Doug Brunk

SAN DIEGO – Among patients diagnosed with obstructive sleep apnea, compliance with continuous positive airway pressure devices was similar whether they received treatment in a primary care clinic or in a sleep clinic, results from a Spanish study demonstrated.

However, after 6 months of follow-up, patients who received treatment in a sleep clinic had significantly better Epworth Sleepiness Scale (ESS) scores and ratings of satisfaction, compared with those who received treatment in a primary care clinic.

"OSA affects 4%-6% of the adult population, but only 10% of those with severe disease are treated," Dr. Ferran Barbé said at an international conference of the American Thoracic Society. "In all prevalent and chronic disease, all levels of assistance must be implicated."

In a controlled, noninferiority study, Dr. Barbé and his associates randomized 210 patients diagnosed with obstructive sleep apnea to receive management of continuous positive airway pressure (CPAP) compliance in one of two settings: 100 to one of eight primary care clinics in the region of Lleida, Spain, and 110 to the sleep unit at the University of Lleida. The main outcome was CPAP compliance at 6 months of follow-up. Secondary outcomes included change in the EuroQol scale score, patient satisfaction based on a 10-point visual analog scale, and the change in the ESS score.

The mean age of study participants was 56 years, and 80% were men. CPAP compliance was similar between patients in the sleep clinic group and those in the primary care group (a mean of 5.2 vs. 4.9 hr/day, respectively; P = .28), as was the change in EuroQol scale score (a mean change of 0.17; P = .49). However, patients in the sleep clinic group reported significantly higher rates of satisfaction, compared with their counterparts in the primary care group (a score of 9 vs. 7.5; P less than .001). They also demonstrated significantly greater changes in ESS score (–6.07 vs. –4.09; P = .04).

Overall treatment costs were less expensive in the primary care group, compared with the sleep clinic group.

Primary care physicians "need to reinforce actions that improve self-reported well-being in OSA patients," Dr. Barbé concluded.

The study was supported by the Instituto de Salud Carlos III, the Spanish Society of Pulmonology and Thoracic Surgery, Societat Catalana de Pneumologia, and ALLER (Respiratory Association of Lleida). Dr. Barbé said he had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Among patients diagnosed with obstructive sleep apnea, compliance with continuous positive airway pressure devices was similar whether they received treatment in a primary care clinic or in a sleep clinic, results from a Spanish study demonstrated.

However, after 6 months of follow-up, patients who received treatment in a sleep clinic had significantly better Epworth Sleepiness Scale (ESS) scores and ratings of satisfaction, compared with those who received treatment in a primary care clinic.

"OSA affects 4%-6% of the adult population, but only 10% of those with severe disease are treated," Dr. Ferran Barbé said at an international conference of the American Thoracic Society. "In all prevalent and chronic disease, all levels of assistance must be implicated."

In a controlled, noninferiority study, Dr. Barbé and his associates randomized 210 patients diagnosed with obstructive sleep apnea to receive management of continuous positive airway pressure (CPAP) compliance in one of two settings: 100 to one of eight primary care clinics in the region of Lleida, Spain, and 110 to the sleep unit at the University of Lleida. The main outcome was CPAP compliance at 6 months of follow-up. Secondary outcomes included change in the EuroQol scale score, patient satisfaction based on a 10-point visual analog scale, and the change in the ESS score.

The mean age of study participants was 56 years, and 80% were men. CPAP compliance was similar between patients in the sleep clinic group and those in the primary care group (a mean of 5.2 vs. 4.9 hr/day, respectively; P = .28), as was the change in EuroQol scale score (a mean change of 0.17; P = .49). However, patients in the sleep clinic group reported significantly higher rates of satisfaction, compared with their counterparts in the primary care group (a score of 9 vs. 7.5; P less than .001). They also demonstrated significantly greater changes in ESS score (–6.07 vs. –4.09; P = .04).

Overall treatment costs were less expensive in the primary care group, compared with the sleep clinic group.

Primary care physicians "need to reinforce actions that improve self-reported well-being in OSA patients," Dr. Barbé concluded.

The study was supported by the Instituto de Salud Carlos III, the Spanish Society of Pulmonology and Thoracic Surgery, Societat Catalana de Pneumologia, and ALLER (Respiratory Association of Lleida). Dr. Barbé said he had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Among patients diagnosed with obstructive sleep apnea, compliance with continuous positive airway pressure devices was similar whether they received treatment in a primary care clinic or in a sleep clinic, results from a Spanish study demonstrated.

However, after 6 months of follow-up, patients who received treatment in a sleep clinic had significantly better Epworth Sleepiness Scale (ESS) scores and ratings of satisfaction, compared with those who received treatment in a primary care clinic.

"OSA affects 4%-6% of the adult population, but only 10% of those with severe disease are treated," Dr. Ferran Barbé said at an international conference of the American Thoracic Society. "In all prevalent and chronic disease, all levels of assistance must be implicated."

In a controlled, noninferiority study, Dr. Barbé and his associates randomized 210 patients diagnosed with obstructive sleep apnea to receive management of continuous positive airway pressure (CPAP) compliance in one of two settings: 100 to one of eight primary care clinics in the region of Lleida, Spain, and 110 to the sleep unit at the University of Lleida. The main outcome was CPAP compliance at 6 months of follow-up. Secondary outcomes included change in the EuroQol scale score, patient satisfaction based on a 10-point visual analog scale, and the change in the ESS score.

The mean age of study participants was 56 years, and 80% were men. CPAP compliance was similar between patients in the sleep clinic group and those in the primary care group (a mean of 5.2 vs. 4.9 hr/day, respectively; P = .28), as was the change in EuroQol scale score (a mean change of 0.17; P = .49). However, patients in the sleep clinic group reported significantly higher rates of satisfaction, compared with their counterparts in the primary care group (a score of 9 vs. 7.5; P less than .001). They also demonstrated significantly greater changes in ESS score (–6.07 vs. –4.09; P = .04).

Overall treatment costs were less expensive in the primary care group, compared with the sleep clinic group.

Primary care physicians "need to reinforce actions that improve self-reported well-being in OSA patients," Dr. Barbé concluded.

The study was supported by the Instituto de Salud Carlos III, the Spanish Society of Pulmonology and Thoracic Surgery, Societat Catalana de Pneumologia, and ALLER (Respiratory Association of Lleida). Dr. Barbé said he had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN FRANCISCO – Bariatric surgery appears to have a preventive effect on the incidence of atrial fibrillation in patients who are morbidly obese, results from a study of more than 400 patients showed.

"Bariatric surgery is a preventative measure that obese patients may choose to take and our study shows that the surgery helps them not only lose weight, but also reduces their risk of developing a serious cardiac condition, like AF," Dr. Yong-Mei Cha, professor of medicine at Mayo Clinic, Rochester, Minn., said in a prepared statement.

In an interview at the annual scientific sessions of the Heart Rhythm Society, Dr. John D. Day, a Murray, Utah–based electrophysiologist and cardiologist who was not involved in the research, characterized the findings as "a message of hope. Too often here in the United States people get a diagnosis of AF and they feel like it’s going to be with them the rest of their lives. The message of hope is that AF – if aggressive lifestyle changes are made early on – is a potentially reversible condition. This study showed that point. And this was just by eliminating the weight. How much more powerful would it be if they made comprehensive lifestyle changes that include more physical activity, dietary changes, and stress reduction?"

Dr. Cha and her associates retrospectively evaluated data from 438 patients in Olmsted County, Minn., who had a body mass index of 40 kg/m² or higher and were considered good candidates for bariatric surgery. One electrophysiologist reviewed the medical records and the diagnosis of AF was documented by ECG or ambulatory monitors. The researchers collected metabolic profiles at baseline and at follow-up.

Of the 438 patients, 326 (74%) underwent bariatric surgery while the remaining 112 were managed medically and served as the control group. At baseline, BMI was significantly greater in the surgery group compared with the control group (a mean of 46.9 vs. 43.2 kg/m², respectively), but the prevalence of AF was similar between the two groups (3.7 vs. 4.5%).

After a mean follow-up of 7.2 years, new onset of AF occurred in 3.1% of the surgery group, compared with 12.5% in the control group, a difference that reached statistical significance. The surgery group also had a significant reduction in BMI and improvements in their metabolic profiles, compared with the control group.

Dr. Day said that the study’s single-center, retrospective design is a limitation, as is the fact that bariatric surgery "is pretty extreme; you can’t offer it to everybody. But [the findings] fit in line with current data. We know that obesity is a powerful risk factor for atrial fibrillation."

The researchers reported no financial conflicts of interest.

dbrunk@frontlinemedcom.com

SAN FRANCISCO – Bariatric surgery appears to have a preventive effect on the incidence of atrial fibrillation in patients who are morbidly obese, results from a study of more than 400 patients showed.

"Bariatric surgery is a preventative measure that obese patients may choose to take and our study shows that the surgery helps them not only lose weight, but also reduces their risk of developing a serious cardiac condition, like AF," Dr. Yong-Mei Cha, professor of medicine at Mayo Clinic, Rochester, Minn., said in a prepared statement.

In an interview at the annual scientific sessions of the Heart Rhythm Society, Dr. John D. Day, a Murray, Utah–based electrophysiologist and cardiologist who was not involved in the research, characterized the findings as "a message of hope. Too often here in the United States people get a diagnosis of AF and they feel like it’s going to be with them the rest of their lives. The message of hope is that AF – if aggressive lifestyle changes are made early on – is a potentially reversible condition. This study showed that point. And this was just by eliminating the weight. How much more powerful would it be if they made comprehensive lifestyle changes that include more physical activity, dietary changes, and stress reduction?"

Dr. Cha and her associates retrospectively evaluated data from 438 patients in Olmsted County, Minn., who had a body mass index of 40 kg/m² or higher and were considered good candidates for bariatric surgery. One electrophysiologist reviewed the medical records and the diagnosis of AF was documented by ECG or ambulatory monitors. The researchers collected metabolic profiles at baseline and at follow-up.

Of the 438 patients, 326 (74%) underwent bariatric surgery while the remaining 112 were managed medically and served as the control group. At baseline, BMI was significantly greater in the surgery group compared with the control group (a mean of 46.9 vs. 43.2 kg/m², respectively), but the prevalence of AF was similar between the two groups (3.7 vs. 4.5%).

