Act of 2007 (S. 898) would double National Institutes of Health funding for AD research to $1.3 billion in 2008; the Alzheimer's Family Assistance Act (S. 897) would provide a $3,000 annual tax credit for families caring for a member with a chronic condition like AD, and includes a long-term care tax deduction as well. Both bills have a House companion and have been referred to committee.

Sen. Mikulski also has held three hearings on the issue. Dr. Samuel Gandy, chairman of the Alzheimer's Association Medical and Scientific Advisory Council, was among the experts who testified.

With a number of promising drug therapies on the horizon, it's more important than ever to push for increased research money, Dr. Gandy told the committee. “Within the next 3 years, it is all but certain that we will have disease-modifying drugs that will fundamentally change the nature of Alzheimer's. For millions of Americans, a diagnosis will no longer be a death sentence, but [rather be] the beginning of a manageable chronic illness.”

The promises of research are a direct result of federal funding support, he said. But NIH funding for Alzheimer's research has declined every year since 2003, and the proposed fiscal year 2008 federal budget contains yet another cut.

Doubling federal research dollars would improve this situation, said Jennifer Zeitzer, associate director of federal policy for the Alzheimer's Association. “It's a very significant request, but that's what the scientific community believes needs to be done to bring these new drugs to market,” she said in an interview. “This would really speed up the time to when prevention becomes a reality, and to when we can detect and treat symptoms before they become disabling.”

Stephen McConnell, the association's vice president for Advocacy and Public Policy, believes the new bills have a chance this time, especially with growing concern about Medicare dollars. “Elected officials are looking at ways to keep Medicare solvent as the Baby Boomers age,” he said in an interview. “Addressing AD is one way to help that cause.”

The disease is also grabbing a lot of headlines—and politicians view those as a meter of public interest. “Elected officials are tuned into that, especially in an election cycle.”

Alzheimer's disease advocates and federal officials are calling for measures to combat what is being called a “looming avalanche” of Alzheimer's disease in the United States.

Alzheimer's disease prevalence in this country is projected to skyrocket in the next 40 years, from 4.5 million to more than 13 million. The national health infrastructure is not equipped for this, said Robert Egge of the Center for Health Transformation.

“Because of our national strategy—or rather the lack of it—we are not on the right footing to get a handle on this before it hits,” Mr. Egge commented in an interview.

The Center for Health Transformation, a health policy think tank founded by former Speaker of the House Newt Gingrich, advocates a national AD strategic plan that would tackle the impending epidemic just as national policy spearheaded the response to HIV/AIDS and the possibility of an avian flu epidemic. That kind of bold commitment is precisely what's long overdue for AD,” said Mr. Egge, director of the center's Alzheimer's disease project.

Such a plan would address two facets of the problem: money and leadership, Mr. Egge said. “We simply don't have anyone at the executive level focused on [AD], and without that, it's hard to imagine how we can get an overall organized approach. Secondly, we need to examine the amount of money we're spending now on treating the disease, compared [with] what we are investing to overcome it.”

The numbers are distressing, he and Mr. Gingrich wrote in a recent commentary. AD is the third most expensive medical condition in the U.S., costing $100 billion annually in Medicare and Medicaid dollars. “Without medical breakthroughs, as the Boomers pass through their elder years, federal spending on AD care will increase to more than $1 trillion per year by 2050, in today's dollars. That is more than 10% of America's current gross domestic product,” they wrote (Alzheimers Dement. 2007;3:239–42).

A national AD strategy would build the case for making substantial national investments in research for both early detection and pharmacotherapy, and urge the Food and Drug Administration to accelerate new drug evaluation, Mr. Gingrich and Mr. Egge wrote. A strategic plan also should help caregivers, perhaps by providing some kind of financial support to those who save Medicare money by keeping a patient at home as long as possible.

The Alzheimer's Association has joined the Center for Health Transformation in taking the first steps toward building a national plan. In mid-July, the two entities announced the formation of a study group cochaired by Mr. Gingrich and former Sen. Bob Kerrey (D-Neb.). The group will consist of nonpartisan, independent health policy experts and is charged with evaluating the nation's efforts to combat the disease and recommend strategies for addressing shortcomings.

The Center for Health Transformation is not the only one nipping at government heels over the Alzheimer's epidemic. Sen. Barbara Mikulski (D-Md.) has introduced two bills to address several of the same issues: shoring up research dollars and assisting families.

