Breaking News
December 16, 2018 - Menlo Therapeutics’ Successful Phase 2 Clinical Trial of Serlopitant Demonstrates Reduction of Pruritus Associated with Psoriasis
December 16, 2018 - Siblings of children with autism or ADHD are at elevated risk for both disorders
December 16, 2018 - New project aims to understand why and how metabolic disorders develop in patients
December 16, 2018 - Diets containing GM maize have no harmful effects on health or metabolism of rats
December 16, 2018 - Are doctors and teachers confusing immaturity and attention deficit?
December 16, 2018 - Hearing loss linked with increased risk for premature death
December 16, 2018 - Chromatrap buffer reagents for lysing cells offer many benefits
December 16, 2018 - Young Breast Cancer Patients Face Higher Risk for Osteoporosis
December 16, 2018 - 3-D printing offers helping hand to people with arthritis
December 16, 2018 - Community Health Choice helps manage complex and chronic care conditions
December 16, 2018 - Regular trips out could dramatically reduce depression in older age
December 16, 2018 - CWRU to use VivaLNK’s Vital Scout device for stress study in student athletes
December 16, 2018 - ‘Easy Way Out’? Stigma May Keep Many From Weight Loss Surgery
December 16, 2018 - Gout drug may protect against chronic kidney disease
December 16, 2018 - Talking about memories enhances the wellbeing of older and younger people
December 16, 2018 - Occupational exposure to pesticides increases risk for cardiovascular disease among Latinos
December 16, 2018 - A biomarker in the brain’s circulation system may be Alzheimer’s earliest warning
December 16, 2018 - Magnesium may play important role in optimizing vitamin D levels, study shows
December 16, 2018 - The effect of probiotics on intestinal flora of premature babies
December 16, 2018 - Parents spend more time talking with kids about mechanics of using mobile devices
December 16, 2018 - Biohaven Announces Positive Results from Ongoing Rimegepant Long-Term Safety Study
December 16, 2018 - Arterial stiffness may predict dementia risk
December 16, 2018 - Study explores link between work stress and increased cancer risk
December 16, 2018 - Sex work criminalization linked to incidences of violence finds study
December 16, 2018 - Johns Hopkins researchers discover swarming behavior in fish-dwelling parasite
December 16, 2018 - Schistosomiasis prevention and treatment could help control HIV
December 16, 2018 - Early postpartum opioids linked with persistent usage
December 16, 2018 - Johns Hopkins researchers identify molecular causes of necrotizing enterocolitis in preemies
December 16, 2018 - Advanced illumination expands capabilities of light-sheet microscopy
December 16, 2018 - Alzheimer’s could possibly be spread via contaminated neurosurgery
December 16, 2018 - Unraveling the complexity of cancer biology can prompt new avenues for drug development
December 16, 2018 - Inflammatory Bowel Disease, Prostate Cancer Linked
December 16, 2018 - Cannabis youth prevention strategy should target mental wellbeing
December 15, 2018 - Recent developments and challenges in hMAT inhibitors
December 15, 2018 - Sewage bacteria found lurking in Hudson River sediments
December 15, 2018 - CDC selects UMass Amherst biostatistician model that helps predict influenza outbreaks
December 15, 2018 - Researchers reveal brain mechanism that drives itch-evoked scratching behavior
December 15, 2018 - New computer model helps predict course of the disease in prostate cancer patients
December 15, 2018 - Obesity to Blame for Almost 1 in 25 Cancers Worldwide
December 15, 2018 - How the brain tells you to scratch that itch
December 15, 2018 - New findings could help develop new immunotherapies against cancer
December 15, 2018 - World’s largest AI-powered medical research network launched by OWKIN
December 15, 2018 - Young people suffering chronic pain battle isolation and stigma as they struggle to forge their identities
December 15, 2018 - Lifespan extension at low temperatures depends on individual’s genes, study shows
December 15, 2018 - New ingestible capsule can be controlled using Bluetooth wireless technology
December 15, 2018 - Researchers uncover microRNAs involved in the control of social behavior
December 15, 2018 - Research offers hope for patients with serious bone marrow cancer
December 15, 2018 - Link between poverty and obesity is only about 30 years old, study shows
December 15, 2018 - Mass spectrometry throws light on old case of intentional heavy metal poisoning
December 15, 2018 - BeyondSpring Announces Phase 3 Study 105 of its Lead Asset Plinabulin for Chemotherapy-Induced Neutropenia Meets Primary Endpoint at Interim Analysis
December 15, 2018 - Study finds that in treating obesity, one size does not fit all
December 15, 2018 - Tenacity and flexibility help maintain psychological well-being, mobility in older people
December 15, 2018 - Study reveals role of brain mechanism in memory recall
December 15, 2018 - High levels of oxygen encourage the brain to remain in deep, restorative sleep
December 15, 2018 - Experimental HIV vaccine strategy works in non-human primates, research shows
December 15, 2018 - Genetically modified pigs could limit replication of classical swine fever virus, study shows
December 15, 2018 - FDA Approves Herzuma (trastuzumab-pkrb), a Biosimilar to Herceptin
December 15, 2018 - Cost and weight-loss potential matter most to bariatric surgery patients
December 15, 2018 - Cancer Research UK and AstraZeneca open new Functional Genomics Centre
December 15, 2018 - New research lays out potential path for treatment of Huntington’s disease
December 15, 2018 - Prestigious R&D 100 Award presented to Leica Microsystems
December 15, 2018 - Study shows septin proteins detect and kill gut pathogen, Shigella
December 15, 2018 - Study sheds new light on disease-spreading mosquitoes
December 15, 2018 - 2017 Saw Slowing in National Health Care Spending
December 15, 2018 - Monitoring movement reflects efficacy of mandibular splint
December 15, 2018 - Study supports BMI as useful tool for assessing obesity and health
December 15, 2018 - Self-guided, internet-based therapy platforms effectively reduce depression
December 15, 2018 - Organically farmed food has bigger climate impact than conventional food production
December 15, 2018 - Faster, cheaper test has potential to enhance prostate cancer evaluation
December 15, 2018 - Researchers study abnormal blood glucose levels of patients after hospital discharge
December 15, 2018 - Swedish scientists explore direct association of dementia and ischemic stroke deaths
December 15, 2018 - Study finds 117% increase in number of dementia sufferers in 26 years
December 15, 2018 - Eczema Can Drive People to Thoughts of Suicide: Study
December 15, 2018 - Link between neonatal vitamin D deficiency and schizophrenia confirmed
December 15, 2018 - Nurse denied life insurance because she carries naloxone
December 15, 2018 - Ritalin drug affects organization of pathways that build brain networks used in attention, learning
December 15, 2018 - Research pinpoints two proteins involved in creation of stem cells
December 15, 2018 - Gut bacteria may modify effectiveness of anti-diabetes drugs
December 15, 2018 - A new type of ‘painless’ adhesive for biomedical applications
December 15, 2018 - Early physical therapy associated with reduction in opioid use
Congenital Cardiac Cath Tx Often Strays from Guidelines