After a mean follow-up of 7.2 years, new onset of AF occurred in 3.1% of the surgery group, compared with 12.5% in the control group, a difference that reached statistical significance. The surgery group also had a significant reduction in BMI and improvements in their metabolic profiles, compared with the control group.

Dr. Day said that the study’s single-center, retrospective design is a limitation, as is the fact that bariatric surgery "is pretty extreme; you can’t offer it to everybody. But [the findings] fit in line with current data. We know that obesity is a powerful risk factor for atrial fibrillation."

The researchers reported no financial conflicts of interest.

dbrunk@frontlinemedcom.com

SAN FRANCISCO – Bariatric surgery appears to have a preventive effect on the incidence of atrial fibrillation in patients who are morbidly obese, results from a study of more than 400 patients showed.

"Bariatric surgery is a preventative measure that obese patients may choose to take and our study shows that the surgery helps them not only lose weight, but also reduces their risk of developing a serious cardiac condition, like AF," Dr. Yong-Mei Cha, professor of medicine at Mayo Clinic, Rochester, Minn., said in a prepared statement.

In an interview at the annual scientific sessions of the Heart Rhythm Society, Dr. John D. Day, a Murray, Utah–based electrophysiologist and cardiologist who was not involved in the research, characterized the findings as "a message of hope. Too often here in the United States people get a diagnosis of AF and they feel like it’s going to be with them the rest of their lives. The message of hope is that AF – if aggressive lifestyle changes are made early on – is a potentially reversible condition. This study showed that point. And this was just by eliminating the weight. How much more powerful would it be if they made comprehensive lifestyle changes that include more physical activity, dietary changes, and stress reduction?"

Dr. Cha and her associates retrospectively evaluated data from 438 patients in Olmsted County, Minn., who had a body mass index of 40 kg/m² or higher and were considered good candidates for bariatric surgery. One electrophysiologist reviewed the medical records and the diagnosis of AF was documented by ECG or ambulatory monitors. The researchers collected metabolic profiles at baseline and at follow-up.

Of the 438 patients, 326 (74%) underwent bariatric surgery while the remaining 112 were managed medically and served as the control group. At baseline, BMI was significantly greater in the surgery group compared with the control group (a mean of 46.9 vs. 43.2 kg/m², respectively), but the prevalence of AF was similar between the two groups (3.7 vs. 4.5%).

After a mean follow-up of 7.2 years, new onset of AF occurred in 3.1% of the surgery group, compared with 12.5% in the control group, a difference that reached statistical significance. The surgery group also had a significant reduction in BMI and improvements in their metabolic profiles, compared with the control group.

Dr. Day said that the study’s single-center, retrospective design is a limitation, as is the fact that bariatric surgery "is pretty extreme; you can’t offer it to everybody. But [the findings] fit in line with current data. We know that obesity is a powerful risk factor for atrial fibrillation."

The researchers reported no financial conflicts of interest.

dbrunk@frontlinemedcom.com

SAN FRANCISCO – Among cases of sports-associated sudden cardiac death in middle-age men, 51% had known preexisting cardiac disease and at least two documented cardiac risk factors, and 31% had cardiovascular symptoms that preceded the sudden cardiac arrest event, results from large ongoing prospective study showed.

"The prevention of SCD during sports should include education of sport participants: The way of practicing sports should be different if you have a known heart disease," and warning symptoms should be heeded, one of the study authors, Dr. Eloi Marijon said in an interview after the annual scientific sessions of the Heart Rhythm Society, where the study was presented.

In the ongoing Oregon-SUDS (Oregon Sudden Unexpected Death Study), Dr. Marijon and his associates identified sudden cardiac arrest (SCA) cases among 944 men aged 35-65 years in the metropolitan area of Portland, Oregon, during 2002-2012, including systematic and comprehensive assessment of their lifetime medical history. "This is the first work aiming to study sudden cardiac death during sports in the community in United States," said Dr. Marijon, a visiting faculty scientist at Cedars-Sinai Medical Center, Los Angeles. "There are some data in the European Union, but data from the United States were coming only from studies carried out among young competitive athletes," he said. These U.S. studies have allowed for significant improvements in the field, notably initiation and optimization of preventive strategies.

However, "recent European experience has emphasized that, in the community, the largest burden of sports-associated SCA results from events among male middle-age participants. However, except for limited data on specific recreational sport activities there are, to the best of our knowledge, no studies evaluating SCA during sports among middle-age subjects in any United States community."

The researchers found that among the 944 SCA cases, 59 (6%) occurred during sports at a mean age of 51 years, which translated into an incidence of 41/million per year. SCA cases associated with sports activity were significantly more likely to be a witnessed event than were those not related to sports (86% vs. 53, respectively), with higher rates of bystander cardiopulmonary resuscitation (46% vs. 26%) and ventricular fibrillation as the presenting rhythm (84% vs. 57%). In addition, survival to hospital discharge was nearly twice as high for sports-related SCA cases than for nonsports–related SCA cases (25% vs. 13%).

The researchers also found that slightly more than half of sports-related SCA cases (51%) had known preexisting cardiac disease and at least two documented cardiac risk factors, while nearly one-third (31%) had cardiovascular symptoms that preceded the SCA event, "opening room for intervention," Dr. Marijon said.

Even though the researchers considered lifetime past medical history in all cases, "investigation of SCA remains particularly challenging, especially since a great majority of subjects die in the field, and consequently the information collected by emergency medical services is often restricted to data regarding the resuscitation process," Dr. Marijon noted. "Details of the past medical history of SCA patients (especially those that cannot be resuscitated) are thus usually sparse and very rarely considered systematically."

The principal investigator of Oregon-SUDS is Dr. Sumeet S. Chugh of the department of genomic cardiology at the Cedars-Sinai Heart Institute.

The study was funded by the National Heart, Lung, and Blood Institute. Dr. Marijon had no relevant financial conflicts of interest to disclose.

dbrunk@frontlinemedcom.com

SAN FRANCISCO – Among cases of sports-associated sudden cardiac death in middle-age men, 51% had known preexisting cardiac disease and at least two documented cardiac risk factors, and 31% had cardiovascular symptoms that preceded the sudden cardiac arrest event, results from large ongoing prospective study showed.

"The prevention of SCD during sports should include education of sport participants: The way of practicing sports should be different if you have a known heart disease," and warning symptoms should be heeded, one of the study authors, Dr. Eloi Marijon said in an interview after the annual scientific sessions of the Heart Rhythm Society, where the study was presented.

In the ongoing Oregon-SUDS (Oregon Sudden Unexpected Death Study), Dr. Marijon and his associates identified sudden cardiac arrest (SCA) cases among 944 men aged 35-65 years in the metropolitan area of Portland, Oregon, during 2002-2012, including systematic and comprehensive assessment of their lifetime medical history. "This is the first work aiming to study sudden cardiac death during sports in the community in United States," said Dr. Marijon, a visiting faculty scientist at Cedars-Sinai Medical Center, Los Angeles. "There are some data in the European Union, but data from the United States were coming only from studies carried out among young competitive athletes," he said. These U.S. studies have allowed for significant improvements in the field, notably initiation and optimization of preventive strategies.

However, "recent European experience has emphasized that, in the community, the largest burden of sports-associated SCA results from events among male middle-age participants. However, except for limited data on specific recreational sport activities there are, to the best of our knowledge, no studies evaluating SCA during sports among middle-age subjects in any United States community."

The researchers found that among the 944 SCA cases, 59 (6%) occurred during sports at a mean age of 51 years, which translated into an incidence of 41/million per year. SCA cases associated with sports activity were significantly more likely to be a witnessed event than were those not related to sports (86% vs. 53, respectively), with higher rates of bystander cardiopulmonary resuscitation (46% vs. 26%) and ventricular fibrillation as the presenting rhythm (84% vs. 57%). In addition, survival to hospital discharge was nearly twice as high for sports-related SCA cases than for nonsports–related SCA cases (25% vs. 13%).

The researchers also found that slightly more than half of sports-related SCA cases (51%) had known preexisting cardiac disease and at least two documented cardiac risk factors, while nearly one-third (31%) had cardiovascular symptoms that preceded the SCA event, "opening room for intervention," Dr. Marijon said.

Even though the researchers considered lifetime past medical history in all cases, "investigation of SCA remains particularly challenging, especially since a great majority of subjects die in the field, and consequently the information collected by emergency medical services is often restricted to data regarding the resuscitation process," Dr. Marijon noted. "Details of the past medical history of SCA patients (especially those that cannot be resuscitated) are thus usually sparse and very rarely considered systematically."

The principal investigator of Oregon-SUDS is Dr. Sumeet S. Chugh of the department of genomic cardiology at the Cedars-Sinai Heart Institute.

The study was funded by the National Heart, Lung, and Blood Institute. Dr. Marijon had no relevant financial conflicts of interest to disclose.

dbrunk@frontlinemedcom.com

SAN FRANCISCO – Among cases of sports-associated sudden cardiac death in middle-age men, 51% had known preexisting cardiac disease and at least two documented cardiac risk factors, and 31% had cardiovascular symptoms that preceded the sudden cardiac arrest event, results from large ongoing prospective study showed.

"The prevention of SCD during sports should include education of sport participants: The way of practicing sports should be different if you have a known heart disease," and warning symptoms should be heeded, one of the study authors, Dr. Eloi Marijon said in an interview after the annual scientific sessions of the Heart Rhythm Society, where the study was presented.

In the ongoing Oregon-SUDS (Oregon Sudden Unexpected Death Study), Dr. Marijon and his associates identified sudden cardiac arrest (SCA) cases among 944 men aged 35-65 years in the metropolitan area of Portland, Oregon, during 2002-2012, including systematic and comprehensive assessment of their lifetime medical history. "This is the first work aiming to study sudden cardiac death during sports in the community in United States," said Dr. Marijon, a visiting faculty scientist at Cedars-Sinai Medical Center, Los Angeles. "There are some data in the European Union, but data from the United States were coming only from studies carried out among young competitive athletes," he said. These U.S. studies have allowed for significant improvements in the field, notably initiation and optimization of preventive strategies.

However, "recent European experience has emphasized that, in the community, the largest burden of sports-associated SCA results from events among male middle-age participants. However, except for limited data on specific recreational sport activities there are, to the best of our knowledge, no studies evaluating SCA during sports among middle-age subjects in any United States community."