The Alzheimer's Breakthrough Act of 2007 (S. 898) would double National Institutes of Health funding for AD research to $1.3 billion in 2008; the Alzheimer's Family Assistance Act (S. 897) would provide a $3,000 annual tax credit for families caring for a member with a chronic condition like AD, and includes a long-term care tax deduction as well. Both bills have a House companion and have been referred to committee.

Sen. Mikulski also has held three hearings on the issue. Dr. Samuel Gandy, chairman of the Alzheimer's Association Medical and Scientific Advisory Council, was among the experts who testified.

With a number of promising drug therapies on the horizon, it's more important than ever to push for increased research money, Dr. Gandy told the committee. “Within the next 3 years, it is all but certain that we will have disease-modifying drugs that will fundamentally change the nature of Alzheimer's. For millions of Americans, a diagnosis will no longer be a death sentence, but [rather be] the beginning of a manageable chronic illness.”

The promises of research are a direct result of federal funding support, he said. But NIH funding for Alzheimer's research has declined every year since 2003, and the proposed fiscal year 2008 federal budget contains yet another cut.

Doubling federal research dollars would improve this situation, said Jennifer Zeitzer, associate director of federal policy for the Alzheimer's Association. “It's a very significant request, but that's what the scientific community believes needs to be done to bring these new drugs to market,” she said in an interview. “This would really speed up the time to when prevention becomes a reality, and to when we can detect and treat symptoms before they become disabling.”

Stephen McConnell, the association's vice president for Advocacy and Public Policy, believes the new bills have a chance this time, especially with growing concern about Medicare dollars. “Elected officials are looking at ways to keep Medicare solvent as the Baby Boomers age,” he said in an interview. “Addressing AD is one way to help that cause.”

The disease is also grabbing a lot of headlines—and politicians view those as a meter of public interest. “Elected officials are tuned into that, especially in an election cycle.”

The placebo effect appears to account for most of the improvements associated with acupuncture for osteoarthritis of the knee, according to an analysis of nine trials.

But Eric Manheimer of the Center for Integrative Medicine at University of Maryland, Baltimore, and his associates also appeared to identify at least a small biologic effect of the procedure, since patients who received genuine acupuncture in sham-controlled trials experienced some short-term improvements in both pain and function.

Still, Mr. Manheimer, field administrator in the complementary medicine program concluded, “It is too soon to recommend acupuncture as a routine part of care for patients with osteoarthritis.”

The analysis included 11 randomized controlled trials conducted from 1999 to 2003 and comprised more than 1,000 patients with knee osteoarthritis. Four studies compared acupuncture with wait list. The other seven studies included a sham treatment. Nine of the 11 studies included enough outcomes data to be included in the pooled analysis (Ann. Intern. Med. 2007;146:868–77).

Acupuncture, as compared with the sham control, provided some improvements in pain and function, both in the short term and at 6 months, but these were deemed clinically irrelevant.

Compared with wait-listed patients, those who received acupuncture reported clinically relevant improvements in pain and function, which were sustained at 6 months.

The sham-controlled trials all used different sham procedures, including a combination of penetrating and nonpenetrating needles; needles inserted away from acupuncture points; and patch electrodes delivering current.

This made it difficult to decipher the treatment response, since it was impossible to tell how many patients receiving the various sham treatments truly believed they could be getting real acupuncture. Additionally, two sham protocols involving the use of penetrating needles placed away from acupuncture points were judged possibly to have exerted some biologically active effect.

The observation of any improvement, however clinically irrelevant, suggested that acupuncture might be a biologically active procedure, according to the authors. They cautioned, however, that the placebo response probably plays a large role. “The fact that both the acupuncture and sham groups reported greater improvements than [did] those of the usual care control groups suggests that acupuncture may elicit a greater placebo effect … than usual care therapies.”

The study may have been limited by the possibility that wait-listed patients were given inaccurate assessments of their actual response to care.

“Patient expectations that acupuncture will work may also affect those on a waiting list. By having to wait for a treatment that they believe is effective, patients waiting for acupuncture may have been disappointed by the delay, which may influence their ratings of subjective outcomes while waiting.”

Several large controlled trials are still ongoing, and at least one additional trial has been completed but remains unpublished. The results of these studies may further elucidate what role, if any, acupuncture may have in the treatment of knee osteoarthritis, the researchers noted.

