Heat-Shock Protein and Acute Coronary Syndromes
Chlamydia pneumoniae heat-shock protein 60 appeared significantly associated with the presence of acute coronary syndromes (ACS), said Italian researchers in this week’s issue of the journal Circulation (Circulation. 2003;107:3015–3017).
When researchers from the Institute of Cardiology, Universita Cattolica in Rome, Medical Mycology, Istituto Superiore di Sinita in Rome, and the Cardiothoracic and Vascular Department in Universita Vita e Salute in Milan, Italy, led by Luigi M. Biasucci, MD, measured the levels of antibodies to Chlamydia pneumoniae and Chlamydia pneumoniae immune globulin in 179 patients with unstable angina, 49 patients with myocardia infarction, 40 patients with stable angina, and 100 normal subjects, they found that 99% of those with ACS were positive for antibodies to the Chlamydia pneumoniae heat shock protein 60, but only 20% of those with stable angina were positive.
They concluded: “Seropositivity for Cp-HSP60 [Chlamydia pneumoniae heat shock protein 60] appears to be a very sensitive and specific marker of ACS. . . . Its causal involvement in instability and its diagnostic role in ACS deserve further studies.”
New AHA Statement Stresses Physical Activity for Health Professionals and Their Patients
Physical activity and exercise training play key roles in preventing atherosclerotic coronary artery disease as well as in managing the risk factors of the disease and treating diseases such as coronary artery disease, heart failure, and claudication, according to a new statement from the American Heart Association’s Council on Clinical Cardiology Subcommittee on Exercise, Rehabilitation, and Prevention, and the Council on Nutrition, Physical Activity, and Metabolism Subcommittee on Physical Activity. The statement appears in this week’s issue of Circulation (Circulation. 2003;107:3109–3116).
The statement also advises that the health professionals themselves:
Engage in an active lifestyle.
Encourage schools to teach skills required for physically active lifestyles and communities to develop programs and facilities conducive to physical activity.
Be educated about exercise as a therapeutic modality and the importance of lifelong physical activity in their patients.
Routinely prescribe exercise and increased physical activity to their patients in accordance with recommendations provided by the US Centers for Disease Control and Prevention and the AHA.
Perform exercise testing before recommending vigorous exercise in selected patients with cardiovascular disease and other patients with symptoms or those at high risk.
The statement advises more research to “address behavioral strategies to increase and maintain physical activity over the lifespan” and “increase the scientific rationale supporting the importance of physical activity by examining the amount of exercise required to alter CAD [coronary artery disease] risk, the effect of exercise on morbidity and mortality, and its cost-effectiveness.”
Counseling for Heart Attack Patients Wards Off Depression
Providing cognitive behavioral therapy to patients after myocardial infarction can help ward off depression or feelings of abandonment, but it does not extend life, said researchers from the National Heart, Lung and Blood Institute (NHLBI) in the June 18, 2003, issue of The Journal of American Medical Association (JAMA. 2003;289:3106–3116).
Researchers led by Susan M. Czajkowski, PhD, of the NHLBI, enrolled 2481 patients from 8 centers who had had heart attacks over a 5-year period. A total of 1238 were assigned to receive the cognitive counseling, and 1243 were assigned to usual care. Those in the counseling group also received a selective serotonin reuptake inhibitor antidepressant when it was indicated. Patients in the usual-care group in the ENhancing Recovery In Coronary Heart Disease patients (ENRICHD) trial received the usual care from their physicians, including written material about heart health.
“Improvement in psychosocial outcomes at six months favored treatment,” the authors reported in their study. “After an average follow-up of 29 months, there was no significant difference in event-free survival between usual care (75.9 percent) and psychosocial intervention (75.8 percent). There were also no differences in survival between the psychosocial intervention and usual care arms in any of the three psychosocial risk groups (depression, LPSS [low-perceived social support], and depression and LPSS patients).”
In an accompanying editorial (JAMA. 2003;289:3171–3173), Nancy Frasure-Smith, PhD, and Francois Lesperance, MD, from Montreal Heart Institute, Montreal, Canada, wrote, “The ENRICHD investigators have demonstrated that depressed coronary artery disease [CAD] patients can be identified, randomized, properly treated with complex interventions, and followed up for long periods. This is a major accomplishment. However, depression remains a CAD risk factor in search of a successful intervention.”
Cost Growth Outstrips Revenue Growth for Cardiologists
Costs in cardiology practices are growing faster than revenues, according to a new study cited in the June 16, 2003, issue of American Medical News.
Citing the 2002 Cost Survey for Cardiovascular/Thoracic Surgery and Cardiology Practices, the Medical Group Management Associated noted that the operating cost per full-time cardiologist increased 15.8% between 2000 and 2001 (from $364 865 to $422 659). At the same time, medical revenue per physician rose only 6.2% from $847 643 in 2000 to $899 919 in 2001.
According to American Medical News, many of the cardiologists surveyed said that they cannot work harder and provide more patient care than they are already. Declines in Medicare reimbursement hit the specialty particularly hard because they see a high percentage of elderly patients.