The researchers found that among the 944 SCA cases, 59 (6%) occurred during sports at a mean age of 51 years, which translated into an incidence of 41/million per year. SCA cases associated with sports activity were significantly more likely to be a witnessed event than were those not related to sports (86% vs. 53, respectively), with higher rates of bystander cardiopulmonary resuscitation (46% vs. 26%) and ventricular fibrillation as the presenting rhythm (84% vs. 57%). In addition, survival to hospital discharge was nearly twice as high for sports-related SCA cases than for nonsports–related SCA cases (25% vs. 13%).

The researchers also found that slightly more than half of sports-related SCA cases (51%) had known preexisting cardiac disease and at least two documented cardiac risk factors, while nearly one-third (31%) had cardiovascular symptoms that preceded the SCA event, "opening room for intervention," Dr. Marijon said.

Even though the researchers considered lifetime past medical history in all cases, "investigation of SCA remains particularly challenging, especially since a great majority of subjects die in the field, and consequently the information collected by emergency medical services is often restricted to data regarding the resuscitation process," Dr. Marijon noted. "Details of the past medical history of SCA patients (especially those that cannot be resuscitated) are thus usually sparse and very rarely considered systematically."

The principal investigator of Oregon-SUDS is Dr. Sumeet S. Chugh of the department of genomic cardiology at the Cedars-Sinai Heart Institute.

The study was funded by the National Heart, Lung, and Blood Institute. Dr. Marijon had no relevant financial conflicts of interest to disclose.

dbrunk@frontlinemedcom.com

SAN FRANCISCO – Adding an electrocardiogram to standard preparticipation screening of high school athletes significantly increased the likelihood of identifying disorders associated with sudden cardiac death, a prospective study of nearly 5,000 athletes showed.

"At this point I’m not advocating that an ECG should definitely be added to the screening, and I’m not advocating that the ECG should replace the history and physical," lead author Dr. Jordan M. Prutkin emphasized in an interview at the annual scientific sessions of the Heart Rhythm Society.

Doug Brunk/Frontline Medical News

"I think we need to be doing more research to figure out what the correct history questions to be asking are. For instance, I think a family history is one of the most important questions to ask about, as is syncope. We also need to find the best ECG criteria that are going to give you the best sensitivity and specificity in an athletic population."

The American Heart Association currently recommends the use of a history and physical in the preparticipation screening of athletes, but it does not recommend use of an ECG.

No definitive data exist to support using a history and physical only to detect heart abnormalities, noted Dr. Prutkin, an electrophysiologist at the University of Washington’s Center for Sports Cardiology, Seattle. "We also don’t have a lot of data that compares the history and physical to an ECG," he said. "The idea of using ECG for screening is a debated topic. In this study we tried to compare the ECG to a history and physical in terms of picking up those things that portend a risk of sudden cardiac arrest on the playing field or in life."

Between October 2010 and June 2013 the researchers conducted preparticipation screening of 4,812 athletes aged 13-19 at 23 high schools in the Seattle area. The protocol included a heart health questionnaire, physical exam recommendations based on AHA guidelines, and a resting 12-lead ECG that was interpreted according to athlete-specific criteria and limited echocardiography.

Slightly more than half of the athletes (54%) were male and 65% were white. In all, 23 athletes (.5%) were found to have a significant cardiac abnormality that required further evaluation. Abnormal history or physical exam led to a diagnosis in 61% of the disorders, while an abnormal ECG led to a diagnosis in 70% of the disorders. In addition, history, physical examination, and ECG had false-positive rates of 22.3%, 14.9%, and 3.6%, respectively, and positive predictive values of 1.0%, 1.0%, and 8.6%.

"Our results matched what we had been seeing [in practice], which is that trying to do a good history in a high school student is very difficult, because a lot of them will complain of chest pain or palpitations," Dr. Prutkin said. "Some of the problems with the history and physical [center around] what are the more directed questions to ask? Do we need to revise the preparticipation examination to get better questions? Also, when interpreting the ECGs, you need to use athlete-specific criteria. By doing that, you can significantly decrease your false-positive rate. You can’t just interpret an ECG the way that you would normally interpret an ECG in a 50-year-old."

He acknowledged certain limitations of the study, including the fact that a screening echocardiogram was used instead of a full echocardiogram. "We looked for coronary artery anomalies, but that’s not always possible to see on a screening echocardiogram, so we may have missed some of those," he said. "We also may have missed some cases of long QT syndrome or hypertropic cardiomyopathy. This is screening; even with the ECG it’s not going to be perfect, but hopefully we are finding those who are at highest risk."

The Nick of Time Foundation helped to arrange the screenings. Dr. Prutkin said that he had no conflicts of interest to disclose.

dbrunk@frontlinemedcom.com

SAN FRANCISCO – Adding an electrocardiogram to standard preparticipation screening of high school athletes significantly increased the likelihood of identifying disorders associated with sudden cardiac death, a prospective study of nearly 5,000 athletes showed.

"At this point I’m not advocating that an ECG should definitely be added to the screening, and I’m not advocating that the ECG should replace the history and physical," lead author Dr. Jordan M. Prutkin emphasized in an interview at the annual scientific sessions of the Heart Rhythm Society.

Doug Brunk/Frontline Medical News

"I think we need to be doing more research to figure out what the correct history questions to be asking are. For instance, I think a family history is one of the most important questions to ask about, as is syncope. We also need to find the best ECG criteria that are going to give you the best sensitivity and specificity in an athletic population."

The American Heart Association currently recommends the use of a history and physical in the preparticipation screening of athletes, but it does not recommend use of an ECG.

No definitive data exist to support using a history and physical only to detect heart abnormalities, noted Dr. Prutkin, an electrophysiologist at the University of Washington’s Center for Sports Cardiology, Seattle. "We also don’t have a lot of data that compares the history and physical to an ECG," he said. "The idea of using ECG for screening is a debated topic. In this study we tried to compare the ECG to a history and physical in terms of picking up those things that portend a risk of sudden cardiac arrest on the playing field or in life."

Between October 2010 and June 2013 the researchers conducted preparticipation screening of 4,812 athletes aged 13-19 at 23 high schools in the Seattle area. The protocol included a heart health questionnaire, physical exam recommendations based on AHA guidelines, and a resting 12-lead ECG that was interpreted according to athlete-specific criteria and limited echocardiography.

Slightly more than half of the athletes (54%) were male and 65% were white. In all, 23 athletes (.5%) were found to have a significant cardiac abnormality that required further evaluation. Abnormal history or physical exam led to a diagnosis in 61% of the disorders, while an abnormal ECG led to a diagnosis in 70% of the disorders. In addition, history, physical examination, and ECG had false-positive rates of 22.3%, 14.9%, and 3.6%, respectively, and positive predictive values of 1.0%, 1.0%, and 8.6%.

"Our results matched what we had been seeing [in practice], which is that trying to do a good history in a high school student is very difficult, because a lot of them will complain of chest pain or palpitations," Dr. Prutkin said. "Some of the problems with the history and physical [center around] what are the more directed questions to ask? Do we need to revise the preparticipation examination to get better questions? Also, when interpreting the ECGs, you need to use athlete-specific criteria. By doing that, you can significantly decrease your false-positive rate. You can’t just interpret an ECG the way that you would normally interpret an ECG in a 50-year-old."

He acknowledged certain limitations of the study, including the fact that a screening echocardiogram was used instead of a full echocardiogram. "We looked for coronary artery anomalies, but that’s not always possible to see on a screening echocardiogram, so we may have missed some of those," he said. "We also may have missed some cases of long QT syndrome or hypertropic cardiomyopathy. This is screening; even with the ECG it’s not going to be perfect, but hopefully we are finding those who are at highest risk."

The Nick of Time Foundation helped to arrange the screenings. Dr. Prutkin said that he had no conflicts of interest to disclose.

dbrunk@frontlinemedcom.com

SAN FRANCISCO – Adding an electrocardiogram to standard preparticipation screening of high school athletes significantly increased the likelihood of identifying disorders associated with sudden cardiac death, a prospective study of nearly 5,000 athletes showed.

"At this point I’m not advocating that an ECG should definitely be added to the screening, and I’m not advocating that the ECG should replace the history and physical," lead author Dr. Jordan M. Prutkin emphasized in an interview at the annual scientific sessions of the Heart Rhythm Society.

Doug Brunk/Frontline Medical News

"I think we need to be doing more research to figure out what the correct history questions to be asking are. For instance, I think a family history is one of the most important questions to ask about, as is syncope. We also need to find the best ECG criteria that are going to give you the best sensitivity and specificity in an athletic population."

The American Heart Association currently recommends the use of a history and physical in the preparticipation screening of athletes, but it does not recommend use of an ECG.

No definitive data exist to support using a history and physical only to detect heart abnormalities, noted Dr. Prutkin, an electrophysiologist at the University of Washington’s Center for Sports Cardiology, Seattle. "We also don’t have a lot of data that compares the history and physical to an ECG," he said. "The idea of using ECG for screening is a debated topic. In this study we tried to compare the ECG to a history and physical in terms of picking up those things that portend a risk of sudden cardiac arrest on the playing field or in life."

Between October 2010 and June 2013 the researchers conducted preparticipation screening of 4,812 athletes aged 13-19 at 23 high schools in the Seattle area. The protocol included a heart health questionnaire, physical exam recommendations based on AHA guidelines, and a resting 12-lead ECG that was interpreted according to athlete-specific criteria and limited echocardiography.

Slightly more than half of the athletes (54%) were male and 65% were white. In all, 23 athletes (.5%) were found to have a significant cardiac abnormality that required further evaluation. Abnormal history or physical exam led to a diagnosis in 61% of the disorders, while an abnormal ECG led to a diagnosis in 70% of the disorders. In addition, history, physical examination, and ECG had false-positive rates of 22.3%, 14.9%, and 3.6%, respectively, and positive predictive values of 1.0%, 1.0%, and 8.6%.

