Patient Education Now Available at Two Sites
A new American Heart Association–sponsored web site, Heart Profilers, is an important and powerful online tool designed “to help patients diagnosed with congestive heart failure, atrial fibrillation, hyperlipidemia, hypertension, and coronary artery disease make informed decisions and participate in their own treatment,” said Clyde D. Yancy, MD, Chairman of the Editorial Board for the new web page. This new tool will be discussed thoroughly in an essay that will be published soon in Circulation.
Combined with the Circulation patient page entitled “Cardiology Patient Page,” recently inaugurated by the journal at http://circ.ahajournals.org/collected/patient.shtml, the new web tools provide patients with the most advanced, complete, and accurate information about heart disease that is available on the Web today. Heart Profilers can be found at the American Heart Association site at www.americanheart.org/profilers.
Through Heart Profilers, patients can obtain personalized reports of scientifically accurate treatment options, lists of questions to ask during their visit with the physician, and other information they need to participate in their treatment. Heart Profilers also provides physicians with information about managing their patient’s treatment through the Professional Heart Profiler, according to the description of the new page. It lists types of studies, abstracts of case studies that mimic patient presentations, and cites relevant studies for physician consideration. Through Heart Profilers, physicians have access to treatment options on the basis of the precise disease state of each person.
The program was demonstrated at the March 2002 meeting of the American College of Cardiology in Atlanta. Heart Profilers is a joint effort of the American Heart Association and a Seattle-based technology company, Nexcura, Inc (http://www.nexcura.com). The American Heart Association provided physicians for the project and Nexcura developed the Internet-based decision-support technology.
The Cardiology Patient Page can be accessed from the Circulationweb site at http://circ.ahajournals.org/ by clicking on the radio button entitled Patient Update. All topics on the site are written by professionals on the subject. Some of the issues covered include:
• aortic valve disease
• chest pain
• atrial fibrillation
• repeat narrowing of a coronary artery: prevention and treatment
• cardiac pacemakers from the patient’s perspective
• statins—powerful drugs for lowering cholesterol: advice for patients
• the implantable cardioverter-defibrillator: patient perspective
• take heart with heart failure
• smoking cessation strategies for the 21st century
• warning signs of a heart attack
Wider Use of Automated External Defibrillators?
Two reports in this week’s issue of Circulation demonstrate the advantage of wider use of automated external defibrillators, both in the United States and in Europe. An accompanying editorial, however, warns that caring for patients with sudden cardiac arrest remains complex.
In the first study (Circulation. 2002;106:1058–1064), led by Robert J. Myerburg, MD, of the Division of Cardiology at the University of Miami School of Medicine, automated external defibrillators (AEDs) were given to all Miami-Dade County police officers. AED-equipped police and conventional emergency medical rescue responders (EMS) were sent at the same time to the scenes of cardiac arrests. When 420 paired dispatches involving police-equipped AEDs and the EMS were compared, the police arrived at the scene within an average of 6.15 minutes after the 9-1-1 call, compared with 7.56 minutes for EMS. Police arrived first in 56% of cases.
Of the 163 patients in pulseless ventricular fibrillation, 28 (17.2%) of those to which the police responded survived to discharge. Only 11 (9%) of those in the standard EMS program survived to leave the hospital. However, many of the patients seen were in unshockable rhythms and the survival rate was very low—only 4 among 257 events in the police AED program and 8 of 196 in the EMS part of the study. When those in shockable rhythm were compared with those with unshockable rhythm, the difference between the police and EMS program was small and statistically insignificant.
The high proportions of those in unshockable rhythms were disappointing, the authors noted. They surmised that it was because it took too long for bystanders to call 9-1-1.
In the second study (Circulation. 2002;106:1065–1070), which took place in Piacenza, Italy, researchers led by Alessandro Apucci, MD, found that when AEDs were broadly disseminated throughout the community, early defibrillation was enabled and it tripled the survival rate from out-of-hospital sudden death. They improved public access to defibrillation by establishing what they called the “Piacenza Progetto Vita” to serve the 173 114 residents in the region. A total of 39 semiautomatic, external biphasic defibrillators were distributed throughout the community. Twelve were placed in high-risk locations, 12 in lay-staffed ambulances, and 15 in police cars. A total of 1285 lay volunteers were trained to use the AEDs without the traditional education in cardiopulmonary resuscitation.
During the first 22 months, 354 sudden cardiac deaths occurred in the area. Volunteers in the program treated 143 sudden death cases. In these cases, it took an average of 4.8 minutes for EMS to arrive after a call was made. Overall, 10.5% of those patients treated by the volunteer program survived to leave the hospital, compared with 3.3% of those who were treated by traditional EMS. For witnessed sudden death, the survival to discharge was 15.5% in the volunteer group, compared with 4.3% for the EMS group.
In the Italian cohorts, a shockable rhythm was found in 23.8% of patients in the volunteer group and in 15.6% in the group treated by EMS. The authors concluded: “The importance of an early defibrillation program by lay volunteers equipped with AEDs in Europe is now well documented. The program is reliable, safe, and cost-effective. The integration of early defibrillation performed by lay volunteers into the EMS system allowed us to dramatically reduce mortality rates, thereby tripling overall and neurologically intact survival rates from SCA (sudden cardiac arrest).”
The authors of the editorial (Circulation. 2002;106: 1030–1033), Jose A. Joglar, MD, and Richard L. Page, MD, both of the Department of Internal Medicine at The University of Texas Southwestern Medical Center at Dallas, concluded, “The concept of public access defibrillation is presently being tested in the Public Access Defibrillation trial, where matched communities are randomized to receive AEDs and training or not (with both groups being trained in cardiac arrest awareness, early call to 9-1-1, and CPR). Although the investigators are to be commended for the effort and the results will be valuable, we believe that the need for AED availability is so great that communities that can afford an AED program should undertake such an initiative without delay.”
Final Version of Privacy Regulation Published
The Bush administration has published the final medical privacy rules without the controversial requirement that patients must give consent to the release of information for routine reasons, although it does say that healthcare entities should make a “good faith” attempt to obtain such approval. Patients must also be given notice of new rights, including the right to refuse disclosure of information for nonroutine reasons, such as an employer’s request, and they must be informed of the practices of their healthcare provider about the privacy of medical records.
According to a story in The Washington Post on August 10, 2002, “Law enforcement agencies have ‘relatively unfettered’ access to medical records.” Records can also be used for public health reasons if patient names and other information are stripped out.
Providers had vehemently opposed a proposal that patients must sign a consent form for usual uses of their patient information. Privacy advocates, however, criticized the laws, saying that they undermine patients’ control over their private health information.
It is anticipated that privacy advocates in the Senate will attempt to strengthen the rules that cannot take effect without congressional approval. The rules are scheduled to go into effect April 14, 2003.