In Western medicine, it is believed that the needles stimulate endorphins. ©MarkThomas/Science Photo Library

The placebo effect appears to account for most of the improvements associated with acupuncture for osteoarthritis of the knee, according to an analysis of nine trials.

But Eric Manheimer of the Center for Integrative Medicine at University of Maryland, Baltimore, and his associates also appeared to identify at least a small biologic effect of the procedure, since patients who received genuine acupuncture in sham-controlled trials experienced some short-term improvements in both pain and function.

Still, Mr. Manheimer, field administrator in the complementary medicine program concluded, “It is too soon to recommend acupuncture as a routine part of care for patients with osteoarthritis.”

The analysis included 11 randomized controlled trials conducted from 1999 to 2003 and comprised more than 1,000 patients with knee osteoarthritis. Four studies compared acupuncture with wait list. The other seven studies included a sham treatment. Nine of the 11 studies included enough outcomes data to be included in the pooled analysis (Ann. Intern. Med. 2007;146:868–77).

Acupuncture, as compared with the sham control, provided some improvements in pain and function, both in the short term and at 6 months, but these were deemed clinically irrelevant.

Compared with wait-listed patients, those who received acupuncture reported clinically relevant improvements in pain and function, which were sustained at 6 months.

The sham-controlled trials all used different sham procedures, including a combination of penetrating and nonpenetrating needles; needles inserted away from acupuncture points; and patch electrodes delivering current.

This made it difficult to decipher the treatment response, since it was impossible to tell how many patients receiving the various sham treatments truly believed they could be getting real acupuncture. Additionally, two sham protocols involving the use of penetrating needles placed away from acupuncture points were judged possibly to have exerted some biologically active effect.

The observation of any improvement, however clinically irrelevant, suggested that acupuncture might be a biologically active procedure, according to the authors. They cautioned, however, that the placebo response probably plays a large role. “The fact that both the acupuncture and sham groups reported greater improvements than [did] those of the usual care control groups suggests that acupuncture may elicit a greater placebo effect … than usual care therapies.”

The study may have been limited by the possibility that wait-listed patients were given inaccurate assessments of their actual response to care.

“Patient expectations that acupuncture will work may also affect those on a waiting list. By having to wait for a treatment that they believe is effective, patients waiting for acupuncture may have been disappointed by the delay, which may influence their ratings of subjective outcomes while waiting.”

Several large controlled trials are still ongoing, and at least one additional trial has been completed but remains unpublished. The results of these studies may further elucidate what role, if any, acupuncture may have in the treatment of knee osteoarthritis, the researchers noted.

In Western medicine, it is believed that the needles stimulate endorphins. ©MarkThomas/Science Photo Library

The placebo effect appears to account for most of the improvements associated with acupuncture for osteoarthritis of the knee, according to an analysis of nine trials.

But Eric Manheimer of the Center for Integrative Medicine at University of Maryland, Baltimore, and his associates also appeared to identify at least a small biologic effect of the procedure, since patients who received genuine acupuncture in sham-controlled trials experienced some short-term improvements in both pain and function.

Still, Mr. Manheimer, field administrator in the complementary medicine program concluded, “It is too soon to recommend acupuncture as a routine part of care for patients with osteoarthritis.”

The analysis included 11 randomized controlled trials conducted from 1999 to 2003 and comprised more than 1,000 patients with knee osteoarthritis. Four studies compared acupuncture with wait list. The other seven studies included a sham treatment. Nine of the 11 studies included enough outcomes data to be included in the pooled analysis (Ann. Intern. Med. 2007;146:868–77).

Acupuncture, as compared with the sham control, provided some improvements in pain and function, both in the short term and at 6 months, but these were deemed clinically irrelevant.

Compared with wait-listed patients, those who received acupuncture reported clinically relevant improvements in pain and function, which were sustained at 6 months.

The sham-controlled trials all used different sham procedures, including a combination of penetrating and nonpenetrating needles; needles inserted away from acupuncture points; and patch electrodes delivering current.

This made it difficult to decipher the treatment response, since it was impossible to tell how many patients receiving the various sham treatments truly believed they could be getting real acupuncture. Additionally, two sham protocols involving the use of penetrating needles placed away from acupuncture points were judged possibly to have exerted some biologically active effect.