Congenital Cardiac Cath Tx Often Strays from Guidelines

image_pdfDownload PDFimage_print

Researchers found a significant amount of practice variation when it came to transcatheter valvuloplasty in children, reporting in a registry study that a substantial number of U.S. cases were not done in accordance with current guidelines.

Patients having a high resting gradient made up 82% of the stated indications for balloon aortic (BAV) and pulmonary valvuloplasty (BPV) from 2011-2015 recorded in the IMPACT registry. Among these interventions, 86% of BAVs and 66% of BPVs were consistent with guideline recommendations published in 2011, which is to say that the pre-treatment gradient was at least the guideline-specified value, according to Andrew Glatz, MD, of the Children’s Hospital of Philadelphia, and colleagues.

Interhospital variation for BAV missed statistical significance (median rate ratio 1.8, 95% CI 1.0-2.3). However, hospitals in the East and South more likely to perform the procedure in accordance with the 2011 guidelines than those in the Midwest and West, they wrote in JACC: Cardiovascular Interventions.

For BPV, no hospital-level factors were tied to guideline-consistent practice, yet there was a significant amount of interhospital variation that was not explained by patient- or procedure-level characteristics (median RR 1.4, 95% CI 1.2-1.6).

Glatz’s group said that they had suspected there was some practice variation despite BAV and BPV being “well-established procedures” in congenital interventional cardiology.

“That these variations exist is beyond dispute. Whether the variations identified constitute evidence of gaps in quality of care is another thing,” commented Thomas Jones, MD, of Seattle Children’s Hospital, in an accompanying editorial.

He questioned the validity of the published thresholds of care in the guidelines.

“A close examination of the evidence used to establish treatment guidelines for balloon valvuloplasty intervention in both congenital aortic and pulmonary valve stenosis reveals that the threshold for treatment is based largely upon surgical outcomes defined more than 40 years ago,” according to Jones. “No specific studies have ever been performed to define a threshold for intervention on the basis of outcomes for either BAV or BPV. Instead, criteria established largely in the surgical era have been applied to percutaneous interventions.”

Ultimately, that the field of pediatric and congenital interventional cardiology treats patients with relatively uncommon conditions is a challenge for research and guideline-writing, the editorialist suggested.

The present IMPACT registry analysis included BAV (n=1,071) and BPV cases (n=2,207) across dozens of centers in the U.S. in a mostly pediatric cohort. It was a limitation that there were no pre-intervention gradients recorded in the database, any information on resource utilization, nor longitudinal follow-up for outcomes.

“The numbers of patients undergoing BAV and BPV treatments far exceed any prior population studies published,” Jones maintained.

Even so, he wrote, “the ability to define thresholds for intervention will require longitudinal follow-up of both treated and untreated patients. This may be a tall order but is a worthy undertaking.”

The study was funded by the American College of Cardiology and National Cardiovascular Data Registry.

Glatz disclosed support from the Children’s Heart Foundation, the CHD Coalition, and Big Hearts to Little Hearts.

Jones disclosed support from and relevant relationships with Medtronic, W. L. Gore & Associates, and Abbott.

2018-03-19T14:00:00-0400

Tagged with:

About author

Related Articles