Postoperative Atrial FibrillationStatin Pre-treatment Reduces the Risk of Postoperative Atrial Fibrillation

Speaker: Germano Di Sciascio, MD, Professor and Chairman of Cardiology, and Director, Department of Cardiovascular Sciences, Campus Biomedico, University of Rome, Rome, Italy

Pre-treatment with the statin atorvastatin (Pfizer) for one week before elective cardiac surgery reduced the risk of postoperative atrial fibrillation, according to findings from the Atorvastatin for deduction of Myocardial. Dysrhythmias After Cardiac Surgery (ARMYDA-3) study.

The randomized study enrolled 200 patients scheduled for elective cardiac surgery for coronary artery bypass graft surgery or heart valve repair or placement. These patients had not received previous statin treatment and had no history of atrial fibrillation.

The patients received daily (n = 101) or placebo (n = 99) starting seven days before the operation. The primary endpoint was the incidence of postoperative atrial fibrillation. Levels of C-reactive protein (CRP), a marker of inflammation, were routinely measured before surgery and every 24 hours postoperatively until discharge.

An analysis of the data indicated that atorvastatin significantly reduced the rate of atrial fibrillation from 57% with placebo to 35% with atorvastatin. CRP levels were higher in patients who developed atrial fibrillation. Although the researchers observed no differences in the duration or time of the beginning of the arrhythmic episodes after surgery between the two study groups, the canadian atorvastatin patients had significantly shorter hospital stays (6.3 days) than the placebo patients (6.9 days) (P = .001).

Darbepoetin alfa Beneficial for Patients with Anemic Heart Failure

Speaker: Dirk J. Von Veldhuisen, MD, PhD, Professor and Chairman, Division of Cardiology, University Medical Center, Groningen, The Netherlands

Treating anemia with darbepoetin alfa (Aranesp, Amgen), a recombinant erythropoietic protein, in patients with symptomatic heart failure (HF) has been found to be safe and well tolerated, effectively raising hemoglobin levels and alleviating symptoms.

Because anemia is common in patients with HF and is associated with severe symptoms and outcomes, a phase 2 multicenter study was performed to assess the value of two dosing regimens of darbepoetin alfa on the rate of hemoglobin elevation, exercise performance, symptoms, and clinical status. Darbepoetin stimulates the production of red blood cells and has been approved by the Food and Drug Administration to treat chemotherapy-induced anemia in patients with non-myeloid malignancies. cheap cialis canadian pharmacy

A randomized, 26-week study enrolled 165 patients with symptomatic HF (New York Heart Association Class II to III) of three months’ duration or more, a left ventricular ejection fraction (LVEF) below 40%, and hemoglobin levels ranging from 9 to 12.5 g/dl. The patients received darbepoetin alfa sub-cutaneously every two weeks at starting doses of 75 mcg/kg (n = 56), a fixed dose of 50 mcg/kg (n = 54), or placebo (n = 55) to achieve and maintain target hemoglobin concentrations of 14 ±1 g/dl (range, 13-15 g/dl).

The primary endpoint was the rate of hemoglobin increase per week during the titration period. Other endpoints included changes from the baseline examination to the sixth month in the six-minute walking distance and scores from various tests: the Patient’s Global Assessment (PGA), the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Kansas City Cardiomyopathy Questionnaire (KCCQ), and a safety profile.

In the patients with symptomatic HF and anemia, darbe-poetin alfa effectively raised hemoglobin levels and was associated with improved total scores of symptoms in the Kansas City Questionnaire: from 1.5 with placebo to 8.2 with darbepoetin alfa (with higher scores indicating better health).

Fixed doses were as effective as doses based on weight in raising hemoglobin levels, with a difference of only 0.05 g/dl per week. Statistically nonsignificant improvements were recorded as follows:

  • Patient’s Global Assessment: darbepoetin alfa, 65% improvement; placebo, 49%
  • Minnesota Questionnaire: darbepoetin alfa, a score of 10.1; placebo, a score of 7.4
  • six-minute walking distance: darbepoetin alfa, 34.2 meters; placebo, 11.4 meters.

Adverse events were comparable in all treatment groups.

Carvedilol Improves Survival in Patients with Heart Failure after Hospital Discharge

Speaker: Gregg C. Fonarow, MD, The Eliot Corday Chair in Cardiovascular Medicine and Science; Professor of Clinical Medicine, Division of Cardiology; Director, Ahmanson University of California, Los Angeles (UCLA) Cardiomyopathy Center; and Co-Director, UCLA Preventative Cardiology Program, David Geffen School of Medicine, UCLA, Los Angeles, California

Carvedilol (GlaxoSmithKline), a well-known beta-blocking agent, when prescribed upon hospital discharge to patients with heart failure (HF), has been associated with improved treatment and survival rates at 60 to 90 days and is exceptionally well tolerated.

These findings were derived from a new analysis from the HF registry and performance improvement program for patients with HF (Organized Program To initiate Life-saving Treatment in Hospitalized Patients with Heart Failure [OPTIMIZE-HF]). This program collects data from participating hospitals in the U.S.

Data were collected from 2,720 patients with HF who were discharged to home from the hospital with left ventricular systolic dysfunction and who were eligible for beta-blocker therapy. The patients were observed for the first 60 to 90 days after discharge. Carvedilol drug was prescribed at the time of discharge to 1,146 patients, and 94% of the patients continued with their therapy for the rest of the follow-up period. For the 361 eligible patients who were not discharged home with any beta-blocker regimen, only 30.4% of them later received prescriptions for a beta blocker.

Patients taking carvedilol after hospital discharge experienced a significantly decreased risk of death, and death or re-hospitalization, without an early risk of recurrent worsening HF. Their risk of death was less than half that in the untreated patients (odds ratio, 0.46 [0.30-0.72]; P = .006), and they were one third less likely to need rehospitalization than untreated patients (odds ratio, 0.71 [0.53-0.91]; P = .02).

As a result of this analysis and earlier studies, the use of carvedilol canadian or one of the other recommended beta blockers upon discharge from the hospital should be adopted as the standard of care among all hospitalized patients with HF and left ventricular systolic dysfunction unless such a regimen is absolutely contraindicated.