"Our results matched what we had been seeing [in practice], which is that trying to do a good history in a high school student is very difficult, because a lot of them will complain of chest pain or palpitations," Dr. Prutkin said. "Some of the problems with the history and physical [center around] what are the more directed questions to ask? Do we need to revise the preparticipation examination to get better questions? Also, when interpreting the ECGs, you need to use athlete-specific criteria. By doing that, you can significantly decrease your false-positive rate. You can’t just interpret an ECG the way that you would normally interpret an ECG in a 50-year-old."

He acknowledged certain limitations of the study, including the fact that a screening echocardiogram was used instead of a full echocardiogram. "We looked for coronary artery anomalies, but that’s not always possible to see on a screening echocardiogram, so we may have missed some of those," he said. "We also may have missed some cases of long QT syndrome or hypertropic cardiomyopathy. This is screening; even with the ECG it’s not going to be perfect, but hopefully we are finding those who are at highest risk."

The Nick of Time Foundation helped to arrange the screenings. Dr. Prutkin said that he had no conflicts of interest to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Subsyndromal delirium was present in 86% of critically ill patients, results from a large observational study demonstrated. In addition, the duration of delirium was associated with increased odds of institutionalization, an association that was modified by the duration of delirium.

"In patients with less delirium, the effect of subsyndromal delirium on institutionalization was actually stronger," lead author Dr. Nathan E. Brummel said in an interview at an international conference of the American Thoracic Society, where the research was presented. "This identifies a cohort of people who previously were considered to have normal brain function, but it appears that this has long-term implications for their lives.

"Screening for delirium should occur not only in the ICU but on the wards as well. Patients who have delirium or delirium symptoms may benefit from measures used to prevent and treat this syndrome, such as the Hospital Elder Life Program, routine mobilization, and frequent reorientation through the use of nursing staff or even family members," he later added. This study data may help clinicians discuss long-term outcomes of critical illness with patients and their family members," he said.

For the study, Dr. Brummel, an instructor in medicine in the division of allergy, pulmonary and critical care medicine at Vanderbilt University Medical Center, Nashville, Tenn., and his associates evaluated 821 medical or surgical ICU patients with respiratory failure and/or shock who were enrolled in the BRAIN-ICU observational cohort study (N. Engl. J. Med. 2013;369:1306-16).

They used the Confusion Assessment Method for the ICU (CAM-ICU) to screen for delirium symptoms twice daily in the ICU and daily thereafter. The researchers considered delirium to be present if the CAM-ICU was positive. If the CAM-ICU was negative, they considered subsyndromal delirium (SSD) to be present if any delirium features were present or if inattention was present with or without other features of delirium.

SSD "is said to be present when a patient exhibits some delirium symptoms but does not meet the full delirium diagnostic criteria," the researchers wrote in their poster. "In patients without critical illness, SSD is associated with institutionalization, mortality, and cognitive decline, but these associations remain unclear in the critically ill."

The researchers tracked discharge location, mortality after hospital discharge and assessed for cognitive impairment at 3 and 12 months follow-up and used multivariate regression to determine the relationship between days of SSD and outcomes.

The mean age of the 821 patients was 61 years and their mean APACHE II score was 25. In all, 702 patients (86%) had SSD that lasted an average of 3 days. The most common SSU pattern based on the CAM-ICU was fluctuation of mental status (which occurred in 50% of assessments) and fluctuation in mental status plus altered level of consciousness (which occurred in 22% of assessments).

Dr. Brummel and his associates also found that the duration of SSD was independently associated with increased odds of institutionalization (odds ratio, 1.90), but SSD did not predict mortality or long-term cognitive impairment at 3 or 12 months. "We don’t yet understand the mechanism behind why subsyndromal delirium and institutionalization are associated," Dr. Brummel said. "It probably relates to an association between SSD and factors that drive institutionalization, such as physical disability and cognitive impairment. Once patients survived the hospital stay, subsyndromal delirium wasn’t associated with an increased risk of mortality. It may be the fact that this less severe form of brain dysfunction in the ICU does not have the same effect as the full syndrome of delirium."

He acknowledged certain limitations of the study, including the fact that the CAM-ICU only measures four features of delirium and that no assessments of cognitive or physical function were conducted at hospital discharge.

The study was supported by the National Institutes of Health, the Vanderbilt Clinical and Translational Scholars Program, and the Veterans Affairs Tennessee Valley Healthcare System Geriatric Research Education and Clinical Centers. Dr. Brummel said that he had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Subsyndromal delirium was present in 86% of critically ill patients, results from a large observational study demonstrated. In addition, the duration of delirium was associated with increased odds of institutionalization, an association that was modified by the duration of delirium.

"In patients with less delirium, the effect of subsyndromal delirium on institutionalization was actually stronger," lead author Dr. Nathan E. Brummel said in an interview at an international conference of the American Thoracic Society, where the research was presented. "This identifies a cohort of people who previously were considered to have normal brain function, but it appears that this has long-term implications for their lives.

"Screening for delirium should occur not only in the ICU but on the wards as well. Patients who have delirium or delirium symptoms may benefit from measures used to prevent and treat this syndrome, such as the Hospital Elder Life Program, routine mobilization, and frequent reorientation through the use of nursing staff or even family members," he later added. This study data may help clinicians discuss long-term outcomes of critical illness with patients and their family members," he said.

For the study, Dr. Brummel, an instructor in medicine in the division of allergy, pulmonary and critical care medicine at Vanderbilt University Medical Center, Nashville, Tenn., and his associates evaluated 821 medical or surgical ICU patients with respiratory failure and/or shock who were enrolled in the BRAIN-ICU observational cohort study (N. Engl. J. Med. 2013;369:1306-16).

They used the Confusion Assessment Method for the ICU (CAM-ICU) to screen for delirium symptoms twice daily in the ICU and daily thereafter. The researchers considered delirium to be present if the CAM-ICU was positive. If the CAM-ICU was negative, they considered subsyndromal delirium (SSD) to be present if any delirium features were present or if inattention was present with or without other features of delirium.

SSD "is said to be present when a patient exhibits some delirium symptoms but does not meet the full delirium diagnostic criteria," the researchers wrote in their poster. "In patients without critical illness, SSD is associated with institutionalization, mortality, and cognitive decline, but these associations remain unclear in the critically ill."

The researchers tracked discharge location, mortality after hospital discharge and assessed for cognitive impairment at 3 and 12 months follow-up and used multivariate regression to determine the relationship between days of SSD and outcomes.

The mean age of the 821 patients was 61 years and their mean APACHE II score was 25. In all, 702 patients (86%) had SSD that lasted an average of 3 days. The most common SSU pattern based on the CAM-ICU was fluctuation of mental status (which occurred in 50% of assessments) and fluctuation in mental status plus altered level of consciousness (which occurred in 22% of assessments).

Dr. Brummel and his associates also found that the duration of SSD was independently associated with increased odds of institutionalization (odds ratio, 1.90), but SSD did not predict mortality or long-term cognitive impairment at 3 or 12 months. "We don’t yet understand the mechanism behind why subsyndromal delirium and institutionalization are associated," Dr. Brummel said. "It probably relates to an association between SSD and factors that drive institutionalization, such as physical disability and cognitive impairment. Once patients survived the hospital stay, subsyndromal delirium wasn’t associated with an increased risk of mortality. It may be the fact that this less severe form of brain dysfunction in the ICU does not have the same effect as the full syndrome of delirium."

He acknowledged certain limitations of the study, including the fact that the CAM-ICU only measures four features of delirium and that no assessments of cognitive or physical function were conducted at hospital discharge.

The study was supported by the National Institutes of Health, the Vanderbilt Clinical and Translational Scholars Program, and the Veterans Affairs Tennessee Valley Healthcare System Geriatric Research Education and Clinical Centers. Dr. Brummel said that he had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Subsyndromal delirium was present in 86% of critically ill patients, results from a large observational study demonstrated. In addition, the duration of delirium was associated with increased odds of institutionalization, an association that was modified by the duration of delirium.

"In patients with less delirium, the effect of subsyndromal delirium on institutionalization was actually stronger," lead author Dr. Nathan E. Brummel said in an interview at an international conference of the American Thoracic Society, where the research was presented. "This identifies a cohort of people who previously were considered to have normal brain function, but it appears that this has long-term implications for their lives.

"Screening for delirium should occur not only in the ICU but on the wards as well. Patients who have delirium or delirium symptoms may benefit from measures used to prevent and treat this syndrome, such as the Hospital Elder Life Program, routine mobilization, and frequent reorientation through the use of nursing staff or even family members," he later added. This study data may help clinicians discuss long-term outcomes of critical illness with patients and their family members," he said.

For the study, Dr. Brummel, an instructor in medicine in the division of allergy, pulmonary and critical care medicine at Vanderbilt University Medical Center, Nashville, Tenn., and his associates evaluated 821 medical or surgical ICU patients with respiratory failure and/or shock who were enrolled in the BRAIN-ICU observational cohort study (N. Engl. J. Med. 2013;369:1306-16).

They used the Confusion Assessment Method for the ICU (CAM-ICU) to screen for delirium symptoms twice daily in the ICU and daily thereafter. The researchers considered delirium to be present if the CAM-ICU was positive. If the CAM-ICU was negative, they considered subsyndromal delirium (SSD) to be present if any delirium features were present or if inattention was present with or without other features of delirium.

SSD "is said to be present when a patient exhibits some delirium symptoms but does not meet the full delirium diagnostic criteria," the researchers wrote in their poster. "In patients without critical illness, SSD is associated with institutionalization, mortality, and cognitive decline, but these associations remain unclear in the critically ill."

The researchers tracked discharge location, mortality after hospital discharge and assessed for cognitive impairment at 3 and 12 months follow-up and used multivariate regression to determine the relationship between days of SSD and outcomes.

The mean age of the 821 patients was 61 years and their mean APACHE II score was 25. In all, 702 patients (86%) had SSD that lasted an average of 3 days. The most common SSU pattern based on the CAM-ICU was fluctuation of mental status (which occurred in 50% of assessments) and fluctuation in mental status plus altered level of consciousness (which occurred in 22% of assessments).

Dr. Brummel and his associates also found that the duration of SSD was independently associated with increased odds of institutionalization (odds ratio, 1.90), but SSD did not predict mortality or long-term cognitive impairment at 3 or 12 months. "We don’t yet understand the mechanism behind why subsyndromal delirium and institutionalization are associated," Dr. Brummel said. "It probably relates to an association between SSD and factors that drive institutionalization, such as physical disability and cognitive impairment. Once patients survived the hospital stay, subsyndromal delirium wasn’t associated with an increased risk of mortality. It may be the fact that this less severe form of brain dysfunction in the ICU does not have the same effect as the full syndrome of delirium."

