Transfusing Elderly Heart Attack Patients
Blood transfusions can reduce short-term mortality among elderly heart attack patients whose admission hematocrit is ≤30% and may even help those with a hematocrit as high as 33%, according to researchers from Brown University Medical School and Yale University School of Medicine (N Engl J Med. 2001;345:1230–1236).
The report in the October 25, 2001, issue of the New England Journal of Medicine was designed to answer the questions about whether transfusion could help elderly patients with myocardial infarction and at what level of anemia. In the study, researchers, who were led by Wen Chih Wu, MD, of the Division of Cardiovascular Diseases at Brown University Medical School in Providence, RI, evaluated the care of 78 974 Medicare patients in the Cooperative Cardiovascular Project who were categorized according to their admission hematocrit. They found that patients who had lower hematocrit values on admission had higher 30-day mortality rates. Blood transfusion reduced the 30-day mortality rates in patients with hematocrits as high as 33%. However, blood transfusion was associated with higher 30-day death rates in patients with admission hematocrits ≥36.1%.
“Although our study indicates that there is an overall benefit of transfusion in patients with acute myocardial infarction and anemia, patients who received transfusion despite the fact that their hematocrit values on admission were >36% had a higher risk of death within 30 days than patients with similar hematocrit values who did not receive transfusions,” the authors wrote. “Very few patients with hematocrit values in this category received transfusions, and we think that the increased risk of death within 30 days is attributable to other events that occurred later during hospitalization that were not measured by analyses. . .Although a randomized, controlled trial would be useful to confirm the validity of this threshold for transfusion, it is unlikely that such a study will be conducted in the near future. In the interim, a more aggressive use of transfusion in the management of lower hematocrit levels in elderly patients with acute coronary disease may be warranted.”
Lasker Awards Given
The Lasker Awards were given to 5 men whose findings spanned the gamut from infertility to smallpox in ceremonies in the Cotillion Room of the Pierre Hotel in New York City, which is located not far from the wreckage of the World Trade Center.
The Albert Lasker Award for Basic Biomedical Research went to Mario Capecchi, PhD, a Howard Hughes Medical Institute investigator at the University of Utah; Oliver Smithies, PhD, professor of pathology at the University of North Carolina in Chapel Hill; and Martin Evans, PhD, head of the Cardiff School of Biosciences and professor of mammalian genetics at Cardiff University in Wales, who, while working from different angles, developed the method for creating transgenic mice. Since that time, >4000 strains of such mice have been created using their methods.
Robert G. Edwards, MD, emeritus professor of human reproduction at the University of Cambridge, received the Albert Lasker Clinical Medical Research Award for the perseverance shown by him and colleague, the late Patrick Steptoe, MD, in developing the technique of in vitro fertilization, which resulted in the birth of the world’s first “test tube” baby, Louise Brown. The success was preceded by >100 failed attempts. Dr Edwards regretted that Dr Steptoe could not share the honor with him, but Lasker awards are not given posthumously.
William Foege, MD, presidential distinguished professor in the department of International Health at Emory University, received the Mary Woodward Lasker Award for Public Service for his work in eradicating smallpox in Africa. Dr Foege is credited with developing the technique that eradicated polio from the continent ahead of schedule and under budget. Later, as director of the Centers for Disease Control and Prevention (CDC), he discovered an alarming rash of toxic shock syndrome in young women that was caused by tampons, which served as breeding grounds for certain types of bacteria. He was also adamant when pharmaceutical companies questioned the finding that aspirin was a risk factor in the development of Reye’s syndrome in children.
Controlling Blood Pressure Important, No Matter What Drug Is Used
A meta-analysis in the October 20, 2001 issue of the Lancet (2001;358:1305–1315) emphasizes that controlling hypertension is important and that all antihypertensive drugs have the same long-term effectiveness and safety. The study was undertaken because some studies have suggested that the mortality effects of some drugs, specifically angiotensin-converting enzyme (ACE) inhibitors, are due to actions other than lowering blood pressure.
In this study, which was led by Jan A. Staessen, MD, from Leuven, Belgium, researchers analyzed 27 trials of blood-pressure–reducing medications involving 136 124 individuals. They determined that the most important effect of all the medication tested was the lowering of blood pressure and that there was little difference among the various drugs used over the years. The purported effect of ACE inhibitors beyond blood pressure lowering remains unproven, they decided.
New Kind of Pacemaker
On October 11, 2001, the US Food and Drug Administration approved a new kind of pacemaker with a tiny transmitter that automatically sends information on the patient’s heart condition to the physician between office visits. Made by Biotronik, Inc, of Lake Oswego, Ore, it is the first implanted medical device to be approved that is capable of automatic, remote data transmission, according to information from the agency.
The Biotronik Home Monitoring System contains a Biotronik pacemaker that is already on the market. However, it has been modified to include a short-range radio frequency transmitter and a cell phone–like device carried by the patient in a pocket or handbag. The transmitter relays data from the heart to the phone, which then sends it to the company’s service center. There, the information is correlated and forwarded by fax to the physician. Data can be collected at varying times, from once a day to once a month.