Breaking News
September 25, 2018 - Lung cancer patients treated with invasive surgery more likely to become chronic opioid users
September 25, 2018 - Oxford VR raises £3.2m to boost innovation in VR for mental health problems
September 25, 2018 - Gene therapy approach could help treat mitochondrial diseases
September 25, 2018 - Few Yogurt Products Qualify As Low-Sugar
September 25, 2018 - Eye disease can cause blindness, and it’s on the rise
September 25, 2018 - Pawnshop density linked to gun-related suicides, Stanford study finds
September 25, 2018 - Pioneering procedure for common prostate condition offered by The London Clinic
September 25, 2018 - Number of people with respiratory diseases likely to increase if UK air pollution remains unchecked
September 25, 2018 - FARXIGA receives positive results in Phase III DECLARE-TIMI 58 cardiovascular outcomes trial
September 25, 2018 - New program to reduce harmful stress effectively improves mood in cancer patients
September 24, 2018 - Florence’s Lingering Threat: Mold – Drugs.com MedNews
September 24, 2018 - For professional baseball players, faster hand-eye coordination linked to batting performance
September 24, 2018 - Bill for later school start times is defeated, but Stanford sleep specialist isn’t
September 24, 2018 - For Heart Failure Patients, Mitral Valve Procedure Improved Outcomes
September 24, 2018 - Successful recovery from addiction means more than achieving abstinence
September 24, 2018 - New nanoplatform technology may reverse drug-resistance in renal cell carcinoma
September 24, 2018 - October 1918 marks the centenary of Spanish Flu that claimed more lives than World War I
September 24, 2018 - LGBT community reports more number of poor mental health days than general population
September 24, 2018 - New research suggests power of zebrafish as tool for cancer drug discovery
September 24, 2018 - New study finds height as possible risk factor for developing varicose veins
September 24, 2018 - Researchers compare weight loss results of online and in-person diabetes prevention program
September 24, 2018 - New HER2 PET Study Uses Affibody’s ABY-025 Tracer to Individualize Breast Cancer Treatment
September 24, 2018 - Drug combination offers more effective care for patients suffering miscarriage
September 24, 2018 - Tallness linked to varicose veins, Stanford study says
September 24, 2018 - For Heart Failure Patients, Mitral Valve Procedure Improved Outcomes
September 24, 2018 - Ecstasy drug makes octopuses more social
September 24, 2018 - Immediate compression therapy could cut risk of complications after deep-vein thrombosis
September 24, 2018 - Transcatheter mitral valve repair reduces mortality for patients with mitral regurgitation
September 24, 2018 - First intracranial aneurysm patients treated with BRAVO Flow Diverter after CE mark approval
September 24, 2018 - ‘Physicians of the mouth’? Dentists absorb the medical billing drill
September 24, 2018 - People more likely to believe those with confident tone of voice than with accent
September 24, 2018 - Harmony Biosciences Presents 5-Year Data On Pitolisant At International Narcolepsy Symposium
September 24, 2018 - Blood test may identify gestational diabetes risk in first trimester
September 24, 2018 - Height may be risk factor for varicose veins | News Center
September 24, 2018 - King’s commemorates opening of new NMR facility with one-day symposium
September 24, 2018 - Eisai receives approval for partial label change of DC Bead device for transcatheter arterial embolization
September 24, 2018 - High-resolution genomic map gives scientists unprecedented view of brain development
September 24, 2018 - Researchers find impact of neurobehavioral symptoms on employment in adults with TBI
September 24, 2018 - Alexion announces positive results from Phase 3 PREVENT study of Soliris in patients with NMOSD
September 24, 2018 - First evaluation of benefits, harms of Alzheimer’s screening for family members of older adults
September 24, 2018 - Ancora Heart announces positive data of study evaluating AccuCinch Ventricular Repair System
September 24, 2018 - Children of mothers using cannabis may start using it at an earlier age, finds study
September 24, 2018 - Gilead Sciences plans to launch authorized generic versions of Epclusa and Harvoni in the US
September 24, 2018 - Most patients who underwent transcatheter valve replacement experience prosthesis-patient mismatch
September 24, 2018 - Lumos acquires license for LUM-201 drug that promotes secretion of growth hormone
September 24, 2018 - New study provides basis for Air Canada to change its facial hair policy for aircrew
September 24, 2018 - Infant walkers lead to thousands of emergency visits for babies
September 24, 2018 - Genes predicting person’s height may provide clues about causes of varicose veins
September 24, 2018 - EPA Plan Will Maintain Carbon Emissions From Power Plants
September 24, 2018 - Characterizing pig hippocampus could improve translational neuroscience
September 24, 2018 - Element3 Health reports social and mental engagement play key role in overall health
September 24, 2018 - Paralympic medalists support Fight for Sight’s unique virtual event
September 24, 2018 - ADCETRIS drug receives approval in Japan as frontline treatment option for Hodgkin lymphoma
September 24, 2018 - Public awareness of urological conditions found to be alarmingly low across Europe
September 24, 2018 - Fitter Folks Suffer Milder Strokes: Study
September 24, 2018 - Novel botulinum toxin compound relieves chronic pain
September 24, 2018 - CHMP recommends approval of Gilenya for treatment of multiple sclerosis in children, adolescents
September 24, 2018 - National Friendly’s private medical insurance is a hit with women living in the South East
September 24, 2018 - Academics receive prestigious awards for achievements in blood pressure research
September 24, 2018 - Obese pregnant women can restrict weight gain safely with proper nutrition guidance
September 24, 2018 - CHMP adopts positive opinion of Takeda’s ALUNBRIG for treatment of ALK+ non-small cell lung cancer
September 24, 2018 - China NMPA approves LENVIMA for treatment of unresectable hepatocellular carcinoma
September 24, 2018 - A new approach for finding Alzheimer’s treatments
September 24, 2018 - USC research uncovers previously unknown genetic risk factor for dementia
September 24, 2018 - Study examining mental health among students finds significant disparities in treatment across race
September 24, 2018 - Breakthrough discovery paves way for future test to identify drowsy drivers
September 24, 2018 - Transcatheter mitral-valve repair in patients with heart failure
September 24, 2018 - Study opens new avenues for treatment of Laing distal myopathy
September 24, 2018 - Stroke Facts | cdc.gov
September 24, 2018 - Sarcolipin tricks muscle cells into using more energy, burning fat
September 24, 2018 - Enrollment in opioid controlled substance agreement reduces primary care visits
September 24, 2018 - UTA researchers patent new smart seat cushion technology that helps prevent painful ulcers
September 24, 2018 - Second HPV-Related Primary Cancers Common in Survivors
September 24, 2018 - How a virus destabilizes the genome
September 24, 2018 - Old letters provide insight into Spanish flu pandemic horror
September 23, 2018 - Smart textile-based soft robotic exosuit helps wearers save energy and traverse difficult terrain
September 23, 2018 - New research hub to drive radical change in development and manufacturing of vaccines
September 23, 2018 - AHA: For Hispanics, Neighborhood May Be Key Factor in Heart Disease Risk
September 23, 2018 - Excessive airway nerves tied to more severe asthma symptoms, study finds
September 23, 2018 - Study highlights need to remain vigilant in maintaining key infection control processes
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