He acknowledged certain limitations of the study, including the fact that the CAM-ICU only measures four features of delirium and that no assessments of cognitive or physical function were conducted at hospital discharge.

The study was supported by the National Institutes of Health, the Vanderbilt Clinical and Translational Scholars Program, and the Veterans Affairs Tennessee Valley Healthcare System Geriatric Research Education and Clinical Centers. Dr. Brummel said that he had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

DENVER – As the nanotechnology field evolves, there are at least three reasons a clinician might prefer to use nanoparticles over conventional drugs, according to Dr. Jack L. Arbiser. The first is to minimize the effects of a systemic drug.

"What if steroids could be directed to the site of the pathologic lesion but not cause side effects such as glucose intolerance, bone fractures, or gastric ulcers?" he asked during a session on nanotechnology at the annual meeting of the American Academy of Dermatology. "What if propranolol could be given to patients with hemangiomas without having to worry about cardiac side effects?"

A second reason to turn to nanoparticles would be to use highly toxic substances in a safe way, continued Dr. Arbiser, a professor of dermatology at Emory University, Atlanta. "We already use Botox by injection, which is one of the most toxic substances known to man, but what if other highly toxic substances could be specifically delivered to cancers, infections, or inflammation?"

A third reason to use nanoparticles is that they may offer a way for compounds "that are not highly active be delivered to sites of disease in high enough concentration so that they have therapeutic activity and provide a high measure of safety," he said.

Dr. Arbiser discussed his nanotechnology experience as part of a research team developing a derivative of gentian violet for cancer treatment. He and his associates observed that gentian violet has potential antitumor activity through inhibition of NADPH (nicotinamide adenine dinucleotide phosphate) oxidase. However, the researchers faced early challenges, because gentian violet is not patentable by itself, and, because it is hydrophilic, it may not pass through the blood-brain barrier.

"Our solution was to synthesize and patent a more lipophilic derivative of gentian violet called imipramine blue," Dr. Arbiser explained. "We packaged it in liposomes so it has a much longer half-life and is directed to tumors because liposomes preferentially localize to leaky blood vessels."

Imipramine blue can be given weekly and is efficacious against cancer tumors. Dr. Arbiser and his associates have demonstrated that systemic delivery of imipramine blue significantly inhibited migration of glioblastoma cells into the brain parenchyma (Sci. Transl. Med. 2012;4:127ra36).

"We also see this [inhibition of spread] in prostate, breast, and melanoma cells," he said. "So it seems to be hitting the same pathway in multiple different tumor types." Such an approach targets delivery of therapeutic and diagnostic imaging agents to the site of cancer and chronic inflammation/infection, potentially reducing side effects and increasing efficacy.

"My own personal bias is that we should start using metal-based nanotechnology for severe illnesses, such as cancers, allowing the effects of these materials to be studied in humans, before widespread introduction into cosmetics," he concluded.

Dr. Arbiser disclosed that he is the cofounder of companies ABBY Therapeutics and Accuitis.

dbrunk@frontlinemedcom.com

DENVER – As the nanotechnology field evolves, there are at least three reasons a clinician might prefer to use nanoparticles over conventional drugs, according to Dr. Jack L. Arbiser. The first is to minimize the effects of a systemic drug.

"What if steroids could be directed to the site of the pathologic lesion but not cause side effects such as glucose intolerance, bone fractures, or gastric ulcers?" he asked during a session on nanotechnology at the annual meeting of the American Academy of Dermatology. "What if propranolol could be given to patients with hemangiomas without having to worry about cardiac side effects?"

A second reason to turn to nanoparticles would be to use highly toxic substances in a safe way, continued Dr. Arbiser, a professor of dermatology at Emory University, Atlanta. "We already use Botox by injection, which is one of the most toxic substances known to man, but what if other highly toxic substances could be specifically delivered to cancers, infections, or inflammation?"

A third reason to use nanoparticles is that they may offer a way for compounds "that are not highly active be delivered to sites of disease in high enough concentration so that they have therapeutic activity and provide a high measure of safety," he said.

Dr. Arbiser discussed his nanotechnology experience as part of a research team developing a derivative of gentian violet for cancer treatment. He and his associates observed that gentian violet has potential antitumor activity through inhibition of NADPH (nicotinamide adenine dinucleotide phosphate) oxidase. However, the researchers faced early challenges, because gentian violet is not patentable by itself, and, because it is hydrophilic, it may not pass through the blood-brain barrier.

"Our solution was to synthesize and patent a more lipophilic derivative of gentian violet called imipramine blue," Dr. Arbiser explained. "We packaged it in liposomes so it has a much longer half-life and is directed to tumors because liposomes preferentially localize to leaky blood vessels."

Imipramine blue can be given weekly and is efficacious against cancer tumors. Dr. Arbiser and his associates have demonstrated that systemic delivery of imipramine blue significantly inhibited migration of glioblastoma cells into the brain parenchyma (Sci. Transl. Med. 2012;4:127ra36).

"We also see this [inhibition of spread] in prostate, breast, and melanoma cells," he said. "So it seems to be hitting the same pathway in multiple different tumor types." Such an approach targets delivery of therapeutic and diagnostic imaging agents to the site of cancer and chronic inflammation/infection, potentially reducing side effects and increasing efficacy.

"My own personal bias is that we should start using metal-based nanotechnology for severe illnesses, such as cancers, allowing the effects of these materials to be studied in humans, before widespread introduction into cosmetics," he concluded.

Dr. Arbiser disclosed that he is the cofounder of companies ABBY Therapeutics and Accuitis.

dbrunk@frontlinemedcom.com

DENVER – As the nanotechnology field evolves, there are at least three reasons a clinician might prefer to use nanoparticles over conventional drugs, according to Dr. Jack L. Arbiser. The first is to minimize the effects of a systemic drug.

"What if steroids could be directed to the site of the pathologic lesion but not cause side effects such as glucose intolerance, bone fractures, or gastric ulcers?" he asked during a session on nanotechnology at the annual meeting of the American Academy of Dermatology. "What if propranolol could be given to patients with hemangiomas without having to worry about cardiac side effects?"

A second reason to turn to nanoparticles would be to use highly toxic substances in a safe way, continued Dr. Arbiser, a professor of dermatology at Emory University, Atlanta. "We already use Botox by injection, which is one of the most toxic substances known to man, but what if other highly toxic substances could be specifically delivered to cancers, infections, or inflammation?"

A third reason to use nanoparticles is that they may offer a way for compounds "that are not highly active be delivered to sites of disease in high enough concentration so that they have therapeutic activity and provide a high measure of safety," he said.

Dr. Arbiser discussed his nanotechnology experience as part of a research team developing a derivative of gentian violet for cancer treatment. He and his associates observed that gentian violet has potential antitumor activity through inhibition of NADPH (nicotinamide adenine dinucleotide phosphate) oxidase. However, the researchers faced early challenges, because gentian violet is not patentable by itself, and, because it is hydrophilic, it may not pass through the blood-brain barrier.

"Our solution was to synthesize and patent a more lipophilic derivative of gentian violet called imipramine blue," Dr. Arbiser explained. "We packaged it in liposomes so it has a much longer half-life and is directed to tumors because liposomes preferentially localize to leaky blood vessels."

Imipramine blue can be given weekly and is efficacious against cancer tumors. Dr. Arbiser and his associates have demonstrated that systemic delivery of imipramine blue significantly inhibited migration of glioblastoma cells into the brain parenchyma (Sci. Transl. Med. 2012;4:127ra36).

"We also see this [inhibition of spread] in prostate, breast, and melanoma cells," he said. "So it seems to be hitting the same pathway in multiple different tumor types." Such an approach targets delivery of therapeutic and diagnostic imaging agents to the site of cancer and chronic inflammation/infection, potentially reducing side effects and increasing efficacy.

"My own personal bias is that we should start using metal-based nanotechnology for severe illnesses, such as cancers, allowing the effects of these materials to be studied in humans, before widespread introduction into cosmetics," he concluded.

Dr. Arbiser disclosed that he is the cofounder of companies ABBY Therapeutics and Accuitis.

dbrunk@frontlinemedcom.com

SAN FRANCISCO – Patients with implantable pacemakers and defibrillators who engage in remote monitoring at more than 75% adherence rates have a 2.4-fold higher rate of survival than those who do not engage in remote monitoring, based on data from 262,574 patients.

"All patients should be enrolled in remote monitoring and [be] encouraged to engage with remote monitoring at a high level, because the mortality reductions associated with remote monitoring are of a very significant and sizeable proportion," Dr. Suneet Mittal said during a press briefing at the annual scientific sessions of the Heart Rhythm Society.

Most patients who undergo device implantation in the United States "are not enrolled in a remote monitoring program, or, if enrolled in a monitoring program, do not reliably engage in remote monitoring," said Dr. Mittal, director of electrophysiology for Valley Health System of New York and New Jersey, Ridgewood, New Jersey. "This is concerning, because one prior study looking at individuals who underwent remote monitoring of their defibrillators suggest a nearly 50% reduction in mortality in the group of patients who were using remote monitoring [Circulation 2010;122[23]:2359-67]."

In a first-of-its-kind study, Dr. Mittal and his associates set out to determine whether this association also applied to pacemaker patients, whether there was a relationship between the amount of remote monitoring of patient use and their ultimate outcome, and whether there were any variables that could be used to identify patients who were or were not using remote monitoring. The population included 262,574 patients with a mean age of 71 years who received implantable pacemakers, cardiac resynchronization therapy pacemakers (CRT-Ps), cardiac resynchronization therapy cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy defibrillators (CRT-Ds). The majority were implanted with a St. Jude Medical pacemaker (112,692), CRT-P (7,704), ICD (82,621), or CRT-D (59,547). Nearly two-thirds of the patients (65%) were men.

Patients who adhered to remote monitoring more than 75% of the time had a 2.4-fold higher rate of survival, compared with patients who were never remotely monitored. "Even more importantly, those who were being remotely monitored more than 75% of the time had a 1.5-fold higher survival than patients who were being remotely monitored but were only engaged in remote monitoring less than 75% of the time," Dr. Mittal added. The magnitude of benefit was the same regardless of the type of device that was implanted, "suggesting that this is a device-independent effect."

