Updates to guidelines on non-cardiac surgery

Updates to the 2014 ESC/ESA guidelines on non-cardiac surgery include notable differences compared to the 2014 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines on perioperative cardiovas-

cular evaluation and management of patients undergoing non-cardiac surgery. Although the ACC/AHA guidelines collapsed the categorization of risk associated with a particular surgery or procedure into low (<1 percent) or elevated (≥1 percent), the ESC/ESA Guidelines continue to classify procedures as low, inter-mediate or high risk.

There is less enthusiasm for the use of beta-blockade and the only Class I indication in both guidelines is for the continuation of such therapy in patients who have received beta-blockade chronically. The ESC/ESA guidelines make an explicit recommendation for the use of atenolol or bisoprolol when beta-blockade is initiated pre-operatively. Both guidelines caution against fixed, high-dose regimens that may lead to hypotension and/or bradycardia. The ESC/ESA guidelines are a bit more restrictive with the recom-mendation for the initiation of statin therapy perioperative only to those undergoing vascular surgery. Both guidelines recommend the continued use of chronic statin therapy. Lastly, both guideline writing committees recognize that the risk of stent thrombosis seems to stabilize after six months following implantation of a second-generation drug-eluting stent and suggests that dual antiplatelet therapy may accordingly be interrupted after 180 days for elective, non-cardiac surgery in select circumstances. For more information, reference the Journal of American College of Cardiology (July 2014) article “Guideline 2014 Perioperative Cardiovascular Evaluation.”

Expedited EC CTA’s help diagnosis acute chest pain patients

Beaumont cardiologists Gilbert Raff, M.D., and Kavitha Chinnaiyan, M.D., co-authored the newly released Society of Cardiovascular Computed Tomog-raphy Guidelines (July 2014) on the use of coronary computed tomography for

patients presenting with acute chest pain to the emergency depart-ment. The cardiology departments at Beaumont pioneered this diagnostic method, which has been shown to lower emergency department costs, decrease admissions and expedite diagnosis for chest pain patients. Dr. Raff, Dr. Chinnaiyan and James Goldstein, M.D., were principal authors of the multicenter CT-STAT randomized controlled trial that led to the use of coronary CTA as an approved test for evaluation of acute chest pain patients worldwide.

Atrial Fibrillation

RESEARCH

Beaumont’s Heart and Vascular Research department is one of the largest in the country with many ongoing leading edge clinical research trials.

Selected Current Trials

Genetic A Fib Trial:

A new genetically, targeted drug being tested through a research study at Beaumont may improve care, quality of life and survival in patients with heart failure and atrial fibrillation (AF). A previous study showed the drug being evaluated, bucindolol hydrochloride, reduced symptom-atic atrial fibrillation when compared with placebo in patients with a specific genotype. In the current study, bucindolol is being compared with metoprolol succinate, an FDA-approved heart failure drug, for the prevention of symptomatic atrial fibrillation.

About half of the U.S. population is believed to have the specific gene variation that responds to bucindolol in the suppression and prevention of AF. Beaumont is the first in Michigan to participate in this multicenter, national trial which will ultimately involve about 200 patients at approximately 50 centers in the U.S. in its first phase.

Principal Investigator: DAVID HAINES, M.D. Study coordinator: PATTY NAISMITH, 248-898-8141 or pnaismith@beaumont.edu

PORTICO Trial

Beaumont is one of 80 sites in the United States and the only site in Michigan to participate in the PORTICO valve trial that will examine the effectiveness of the heart valve “Portico™ Transcatheter Aortic Valve System. The PORTICO valve is an innovative, repositionable aortic heart valve and delivery system for patients who are not good candidates for open heart surgery. This newly designed valve is self-expanding, repositionable and deploys easier than current transcatheter devices. It also allows physicians to more accurately place the valve at the implant site or retrieve it before it is deployed from the delivery system. In the trial, high risk and inoperable patients will be randomized to the PORTICO™ valve versus commercially available transcatheter heart valves.

