Fidest – Agenzia giornalistica/press agency

Quotidiano di informazione – Anno 31 n° 229

Posts Tagged ‘cardiac arrest’

European Sudden Cardiac Arrest network explores gender-based prevention and treatment

Posted by fidest press agency su lunedì, 19 marzo 2018

Barcelona, Spain Researchers will use a European network of 90,000 patients to explore different approaches to prevention and treatment of sudden cardiac arrest for men and women, they announced today during a workshop on sex and gender differences at EHRA 2018.1
The European Sudden Cardiac Arrest network (ESCAPE-NET) is backed by the European Heart Rhythm Association (EHRA), a branch of the European Society of Cardiology (ESC), and the European Resuscitation Council (ERC).Sudden cardiac arrest is the consequence of a heart rhythm disorder called ventricular fibrillation. It is deadly within minutes if left untreated and survival rates are just 5–20%.
ESCAPE-NET has pooled the patient populations of 16 organisations across Europe. The resulting database of sudden cardiac arrest in the community is sufficiently large to study causes, treatments and prevention strategies, and how these vary between women and men.The electrical properties of the heart differ between men and women. The heart beats by an electrical conduction system in which ions (electrically charged molecules such as potassium) move back and forth across channels in the membranes of heart cells. Women have fewer potassium channels than men.Commonly prescribed drugs that work by blocking ion channels can increase the risk of ventricular fibrillation and sudden cardiac arrest. For potassium channel blockers, such as selective serotonin reuptake inhibitors (SSRIs) for depression, antibiotics including erythromycin, antifungal medications, and domperidone, the increased risk of sudden cardiac arrest may be larger in women.“Doctors want to know when these drugs can be safely prescribed in women,” said Dr Hanno Tan, ESCAPE-NET project leader and cardiologist, Academic Medical Centre, Amsterdam, The Netherlands.
One of the aims of ESCAPE-NET is to create a risk score that includes age, sex, comorbidities and genetic profile. Doctors will be able to use the score to determine the risk, for example, of prescribing erythromycin for a female patient.Dr Tan said: “We think that sudden cardiac arrest is caused by the interaction of various risk factors. Our research will uncover which factors are relevant in women and men and use this information to develop a risk score.”There is also evidence that women are more likely to die from sudden cardiac arrest than men because they are less likely to be resuscitated by a bystander. This appears to be due to sociological factors rather than biological sex. For example, women are more likely to be living alone because they have outlived their spouse.
ESCAPE-NET will identify specific reasons for differences in survival between men and women and which factors might be changed.Dr Tan said: “The major strength of ESCAPE-NET is the large number of patients. These cohorts are normally very difficult to collect because sudden cardiac arrest occurs quickly.”

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Italian law must change to improve survival from cardiac arrest