The observation of any improvement, however clinically irrelevant, suggested that acupuncture might be a biologically active procedure, according to the authors. They cautioned, however, that the placebo response probably plays a large role. “The fact that both the acupuncture and sham groups reported greater improvements than [did] those of the usual care control groups suggests that acupuncture may elicit a greater placebo effect … than usual care therapies.”

The study may have been limited by the possibility that wait-listed patients were given inaccurate assessments of their actual response to care.

“Patient expectations that acupuncture will work may also affect those on a waiting list. By having to wait for a treatment that they believe is effective, patients waiting for acupuncture may have been disappointed by the delay, which may influence their ratings of subjective outcomes while waiting.”

Several large controlled trials are still ongoing, and at least one additional trial has been completed but remains unpublished. The results of these studies may further elucidate what role, if any, acupuncture may have in the treatment of knee osteoarthritis, the researchers noted.

In Western medicine, it is believed that the needles stimulate endorphins. ©MarkThomas/Science Photo Library

BOSTON — The risk of an early ischemic stroke following a transient ischemic attack is significantly higher in patients who are discharged from the emergency department than in those who are admitted to the hospital for a TIA evaluation.

Neurologist consultation may be a key factor in the protective effect of hospitalization, Dr. Sharon Poisson said at the annual meeting of the American Academy of Neurology. “In the emergency room, only 1% of the discharged group and 4% of the admitted group received a neurologist consultation. But an additional 50% of those who were admitted did see a neurologist during that admission.”

Dr. Poisson of the University of Michigan, Ann Arbor, presented a subanalysis of the Brain Attack Surveillance in Corpus Christi (BASIC) study. The prospective, population-based study tracks strokes and transient ischemic attacks occurring in the coastal Texas city. Dr. Poisson's data were collected from 2000 to 2005 and included 552 first-time probable or possible TIAs. Of these, 31% (171) were discharged from the emergency department and 69% (381) were admitted to the hospital. The average patient age was 71 years; 42% were male.

Stroke occurrence at 3 and 7 days in those discharged from the ED was 4.7% and 5.9%, compared with 0.26% and 0.53% in those admitted. By 30 days, 19 ischemic strokes had occurred in 7% of those discharged and 2% of those admitted–a statistically significant difference.

Over the next 2 years, more ischemic strokes occurred at every time point in those discharged, compared with those admitted, but the differences were not significant.

The association between admission and lower stroke risk persisted even after adjustment for age, gender, ethnicity, hypertension, diabetes, atrial fibrillation, hyperlipidemia, smoking, and coronary artery disease, Dr. Poisson said.

BOSTON — The risk of an early ischemic stroke following a transient ischemic attack is significantly higher in patients who are discharged from the emergency department than in those who are admitted to the hospital for a TIA evaluation.

Neurologist consultation may be a key factor in the protective effect of hospitalization, Dr. Sharon Poisson said at the annual meeting of the American Academy of Neurology. “In the emergency room, only 1% of the discharged group and 4% of the admitted group received a neurologist consultation. But an additional 50% of those who were admitted did see a neurologist during that admission.”

Dr. Poisson of the University of Michigan, Ann Arbor, presented a subanalysis of the Brain Attack Surveillance in Corpus Christi (BASIC) study. The prospective, population-based study tracks strokes and transient ischemic attacks occurring in the coastal Texas city. Dr. Poisson's data were collected from 2000 to 2005 and included 552 first-time probable or possible TIAs. Of these, 31% (171) were discharged from the emergency department and 69% (381) were admitted to the hospital. The average patient age was 71 years; 42% were male.

Stroke occurrence at 3 and 7 days in those discharged from the ED was 4.7% and 5.9%, compared with 0.26% and 0.53% in those admitted. By 30 days, 19 ischemic strokes had occurred in 7% of those discharged and 2% of those admitted–a statistically significant difference.

Over the next 2 years, more ischemic strokes occurred at every time point in those discharged, compared with those admitted, but the differences were not significant.

The association between admission and lower stroke risk persisted even after adjustment for age, gender, ethnicity, hypertension, diabetes, atrial fibrillation, hyperlipidemia, smoking, and coronary artery disease, Dr. Poisson said.

BOSTON — The risk of an early ischemic stroke following a transient ischemic attack is significantly higher in patients who are discharged from the emergency department than in those who are admitted to the hospital for a TIA evaluation.