Principal investigator: FRANCIS SHANNON, M.D. and GEORGE HANZEL, M.D. Nurse coordinator: PAT OBRYAN, pat.obryan@beaumont.edu or 248-898-5584

SEPTEMBER 2014, ISSUE X | TRENDING NEWS IN HEART & VASCULAR DISEASE AND SERVICES

Visit: heart.beaumont.edu for other Beaumont Health System heart and vascular information.

Loop recorder monitors patients with suspected arrhythmia up to three years

Diagnosing infrequent arrhythmia events can be a challenge. Also, symptom-rhythm correlation is a critical factor in arrhythmia management. To address these needs, prolonged ambulatory moni-toring is the mainstay. Wearable monitors

are useful for periods up to one month, but they are cumbersome and sometimes a one-month monitoring duration is insufficient.

Implantable loop recorders (ILRs) allow patients to be monitored continuously for up to three years. These devices have automatic arrhythmia detection as well as patient-activated recording during symptomatic events. The recorded events are stored in the device memory or transmitted wirelessly on a daily basis to a bedside monitor and relayed to the clinician. One new device is so small that it can be injected into the subcutaneous tissue in the chest through an eight millimeter incision that can be closed with Steri-Strips. The insertion procedure takes about three minutes. A recent study (CRYSTAL-AF) demonstrated that the ILR increased the diagnosis of atrial fibrillation ten-fold compared to conventional monitor in patients with cryptogenic stroke. This powerful tool significantly improves the ease and accuracy of diagnosis in patients with suspected arrhythmia.

Minimally invasive heart valve surgery provides treatments options to inoperable patients

Beaumont’s heart valve program offers the most advanced, innovative approaches for treating all types of heart disease. Beaumont is the leader in Michigan for minimally invasive heart valve procedures with excellent

outcomes. Through the advancements of Beaumont’s structural heart and valve disease program, patients with no treatment options in the past, now have options for even the most complex valve disease with low morbidity, mortality, lower length of stay and earlier return to normal activity. For more information, call the Heart Valve Clinic at 248-898-0230.

D ID YOU KN OW ?

If your patient has a wound that has not healed in four to six weeks, the medical team at the Wound Treatment Center can help. Likely candidates for treatment at the Wound Treatment Center are those suffering from diabetic ulcers, pressure ulcers, venous ulcers, arterial ulcers, open surgical wounds and trauma. Specialists, including plastic surgeons, vascular surgeons, general surgeons and podiatrists provide chronic wound care. For more information, call the Wound Treatment Center at 248-551-7500.

3601 West 13 Mile Rd. | Royal Oak, MI 48073-6769heart.beaumont.edu

MARK YOU R CALEN DAR

U PCO M IN G CO N FEREN CES/EVENTS

Advances in Cardiovascular Imaging and InterventionsOct. 9 - 11, 2014TROY MARRIOTT, TROY, MI

Practical Update in Cardiology, 2014Nov. 1, 2014TROY MARRIOTT, TROY, MI

24th Annual Cardiovascular ConferenceFeb. 22 – 25, 2015PARK HYATT BEAVER CREEK, BEAVER CREEK, CO

Alcohol Septal Ablation Live Proctoring Course 2015April 26 - 28, 2015TYNER CENTER FOR CARDIOVASCULAR INTERVENTIONS, BEAUMONT HOSPITAL, ROYAL OAK

To receive the Beaumont Heart & Vascular Update for Physicians e-newsletter, opt-in at heart.beaumont.edu.

Visit: heart.beaumont.edu for other Beaumont Health System heart and vascular information.

TRENDING NEWS IN HEART & VASCULAR DISEASE AND SERVICES

BEAUMONT HEART & VASCULAR UPDATE FOR PHYSICIANS

EDITORS:

Steven Almany, M.D. & Simon Dixon, MBChB, FACC

For more information visit: heart.beaumont.edu or to talk to a Beaumont heart and vascular specialist, call 888-877-8766.

For more information or to register for any of the above conferences, visit: http://meded.beaumont.edu/cardiology-conferences

For more information about Heart and Vascular Continuing Medical Education, contact Shannon Herrington, CMP, Heart and Vascular Education at 800-732-6368 or email heartandvascularconferences@beaumont.edu.