Dr. Mittal reported that 54% of patients never enrolled in remote monitoring.

The researchers analyzed U.S. Census data including demographics, poverty level, and education level in an effort to identify potential explanatory variables, but "we could not identify any variable that identified whether patients were using remote monitoring or not," Dr. Mittal said. "Somewhat surprisingly, patients living in the highest population density zones in the U.S. were the least likely to be enrolled and using remote monitoring as opposed to those individuals living in the Midwest and the Pacific Northwest."

Dr. Mittal disclosed that he is a consultant to multiple device makers including St. Jude Medical.

dbrunk@frontlinemedcom.com

On Twitter @dougbrunk

SAN FRANCISCO – Patients with implantable pacemakers and defibrillators who engage in remote monitoring at more than 75% adherence rates have a 2.4-fold higher rate of survival than those who do not engage in remote monitoring, based on data from 262,574 patients.

"All patients should be enrolled in remote monitoring and [be] encouraged to engage with remote monitoring at a high level, because the mortality reductions associated with remote monitoring are of a very significant and sizeable proportion," Dr. Suneet Mittal said during a press briefing at the annual scientific sessions of the Heart Rhythm Society.

Most patients who undergo device implantation in the United States "are not enrolled in a remote monitoring program, or, if enrolled in a monitoring program, do not reliably engage in remote monitoring," said Dr. Mittal, director of electrophysiology for Valley Health System of New York and New Jersey, Ridgewood, New Jersey. "This is concerning, because one prior study looking at individuals who underwent remote monitoring of their defibrillators suggest a nearly 50% reduction in mortality in the group of patients who were using remote monitoring [Circulation 2010;122[23]:2359-67]."

In a first-of-its-kind study, Dr. Mittal and his associates set out to determine whether this association also applied to pacemaker patients, whether there was a relationship between the amount of remote monitoring of patient use and their ultimate outcome, and whether there were any variables that could be used to identify patients who were or were not using remote monitoring. The population included 262,574 patients with a mean age of 71 years who received implantable pacemakers, cardiac resynchronization therapy pacemakers (CRT-Ps), cardiac resynchronization therapy cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy defibrillators (CRT-Ds). The majority were implanted with a St. Jude Medical pacemaker (112,692), CRT-P (7,704), ICD (82,621), or CRT-D (59,547). Nearly two-thirds of the patients (65%) were men.

Patients who adhered to remote monitoring more than 75% of the time had a 2.4-fold higher rate of survival, compared with patients who were never remotely monitored. "Even more importantly, those who were being remotely monitored more than 75% of the time had a 1.5-fold higher survival than patients who were being remotely monitored but were only engaged in remote monitoring less than 75% of the time," Dr. Mittal added. The magnitude of benefit was the same regardless of the type of device that was implanted, "suggesting that this is a device-independent effect."

Dr. Mittal reported that 54% of patients never enrolled in remote monitoring.

The researchers analyzed U.S. Census data including demographics, poverty level, and education level in an effort to identify potential explanatory variables, but "we could not identify any variable that identified whether patients were using remote monitoring or not," Dr. Mittal said. "Somewhat surprisingly, patients living in the highest population density zones in the U.S. were the least likely to be enrolled and using remote monitoring as opposed to those individuals living in the Midwest and the Pacific Northwest."

Dr. Mittal disclosed that he is a consultant to multiple device makers including St. Jude Medical.

dbrunk@frontlinemedcom.com

On Twitter @dougbrunk

SAN FRANCISCO – Patients with implantable pacemakers and defibrillators who engage in remote monitoring at more than 75% adherence rates have a 2.4-fold higher rate of survival than those who do not engage in remote monitoring, based on data from 262,574 patients.

"All patients should be enrolled in remote monitoring and [be] encouraged to engage with remote monitoring at a high level, because the mortality reductions associated with remote monitoring are of a very significant and sizeable proportion," Dr. Suneet Mittal said during a press briefing at the annual scientific sessions of the Heart Rhythm Society.

Most patients who undergo device implantation in the United States "are not enrolled in a remote monitoring program, or, if enrolled in a monitoring program, do not reliably engage in remote monitoring," said Dr. Mittal, director of electrophysiology for Valley Health System of New York and New Jersey, Ridgewood, New Jersey. "This is concerning, because one prior study looking at individuals who underwent remote monitoring of their defibrillators suggest a nearly 50% reduction in mortality in the group of patients who were using remote monitoring [Circulation 2010;122[23]:2359-67]."

In a first-of-its-kind study, Dr. Mittal and his associates set out to determine whether this association also applied to pacemaker patients, whether there was a relationship between the amount of remote monitoring of patient use and their ultimate outcome, and whether there were any variables that could be used to identify patients who were or were not using remote monitoring. The population included 262,574 patients with a mean age of 71 years who received implantable pacemakers, cardiac resynchronization therapy pacemakers (CRT-Ps), cardiac resynchronization therapy cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy defibrillators (CRT-Ds). The majority were implanted with a St. Jude Medical pacemaker (112,692), CRT-P (7,704), ICD (82,621), or CRT-D (59,547). Nearly two-thirds of the patients (65%) were men.

Patients who adhered to remote monitoring more than 75% of the time had a 2.4-fold higher rate of survival, compared with patients who were never remotely monitored. "Even more importantly, those who were being remotely monitored more than 75% of the time had a 1.5-fold higher survival than patients who were being remotely monitored but were only engaged in remote monitoring less than 75% of the time," Dr. Mittal added. The magnitude of benefit was the same regardless of the type of device that was implanted, "suggesting that this is a device-independent effect."

Dr. Mittal reported that 54% of patients never enrolled in remote monitoring.

The researchers analyzed U.S. Census data including demographics, poverty level, and education level in an effort to identify potential explanatory variables, but "we could not identify any variable that identified whether patients were using remote monitoring or not," Dr. Mittal said. "Somewhat surprisingly, patients living in the highest population density zones in the U.S. were the least likely to be enrolled and using remote monitoring as opposed to those individuals living in the Midwest and the Pacific Northwest."

Dr. Mittal disclosed that he is a consultant to multiple device makers including St. Jude Medical.

dbrunk@frontlinemedcom.com

On Twitter @dougbrunk

SAN DIEGO – Following an ICU stay, about one-fourth of critical illness survivors are affected by symptoms of posttraumatic stress disorder, a meta-analysis of studies representing 3,437 patients demonstrated.

During a press briefing at an international conference of the American Thoracic Society, Dr. Ann Parker, a fellow in pulmonary and critical care medicine at Johns Hopkins University, Baltimore, discussed the findings and noted that certain patient-related risk factors influenced the association, including younger age, preexisting mental health problems, and post-ICU memories of frightening experiences in the ICU.

dbrunk@frontlinemedcom.com

On Twitter @dougbrunk

SAN DIEGO – Following an ICU stay, about one-fourth of critical illness survivors are affected by symptoms of posttraumatic stress disorder, a meta-analysis of studies representing 3,437 patients demonstrated.

During a press briefing at an international conference of the American Thoracic Society, Dr. Ann Parker, a fellow in pulmonary and critical care medicine at Johns Hopkins University, Baltimore, discussed the findings and noted that certain patient-related risk factors influenced the association, including younger age, preexisting mental health problems, and post-ICU memories of frightening experiences in the ICU.

dbrunk@frontlinemedcom.com

On Twitter @dougbrunk

SAN DIEGO – Following an ICU stay, about one-fourth of critical illness survivors are affected by symptoms of posttraumatic stress disorder, a meta-analysis of studies representing 3,437 patients demonstrated.

During a press briefing at an international conference of the American Thoracic Society, Dr. Ann Parker, a fellow in pulmonary and critical care medicine at Johns Hopkins University, Baltimore, discussed the findings and noted that certain patient-related risk factors influenced the association, including younger age, preexisting mental health problems, and post-ICU memories of frightening experiences in the ICU.

dbrunk@frontlinemedcom.com

On Twitter @dougbrunk

LAS VEGAS – Many barriers to chronic kidney disease detection and screening exist in today’s health care landscape, according to Dr. Georges Saab.

For one thing, patient have a lack of knowledge about chronic kidney disease (CKD) and receive very little education about it, explained Dr. Saab of the department of medicine at Case Western Reserve University and MetroHealth Medical Center, Cleveland.

Patients lack education about CKD "because they don’t ask about it," Dr. Saab said at a meeting sponsored by the National Kidney Foundation. "They know about their hypertension, diabetes, and cholesterol, but they don’t know about kidney disease; they don’t take medications for kidney disease, so they fail to recognize it as a distinct entity."

He noted that some primary care physicians feel they lack the knowledge and skills to educate patients on CKD. Thus, measures to enhance these skills are needed. Others are not familiar with published CKD screening guidelines, and among those that are, the recommendations are not consistent in whom to screen.

Dr. Saab called for ways to improve physician and patient education on risk factors for CKD and on the impact of the disease. Such information is available from the National Kidney Foundation and the National Kidney Disease Education Program. Recently, the National Kidney Foundation launched the CKD Primary Care Initiative to identify and overcome barriers to CKD testing, detection, and management in the primary care setting. The NKF’s CKD Primary Care Initiative will disseminate CKD guidelines to PCPs around the United States through education programs, symposia, and practical implementation tools.

Other strategies that could be used include implementing clinical reminders to screen for CKD in high-risk groups, routine reporting of estimated glomerular filtration rate (eGFR), incentivizing providers for higher-quality care, including screening for CKD, and providing patients with access to their laboratory data. He notes that patients themselves may initiate the process of referral to a nephrologist if given access to their results.

Community-based screening also has the potential to eliminate or mitigate some of the patient and physician barriers to screening. Dr. Saab cited the NKF’s Kidney Early Evaluation Program (KEEP) as an example. Between 2000 and 2013, KEEP reached more than 185,000 individuals at increased risk for developing CKD. The KEEP program "is free, it’s in a nonmedical location, such as a church or town hall, and it’s managed by a trained staff and nephrologists," Dr. Saab said of the program. "It’s also short in duration – it only takes about 45 minutes – and it’s focused on CKD and related issues."