Neurologist consultation may be a key factor in the protective effect of hospitalization, Dr. Sharon Poisson said at the annual meeting of the American Academy of Neurology. “In the emergency room, only 1% of the discharged group and 4% of the admitted group received a neurologist consultation. But an additional 50% of those who were admitted did see a neurologist during that admission.”

Dr. Poisson of the University of Michigan, Ann Arbor, presented a subanalysis of the Brain Attack Surveillance in Corpus Christi (BASIC) study. The prospective, population-based study tracks strokes and transient ischemic attacks occurring in the coastal Texas city. Dr. Poisson's data were collected from 2000 to 2005 and included 552 first-time probable or possible TIAs. Of these, 31% (171) were discharged from the emergency department and 69% (381) were admitted to the hospital. The average patient age was 71 years; 42% were male.

Stroke occurrence at 3 and 7 days in those discharged from the ED was 4.7% and 5.9%, compared with 0.26% and 0.53% in those admitted. By 30 days, 19 ischemic strokes had occurred in 7% of those discharged and 2% of those admitted–a statistically significant difference.

Over the next 2 years, more ischemic strokes occurred at every time point in those discharged, compared with those admitted, but the differences were not significant.

The association between admission and lower stroke risk persisted even after adjustment for age, gender, ethnicity, hypertension, diabetes, atrial fibrillation, hyperlipidemia, smoking, and coronary artery disease, Dr. Poisson said.

WASHINGTON — Women are half as likely as men to receive tissue plasminogen activator when they present to a hospital with acute stroke, Matthew Reeves, Ph.D., said at a conference sponsored by the American Heart Association.

The difference remained constant even when considering only those who arrived within 2 hours of symptom onset and had no contraindications, said Dr. Reeves of Michigan State University, East Lansing.

“There was definitely a robust gender difference that was difficult to explain away,” he said. The disparity in TPA therapy may be one factor that contributes to the gender differences in stroke outcome, he theorized. “Women are less likely to be discharged home and less likely to have good functional outcomes after a stroke. The medical therapy provided in the hospital may be one reason behind these differences.”

Dr. Reeves reviewed the charts of 2,566 patients who presented at 15 Michigan hospitals during a 6-month period in 2002. There were some significant differences at baseline, he said. Women were on average 3 years older than men (70 vs. 67 years), and more were older than 80 at the time of their stroke (33% vs. 20% of men). Additionally, women were significantly less likely to have a history of prior heart disease and dyslipidemia, less likely to be smokers or to have been ambulatory before the stroke, and more likely to have a history of heart failure and hypertension.

For most in-hospital treatments, there were no significant gender disparities, Dr. Reeves said. Women had slightly less cardiac monitoring, angiography, echocardiography, and cerebrovascular investigation, but those differences dissipated after adjusting for age and other confounders.

“The most striking difference we found was that among ischemic stroke patients, women were half as likely as men to get TPA,” he said (2.2% vs. 4.4%). “We even subanalyzed the group that arrived within the 2-hour treatment window and had no contraindications to the therapy, and although the treatment numbers went way up, to 18% for women and 28% for men, the difference between them remained significant.”

He also found a significant difference in lipid testing (42% vs. 51%). But it was interesting that there was no difference in the percent of patients who received lipid-lowering drugs at discharge, he said.

Nor were there many significant differences in in-hospital outcomes, he said. Women had slightly higher unadjusted mortality rates (9.3% vs. 8.5%), but the difference disappeared after adjusting for age. Women did have a marginally significant higher risk of worse function outcome at discharge–17%. There were no significant adjusted differences in deep vein thromboses, pulmonary embolism, or pneumonia.

The only significant outcome difference Dr. Reeves discovered was in urinary tract infection: There were more in women than in men (11% vs. 4%; OR 2.6).

There were no differences in use of warfarin, antithrombotics, or DVT prophylaxis, he added.

WASHINGTON — Women are half as likely as men to receive tissue plasminogen activator when they present to a hospital with acute stroke, Matthew Reeves, Ph.D., said at a conference sponsored by the American Heart Association.

The difference remained constant even when considering only those who arrived within 2 hours of symptom onset and had no contraindications, said Dr. Reeves of Michigan State University, East Lansing.

“There was definitely a robust gender difference that was difficult to explain away,” he said. The disparity in TPA therapy may be one factor that contributes to the gender differences in stroke outcome, he theorized. “Women are less likely to be discharged home and less likely to have good functional outcomes after a stroke. The medical therapy provided in the hospital may be one reason behind these differences.”