Posted by fidest press agency su martedì, 6 marzo 2018

Milan (Italy) An Italian law requiring citizens to hold a certificate to use a defibrillator must change to improve survival from cardiac arrest, researchers argued today at Acute Cardiovascular Care 2018, a European Society of Cardiology congress. “Automated external defibrillator (AED) use before the arrival of the emergency medical services (EMS) plays a key role in improving victim survival from out-of-hospital cardiac arrest,” said lead author Dr Enrico Baldi, resident physician in cardiology at IRCCS Policlinico San Matteo, Pavia, Italy.The study included two separate analyses – the first to assess how many times AEDs are used when people have an out-of-hospital cardiac arrest witnessed by a bystander in Pavia Province and the second to assess the impact on survival of the use of AEDs by a layperson before the arrival of the EMS.The study used the Pavia Cardiac Arrest Registry (Pavia CARe), which was set up in October 2014 and enrols all out-of-hospital cardiac arrest patients in the province. All patients enrolled in the Registry up to March 2017 were included, with the exception of those whose cardiac arrest was witnessed by EMS.The researchers calculated the rate of AED use before EMS arrival in the patients whose cardiac arrest was witnessed by a layperson and whose first heart rhythm was shockable.2 An AED was used by a layperson in just 9 out of 140 patients (6.4%).“This is an extremely low rate of AED use,” said Dr Baldi. “In countries where the ‘Good Samaritan’ law is in place and all citizens can use an AED, the rate of AED use before EMS arrival is around 15–20%.” The second analysis was conducted in patients who received bystander defibrillation and had a shockable rhythm. This group of patients also included those where the cardiac arrest itself had not been witnessed. A total of 10 patients in this analysis received the first shock by a layperson before EMS arrival. The researchers compared the survival of those 10 patients and the 99 patients who received the first shock by EMS. The two groups were similar in terms of age and sex. The rate of survival at 30 days was significantly higher in the patients with defibrillation provided by bystanders (60%) compared to those with defibrillation by EMS (24%) (p=0.02). The time from cardiac arrest to the first shock was significantly shorter in the group receiving defibrillation by bystanders (5 minutes) compared to those receiving defibrillation by EMS (12 minutes) (p<0.01). “These results confirm the positive impact on survival of AED use before the arrival of EMS,” said Dr Baldi. “It is crucial to act quickly in cardiac arrest and bystanders can be instrumental in determining whether a patient lives or dies.” “The Italian law requiring people to be certified in the use of AEDs is a major limitation on their use by members of the public,” he added. “There is no shortage of defibrillators – there are 503 AEDs in public places in Pavia Province, which amounts to one for every 1,093 residents.”
In addition to the legal challenge, another factor that contributes to the low rate of AED use in Italy compared to some other parts of Europe is that there is currently no system to alert people nearby who may be able to assist when someone has had a cardiac arrest – such as phone apps that are used in some countries – or to automatically alert the fire brigade and police that a cardiac arrest has occurred. If they are nearby, these emergency services, who carry AEDs and are trained in their use, could arrive more quickly than the EMS.Dr Baldi said: “Italian law should be urgently reviewed to allow all citizens to use an AED regardless of whether they have been trained. We also need to create systems to alert nearby citizens and the fire brigade and police that someone has suffered a cardiac arrest. Every moment is critical in these cases. Just three or four minutes can make the difference between life and death.”

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Harmless’ painkillers associated with increased risk of cardiac arrest

Posted by fidest press agency su giovedì, 16 marzo 2017

Sophia Antipolis. Painkillers considered harmless by the general public are associated with increased risk of caSophia Antipolisrdiac arrest, according to research published today in the March issue of European Heart Journal – Cardiovascular Pharmacotherapy. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used drugs worldwide and some, including ibuprofen, are available over the counter. “Allowing these drugs to be purchased without a prescription, and without any advice or restrictions, sends a message to the public that they must be safe,” said author Professor Gunnar H. Gislason, professor of cardiology at Copenhagen University Hospital Gentofte, Denmark. “Previous studies have shown that NSAIDs are related to increased cardiovascular risk which is a concern because they are widely used.”The current study investigated the link between NSAID use and cardiac arrest. All patients who had an out-of-hospital cardiac arrest in Denmark between 2001 and 2010 were identified from the nationwide Danish Cardiac Arrest Registry. Data was collected on all redeemed prescriptions for NSAIDs from Danish pharmacies since 1995. These included the non-selective NSAIDs (diclofenac, naproxen, ibuprofen), and COX-2 selective inhibitors (rofecoxib, celecoxib).A case-time-control design was used to examine the association between NSAID use and cardiac arrest. Each patient served as both case and control in two different time periods, eliminating the confounding effect of chronic comorbidities. Use of NSAIDs during the 30 days before cardiac arrest (case period) was compared to used of NSAIDs during a preceding 30 day period without cardiac arrest (control period).Information was not obtained on over-the-counter drugs. Ibuprofen is the only over-the-counter NSAID in Denmark and is limited to small packages of 200 mg dosages. As patients were their own control, any underestimation of ibuprofen use should be equally distributed between the case and control periods.
A total of 28 947 patients had an out-of-hospital cardiac arrest in Denmark during the ten year period. Of these, 3 376 were treated with an NSAID up to 30 days before the event. Ibuprofen and diclofenac were the most commonly used NSAIDs, making up 51% and 22% of total NSAID use, respectively.Use of any NSAID was associated with a 31% increased risk of cardiac arrest. Diclofenac and ibuprofen were associated with a 50% and 31% increased risk, respectively. Naproxen, celecoxib and rofecoxib were not associated with the occurrence of cardiac arrest, probably due to a low number of events.
NSAIDs exert numerous effects on the cardiovascular system which could explain the link with cardiac arrest. These include influencing platelet aggregation and causing blood clots, causing the arteries to constrict, increasing fluid retention, and raising blood pressure.

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