Of KEEP data collected through 2010, roughly 20% of participants were found to have CKD (Am. J. Kidney Dis. 2012;60:692-3. At the time of screening, patients are asked if they’re aware if they have any kidney problems or not. Awareness increased from 8.8% in 2000-2002 to 16.6% in 2009-2011, "which means that the message is getting out there, and patients are getting screened a little more commonly than they were before," he said.

Community screening for CKD appears to increase patient awareness of chronic kidney disease, "and it may indirectly lead to increased screening in clinical encounters," Dr. Saab said. "For example, KEEP reports sent to PCPs may influence screening and detection, and friends and family members of those screened may also seek screening."

Another community-based initiative is the NKF’s KEEP Healthy program, designed to educate people about the kidneys and risk factors for kidney disease. A check-up for participants includes a risk survey, body mass index, blood pressure check, free educational materials, and an opportunity to speak with a health care professional.

"Awareness of CKD is low," Dr. Peter A. McCullough, chair of the NKF’s Kidney Early Evaluation Program Steering Committee, said during a separate presentation at the meeting. "We have to get to levels of awareness of diabetes, heart disease, and cancer. In kidney disease, we haven’t gotten there yet. I haven’t seen a single data set where [awareness] is more than 50%."

In his opinion, clinicians should screen for CKD with KEEP Healthy and other clinical and community approaches, "because it raises awareness for risk factors and CKD, it potentially triggers better risk factor control, it potentially helps avoid additional insults along the way, and it readies for the next steps."

Dr. Saab acknowledged limitations of community-based screening, including the fact that isolated measurements may lead to misclassification. "But that is usually the case in all screening processes," he added. "It also requires external funding, and it does attract patients who are motivated to be screened, so you may not necessarily be catching the people who aren’t aware of CKD."

Electronic health records also have the potential to improve CKD screening and detection, he said. For example, a record query can be designed to extract variables that may impact detection or screening, including those at the patient, physician, or institutional level.

"You can also identify potential patients to be screened who don’t have eGFR or albuminuria assessment," Dr. Saab said, including the elderly and those with cardiovascular disease or obesity.

The remedy for improving current shortfalls in CKD screening and detection is likely to involve some combination of amendments to clinical encounters, community-based screening, and electronic health record queries, Dr. Saab predicted.

Dr. Saab said that he had no relevant financial disclosures.

dbrunk@frontlinemedcom.com

LAS VEGAS – Many barriers to chronic kidney disease detection and screening exist in today’s health care landscape, according to Dr. Georges Saab.

For one thing, patient have a lack of knowledge about chronic kidney disease (CKD) and receive very little education about it, explained Dr. Saab of the department of medicine at Case Western Reserve University and MetroHealth Medical Center, Cleveland.

Patients lack education about CKD "because they don’t ask about it," Dr. Saab said at a meeting sponsored by the National Kidney Foundation. "They know about their hypertension, diabetes, and cholesterol, but they don’t know about kidney disease; they don’t take medications for kidney disease, so they fail to recognize it as a distinct entity."

He noted that some primary care physicians feel they lack the knowledge and skills to educate patients on CKD. Thus, measures to enhance these skills are needed. Others are not familiar with published CKD screening guidelines, and among those that are, the recommendations are not consistent in whom to screen.

Dr. Saab called for ways to improve physician and patient education on risk factors for CKD and on the impact of the disease. Such information is available from the National Kidney Foundation and the National Kidney Disease Education Program. Recently, the National Kidney Foundation launched the CKD Primary Care Initiative to identify and overcome barriers to CKD testing, detection, and management in the primary care setting. The NKF’s CKD Primary Care Initiative will disseminate CKD guidelines to PCPs around the United States through education programs, symposia, and practical implementation tools.

Other strategies that could be used include implementing clinical reminders to screen for CKD in high-risk groups, routine reporting of estimated glomerular filtration rate (eGFR), incentivizing providers for higher-quality care, including screening for CKD, and providing patients with access to their laboratory data. He notes that patients themselves may initiate the process of referral to a nephrologist if given access to their results.

Community-based screening also has the potential to eliminate or mitigate some of the patient and physician barriers to screening. Dr. Saab cited the NKF’s Kidney Early Evaluation Program (KEEP) as an example. Between 2000 and 2013, KEEP reached more than 185,000 individuals at increased risk for developing CKD. The KEEP program "is free, it’s in a nonmedical location, such as a church or town hall, and it’s managed by a trained staff and nephrologists," Dr. Saab said of the program. "It’s also short in duration – it only takes about 45 minutes – and it’s focused on CKD and related issues."

Of KEEP data collected through 2010, roughly 20% of participants were found to have CKD (Am. J. Kidney Dis. 2012;60:692-3. At the time of screening, patients are asked if they’re aware if they have any kidney problems or not. Awareness increased from 8.8% in 2000-2002 to 16.6% in 2009-2011, "which means that the message is getting out there, and patients are getting screened a little more commonly than they were before," he said.

Community screening for CKD appears to increase patient awareness of chronic kidney disease, "and it may indirectly lead to increased screening in clinical encounters," Dr. Saab said. "For example, KEEP reports sent to PCPs may influence screening and detection, and friends and family members of those screened may also seek screening."

Another community-based initiative is the NKF’s KEEP Healthy program, designed to educate people about the kidneys and risk factors for kidney disease. A check-up for participants includes a risk survey, body mass index, blood pressure check, free educational materials, and an opportunity to speak with a health care professional.

"Awareness of CKD is low," Dr. Peter A. McCullough, chair of the NKF’s Kidney Early Evaluation Program Steering Committee, said during a separate presentation at the meeting. "We have to get to levels of awareness of diabetes, heart disease, and cancer. In kidney disease, we haven’t gotten there yet. I haven’t seen a single data set where [awareness] is more than 50%."

In his opinion, clinicians should screen for CKD with KEEP Healthy and other clinical and community approaches, "because it raises awareness for risk factors and CKD, it potentially triggers better risk factor control, it potentially helps avoid additional insults along the way, and it readies for the next steps."

Dr. Saab acknowledged limitations of community-based screening, including the fact that isolated measurements may lead to misclassification. "But that is usually the case in all screening processes," he added. "It also requires external funding, and it does attract patients who are motivated to be screened, so you may not necessarily be catching the people who aren’t aware of CKD."

Electronic health records also have the potential to improve CKD screening and detection, he said. For example, a record query can be designed to extract variables that may impact detection or screening, including those at the patient, physician, or institutional level.

"You can also identify potential patients to be screened who don’t have eGFR or albuminuria assessment," Dr. Saab said, including the elderly and those with cardiovascular disease or obesity.

The remedy for improving current shortfalls in CKD screening and detection is likely to involve some combination of amendments to clinical encounters, community-based screening, and electronic health record queries, Dr. Saab predicted.

Dr. Saab said that he had no relevant financial disclosures.

dbrunk@frontlinemedcom.com

LAS VEGAS – Many barriers to chronic kidney disease detection and screening exist in today’s health care landscape, according to Dr. Georges Saab.

For one thing, patient have a lack of knowledge about chronic kidney disease (CKD) and receive very little education about it, explained Dr. Saab of the department of medicine at Case Western Reserve University and MetroHealth Medical Center, Cleveland.

Patients lack education about CKD "because they don’t ask about it," Dr. Saab said at a meeting sponsored by the National Kidney Foundation. "They know about their hypertension, diabetes, and cholesterol, but they don’t know about kidney disease; they don’t take medications for kidney disease, so they fail to recognize it as a distinct entity."

He noted that some primary care physicians feel they lack the knowledge and skills to educate patients on CKD. Thus, measures to enhance these skills are needed. Others are not familiar with published CKD screening guidelines, and among those that are, the recommendations are not consistent in whom to screen.

Dr. Saab called for ways to improve physician and patient education on risk factors for CKD and on the impact of the disease. Such information is available from the National Kidney Foundation and the National Kidney Disease Education Program. Recently, the National Kidney Foundation launched the CKD Primary Care Initiative to identify and overcome barriers to CKD testing, detection, and management in the primary care setting. The NKF’s CKD Primary Care Initiative will disseminate CKD guidelines to PCPs around the United States through education programs, symposia, and practical implementation tools.

Other strategies that could be used include implementing clinical reminders to screen for CKD in high-risk groups, routine reporting of estimated glomerular filtration rate (eGFR), incentivizing providers for higher-quality care, including screening for CKD, and providing patients with access to their laboratory data. He notes that patients themselves may initiate the process of referral to a nephrologist if given access to their results.

Community-based screening also has the potential to eliminate or mitigate some of the patient and physician barriers to screening. Dr. Saab cited the NKF’s Kidney Early Evaluation Program (KEEP) as an example. Between 2000 and 2013, KEEP reached more than 185,000 individuals at increased risk for developing CKD. The KEEP program "is free, it’s in a nonmedical location, such as a church or town hall, and it’s managed by a trained staff and nephrologists," Dr. Saab said of the program. "It’s also short in duration – it only takes about 45 minutes – and it’s focused on CKD and related issues."

Of KEEP data collected through 2010, roughly 20% of participants were found to have CKD (Am. J. Kidney Dis. 2012;60:692-3. At the time of screening, patients are asked if they’re aware if they have any kidney problems or not. Awareness increased from 8.8% in 2000-2002 to 16.6% in 2009-2011, "which means that the message is getting out there, and patients are getting screened a little more commonly than they were before," he said.

Community screening for CKD appears to increase patient awareness of chronic kidney disease, "and it may indirectly lead to increased screening in clinical encounters," Dr. Saab said. "For example, KEEP reports sent to PCPs may influence screening and detection, and friends and family members of those screened may also seek screening."

Another community-based initiative is the NKF’s KEEP Healthy program, designed to educate people about the kidneys and risk factors for kidney disease. A check-up for participants includes a risk survey, body mass index, blood pressure check, free educational materials, and an opportunity to speak with a health care professional.

"Awareness of CKD is low," Dr. Peter A. McCullough, chair of the NKF’s Kidney Early Evaluation Program Steering Committee, said during a separate presentation at the meeting. "We have to get to levels of awareness of diabetes, heart disease, and cancer. In kidney disease, we haven’t gotten there yet. I haven’t seen a single data set where [awareness] is more than 50%."