Dr. Reeves reviewed the charts of 2,566 patients who presented at 15 Michigan hospitals during a 6-month period in 2002. There were some significant differences at baseline, he said. Women were on average 3 years older than men (70 vs. 67 years), and more were older than 80 at the time of their stroke (33% vs. 20% of men). Additionally, women were significantly less likely to have a history of prior heart disease and dyslipidemia, less likely to be smokers or to have been ambulatory before the stroke, and more likely to have a history of heart failure and hypertension.

For most in-hospital treatments, there were no significant gender disparities, Dr. Reeves said. Women had slightly less cardiac monitoring, angiography, echocardiography, and cerebrovascular investigation, but those differences dissipated after adjusting for age and other confounders.

“The most striking difference we found was that among ischemic stroke patients, women were half as likely as men to get TPA,” he said (2.2% vs. 4.4%). “We even subanalyzed the group that arrived within the 2-hour treatment window and had no contraindications to the therapy, and although the treatment numbers went way up, to 18% for women and 28% for men, the difference between them remained significant.”

He also found a significant difference in lipid testing (42% vs. 51%). But it was interesting that there was no difference in the percent of patients who received lipid-lowering drugs at discharge, he said.

Nor were there many significant differences in in-hospital outcomes, he said. Women had slightly higher unadjusted mortality rates (9.3% vs. 8.5%), but the difference disappeared after adjusting for age. Women did have a marginally significant higher risk of worse function outcome at discharge–17%. There were no significant adjusted differences in deep vein thromboses, pulmonary embolism, or pneumonia.

The only significant outcome difference Dr. Reeves discovered was in urinary tract infection: There were more in women than in men (11% vs. 4%; OR 2.6).

There were no differences in use of warfarin, antithrombotics, or DVT prophylaxis, he added.

WASHINGTON — Women are half as likely as men to receive tissue plasminogen activator when they present to a hospital with acute stroke, Matthew Reeves, Ph.D., said at a conference sponsored by the American Heart Association.

The difference remained constant even when considering only those who arrived within 2 hours of symptom onset and had no contraindications, said Dr. Reeves of Michigan State University, East Lansing.

“There was definitely a robust gender difference that was difficult to explain away,” he said. The disparity in TPA therapy may be one factor that contributes to the gender differences in stroke outcome, he theorized. “Women are less likely to be discharged home and less likely to have good functional outcomes after a stroke. The medical therapy provided in the hospital may be one reason behind these differences.”

Dr. Reeves reviewed the charts of 2,566 patients who presented at 15 Michigan hospitals during a 6-month period in 2002. There were some significant differences at baseline, he said. Women were on average 3 years older than men (70 vs. 67 years), and more were older than 80 at the time of their stroke (33% vs. 20% of men). Additionally, women were significantly less likely to have a history of prior heart disease and dyslipidemia, less likely to be smokers or to have been ambulatory before the stroke, and more likely to have a history of heart failure and hypertension.

For most in-hospital treatments, there were no significant gender disparities, Dr. Reeves said. Women had slightly less cardiac monitoring, angiography, echocardiography, and cerebrovascular investigation, but those differences dissipated after adjusting for age and other confounders.

“The most striking difference we found was that among ischemic stroke patients, women were half as likely as men to get TPA,” he said (2.2% vs. 4.4%). “We even subanalyzed the group that arrived within the 2-hour treatment window and had no contraindications to the therapy, and although the treatment numbers went way up, to 18% for women and 28% for men, the difference between them remained significant.”

He also found a significant difference in lipid testing (42% vs. 51%). But it was interesting that there was no difference in the percent of patients who received lipid-lowering drugs at discharge, he said.

Nor were there many significant differences in in-hospital outcomes, he said. Women had slightly higher unadjusted mortality rates (9.3% vs. 8.5%), but the difference disappeared after adjusting for age. Women did have a marginally significant higher risk of worse function outcome at discharge–17%. There were no significant adjusted differences in deep vein thromboses, pulmonary embolism, or pneumonia.

The only significant outcome difference Dr. Reeves discovered was in urinary tract infection: There were more in women than in men (11% vs. 4%; OR 2.6).

There were no differences in use of warfarin, antithrombotics, or DVT prophylaxis, he added.