In his opinion, clinicians should screen for CKD with KEEP Healthy and other clinical and community approaches, "because it raises awareness for risk factors and CKD, it potentially triggers better risk factor control, it potentially helps avoid additional insults along the way, and it readies for the next steps."

Dr. Saab acknowledged limitations of community-based screening, including the fact that isolated measurements may lead to misclassification. "But that is usually the case in all screening processes," he added. "It also requires external funding, and it does attract patients who are motivated to be screened, so you may not necessarily be catching the people who aren’t aware of CKD."

Electronic health records also have the potential to improve CKD screening and detection, he said. For example, a record query can be designed to extract variables that may impact detection or screening, including those at the patient, physician, or institutional level.

"You can also identify potential patients to be screened who don’t have eGFR or albuminuria assessment," Dr. Saab said, including the elderly and those with cardiovascular disease or obesity.

The remedy for improving current shortfalls in CKD screening and detection is likely to involve some combination of amendments to clinical encounters, community-based screening, and electronic health record queries, Dr. Saab predicted.

Dr. Saab said that he had no relevant financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Home-based testing for obstructive sleep apnea averaged $564 less than laboratory-based testing and did not increase other costs or produce clinically inferior outcomes, based on data from a study of Veterans Affairs patients.

"If you do the home testing approach, that saves you money right off the bat, compared with laboratory testing," Dr. Charles W. Atwood said in an interview in advance of an international conference of the American Thoracic Society, where the research was presented.

"Everything else for the patients is pretty comparable," he said. "That’s a good thing for people in favor of home testing. People don’t have deleterious outcomes because they were evaluated in the home setting, or because treatment was initiated in the home setting instead of a laboratory setting. People don’t generate more health care bills because they were evaluated in the home instead of in a lab."

In what he characterized as the most comprehensive study of its kind, Dr. Atwood, associate professor of medicine at the University of Pittsburgh, and his associates enrolled 296 patients from two VA sites who were randomized to standard in-laboratory polysomnography testing (lab group) or unattended home testing (home group). Patients in the home group underwent overnight recording with an Embla type 3 portable monitor followed by at least three nights of using a Philips Respironics auto-titrating positive airway pressure apparatus.

The researchers obtained data from case report forms, staff logs, and VA records, and categorized the costs as sleep-related, pharmaceutical, lab, hospital, or "other." Next, they estimated costs per category using repeated measure generalized linear models reported in 2010 dollars and discounted at 3% per year.

The majority of study participants (95%) were male. Of the 296 patients, 223 (110 in the lab group and 113 in the home group) were initiated on continuous positive airway pressure (CPAP). Patients in the lab group were slightly younger, compared with their counterparts in the home group (an average of 52 vs. 55 years, respectively; P = .02), but no other baseline characteristics were significantly different between the groups.

After an average follow-up of 2.75 years, the researchers determined that home-based testing costs were $564 lower, compared with lab-based testing (an average per-patient cost of $4,057 vs. $4,621, respectively; P = .007). Differences in the other four categories of cost did not reach statistical significance, with P values ranging between .19 and .82. Results of the Functional Outcomes of Sleep Questionnaire revealed no statistical difference in clinical outcomes between the two groups.

"This is more evidence that supports the use of home sleep apnea testing, followed by initiation of CPAP in the home setting as opposed to the laboratory setting, for people with routine OSA," said Dr. Atwood, who is also director of the sleep disorders program for the VA Pittsburgh Health Care System.

One limitation of the study, he said, is that it was conducted in the VA hospital system and may not be generalizable to other practice settings. Also, "this was done mostly in men; there were relatively few women," he said. "So whether this would work as well in women we can’t really say. We did not exclude people with other comorbid conditions, so that’s actually in our favor. A lot of studies that have been done in the home testing arena have excluded people with a history of mental illness or behavioral health problems, and those with any degree of congestive heart failure or CPOD. We did not exclude people on the basis of those other disorders. In that sense, it’s a broader population than has been typically studied in the home setting."

Embla provided the portable monitors used in the study and Philips Respironics provided the auto-titrating CPAP apparatus. The study was funded by the VA’s Health Research and Development Service. Dr. Atwood said that he had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Home-based testing for obstructive sleep apnea averaged $564 less than laboratory-based testing and did not increase other costs or produce clinically inferior outcomes, based on data from a study of Veterans Affairs patients.

"If you do the home testing approach, that saves you money right off the bat, compared with laboratory testing," Dr. Charles W. Atwood said in an interview in advance of an international conference of the American Thoracic Society, where the research was presented.

"Everything else for the patients is pretty comparable," he said. "That’s a good thing for people in favor of home testing. People don’t have deleterious outcomes because they were evaluated in the home setting, or because treatment was initiated in the home setting instead of a laboratory setting. People don’t generate more health care bills because they were evaluated in the home instead of in a lab."

In what he characterized as the most comprehensive study of its kind, Dr. Atwood, associate professor of medicine at the University of Pittsburgh, and his associates enrolled 296 patients from two VA sites who were randomized to standard in-laboratory polysomnography testing (lab group) or unattended home testing (home group). Patients in the home group underwent overnight recording with an Embla type 3 portable monitor followed by at least three nights of using a Philips Respironics auto-titrating positive airway pressure apparatus.

The researchers obtained data from case report forms, staff logs, and VA records, and categorized the costs as sleep-related, pharmaceutical, lab, hospital, or "other." Next, they estimated costs per category using repeated measure generalized linear models reported in 2010 dollars and discounted at 3% per year.

The majority of study participants (95%) were male. Of the 296 patients, 223 (110 in the lab group and 113 in the home group) were initiated on continuous positive airway pressure (CPAP). Patients in the lab group were slightly younger, compared with their counterparts in the home group (an average of 52 vs. 55 years, respectively; P = .02), but no other baseline characteristics were significantly different between the groups.

After an average follow-up of 2.75 years, the researchers determined that home-based testing costs were $564 lower, compared with lab-based testing (an average per-patient cost of $4,057 vs. $4,621, respectively; P = .007). Differences in the other four categories of cost did not reach statistical significance, with P values ranging between .19 and .82. Results of the Functional Outcomes of Sleep Questionnaire revealed no statistical difference in clinical outcomes between the two groups.

"This is more evidence that supports the use of home sleep apnea testing, followed by initiation of CPAP in the home setting as opposed to the laboratory setting, for people with routine OSA," said Dr. Atwood, who is also director of the sleep disorders program for the VA Pittsburgh Health Care System.

One limitation of the study, he said, is that it was conducted in the VA hospital system and may not be generalizable to other practice settings. Also, "this was done mostly in men; there were relatively few women," he said. "So whether this would work as well in women we can’t really say. We did not exclude people with other comorbid conditions, so that’s actually in our favor. A lot of studies that have been done in the home testing arena have excluded people with a history of mental illness or behavioral health problems, and those with any degree of congestive heart failure or CPOD. We did not exclude people on the basis of those other disorders. In that sense, it’s a broader population than has been typically studied in the home setting."

Embla provided the portable monitors used in the study and Philips Respironics provided the auto-titrating CPAP apparatus. The study was funded by the VA’s Health Research and Development Service. Dr. Atwood said that he had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com

SAN DIEGO – Home-based testing for obstructive sleep apnea averaged $564 less than laboratory-based testing and did not increase other costs or produce clinically inferior outcomes, based on data from a study of Veterans Affairs patients.

"If you do the home testing approach, that saves you money right off the bat, compared with laboratory testing," Dr. Charles W. Atwood said in an interview in advance of an international conference of the American Thoracic Society, where the research was presented.

"Everything else for the patients is pretty comparable," he said. "That’s a good thing for people in favor of home testing. People don’t have deleterious outcomes because they were evaluated in the home setting, or because treatment was initiated in the home setting instead of a laboratory setting. People don’t generate more health care bills because they were evaluated in the home instead of in a lab."

In what he characterized as the most comprehensive study of its kind, Dr. Atwood, associate professor of medicine at the University of Pittsburgh, and his associates enrolled 296 patients from two VA sites who were randomized to standard in-laboratory polysomnography testing (lab group) or unattended home testing (home group). Patients in the home group underwent overnight recording with an Embla type 3 portable monitor followed by at least three nights of using a Philips Respironics auto-titrating positive airway pressure apparatus.

The researchers obtained data from case report forms, staff logs, and VA records, and categorized the costs as sleep-related, pharmaceutical, lab, hospital, or "other." Next, they estimated costs per category using repeated measure generalized linear models reported in 2010 dollars and discounted at 3% per year.

The majority of study participants (95%) were male. Of the 296 patients, 223 (110 in the lab group and 113 in the home group) were initiated on continuous positive airway pressure (CPAP). Patients in the lab group were slightly younger, compared with their counterparts in the home group (an average of 52 vs. 55 years, respectively; P = .02), but no other baseline characteristics were significantly different between the groups.

After an average follow-up of 2.75 years, the researchers determined that home-based testing costs were $564 lower, compared with lab-based testing (an average per-patient cost of $4,057 vs. $4,621, respectively; P = .007). Differences in the other four categories of cost did not reach statistical significance, with P values ranging between .19 and .82. Results of the Functional Outcomes of Sleep Questionnaire revealed no statistical difference in clinical outcomes between the two groups.

"This is more evidence that supports the use of home sleep apnea testing, followed by initiation of CPAP in the home setting as opposed to the laboratory setting, for people with routine OSA," said Dr. Atwood, who is also director of the sleep disorders program for the VA Pittsburgh Health Care System.

One limitation of the study, he said, is that it was conducted in the VA hospital system and may not be generalizable to other practice settings. Also, "this was done mostly in men; there were relatively few women," he said. "So whether this would work as well in women we can’t really say. We did not exclude people with other comorbid conditions, so that’s actually in our favor. A lot of studies that have been done in the home testing arena have excluded people with a history of mental illness or behavioral health problems, and those with any degree of congestive heart failure or CPOD. We did not exclude people on the basis of those other disorders. In that sense, it’s a broader population than has been typically studied in the home setting."

Embla provided the portable monitors used in the study and Philips Respironics provided the auto-titrating CPAP apparatus. The study was funded by the VA’s Health Research and Development Service. Dr. Atwood said that he had no relevant financial conflicts to disclose.

dbrunk@frontlinemedcom.com