Interesting Research Material
Aspirin
Aspirin is taken daily by millions of Britons but should only be used by people with heart disease or after a stroke - Medics warn.
The pill cannot prevent cardiac attacks even in high-risk groups — and should not be dished out as a “wonderdrug”, say researchers.
A study of 1,200 diabetics found the bloodthinning drug provided no extra benefit over a dummy medicine.
Aspirin has been recommended for high blood pressure, which increases the risk of heart disease.
Some say it should be given to most healthy patients at middle age.
Professor Jill Belch reports in the British Medical Journal: “Aspirin can also cause stomach bleeding."
“We found no evidence it can prevent heart attacks.”
"The research, conducted by Professor Jill Belch of the Institute of Cardiovascular Research at Dundee University, warned that the drug was most effective if prescribed to people with more serious cardiovascular problems."
The same article but worded completely different, as in it is not such a scaremongering article.
Taken from http://news.bbc.co.uk/1/hi/health/7673587.stm
Aspirin should not routinely be used to prevent heart attacks in people with diabetes, Scottish research suggests.
The British Medical Journal reported that in 1,300 adults with no symptoms of heart disease the drug, which can cause stomach bleeds, had no benefit.
The findings contradict many guidelines which advocate people with diabetes use aspirin to counter the underlying high risk of heart attack and stroke.
But there are key high-risk groups who still need the drug, experts said.
Patients with concerns are advised to consult their GP before changing medication.
In people who have already had a heart attack or stroke, or have been diagnosed with coronary artery disease, aspirin has been shown to reduce the risk of future "events" by around 25%.
"We have got a bit ahead of ourselves with aspirin" Professor Jill Belch.
However, in recent years doctors have begun to focus on people who have not yet developed so-called cardiovascular disease, but are at high-risk of having it in the future - such as people with diabetes.
There are around two million people over 40 with diabetes in the UK.
Around 80% of people with diabetes die of cardiovascular disease including strokes and heart attacks.
A daily dose of aspirin is recommended by several UK guidelines as a "preventive" treatment in these groups.
No benefit
But in the latest study in adults over 40 years with type 1 or type 2 diabetes and no symptoms of cardiovascular disease, there was no difference over seven years in heart attacks or strokes between those given aspirin and those given a dummy pill.
Study leader Professor Jill Belch, from the University of Dundee, said aspirin was one of the most common causes of hospital admission for gastrointestinal bleeding.
"We need to think again about using it for primary prevention."
However she stressed the drug was beneficial in people who had already had a heart attack or stroke.
"Patients shouldn't panic or stop taking aspirin" Professor Steve Field, Royal College of GPs.
Professor Peter Sever, an expert in clinical pharmacology and therapeutics at Imperial College London, said the study was "extremely important".
"It confirms many concerns we have that aspirin is very widely used in the general population without an evidence base to support its overall benefits. Thousands of people buy aspirin over the counter - I'm forever saying to patients you shouldn't be taking this. I have had a couple of patients admitted to hospital with major gastrointestinal bleeding when there was no evidence it was doing any good."
The number of people diagnosed with diabetes and as having a high risk of cardiovascular disease is set to increase, with government plans in England to introduce a national screening programme for the over-40s next year.
Professor Steve Field, Chair of the Royal College of GPs, said it would be worth revisiting the guidlines.
Judy O'Sullivan, Cardiac Nurse at the British Heart Foundation, said: "This study adds weight to the evidence that aspirin should not be prescribed to prevent disease of the heart and circulation to people with diabetes, and other high risk groups, who do not already have symptoms of the disease."
Children recieving surgery for Hypoplastic Left Heart Syndrome have better outcomes at hospitals that perform more such surgeries
Children born with the congenital heart defect, Hypoplastic Left Heart Syndrome (HLHS), usually die within the first days or months of life without treatment. In this condition, the entire left half of the heart (aorta, aortic valve, left ventricle and mitral valve) is underdeveloped (hypoplastic). Treatment options for children with HLHS include staged surgical palliation known as Stage 1 (usually shortly after birth), Orthotopic Heart Transplantation, or Comfort Care. Children with HLHS who underwent Stage 1 palliation surgery in teaching hospitals in 1997 were 2.6 times more likely to die than those who underwent the surgery at non-teaching hospitals. This was after accounting for hospital palliation surgery volume (usually indicative of outcomes) and severity of the child's consition.
However, by 2000, palliation surgery was centralised at teaching hospitals, with only 2 percent of surgeries performed at non-teaching hospitals. This centralisation of surgery, along with advances in post-operative medical and surgical care for these children, was associated with an overall decrease in mortality from 28 to 24 percent. Yet mortality rates continued to approach 50 percent at hospitals that conducted only one or two of these surgeries a year (compared with 19 percent for high-volume hospitals), according to the study supported in part by the Agency for Healthcare Research and Quality (AHRQ) (HS11826).
Researchers retrospectively examined in-hospital mortality rates for 754 children with HLHS in 1997 and 880 children with HLHS in 2000 using the Kids' Inpatient Database (created as part of AHRQ's Healthcare Cost and Utilization Project). Over one-fourth (28 percent) of the children in 1997 and 24 percent in 2000 died in the hospital. Limited access to higher volume hospitals and patient preference for local health care may be contributing factors for the continued use of low-volume hospitals in 2000.
What happens in your babies' Open Heart Surgery (OHS)?
This term is used to describe operations on the heart and major blood vessels when the heart’s action is stopped. During the heart's operation, the blood supply to the body is able to be continued by a heart bypass machine. This works by an artificial pump and oxygentator known as heart/lung bypass which takes over the the job of both organs. This is connected to the veins and arteries by a set of tubes and maintains the blood supply to the body while the surgery is being undertaken. The temperature of the childs body is frequently cooled (called hyperthermia) and to reduce the demands of the body while the surgery is being performed a special salt solution (cardioplegia) is used to protect the heart muscle.
The children are anaesthetised and have several fine tubes inserted into the large vena cava and veins, often in the neck, to be able to measure pressures within the veins and to give drugs. A line is placed in an artery, usually in the arm or the leg to measure the blood pressure. The operations are usually carried out through the chest bone (sternum) and take between three and five hours depending on the complexity.
The heart and lung machine, and its tubes are connected to the patient, maintaining blood supply to the body and the heart is relaxed. The heart chamber or vessel is then opened, the defect repaired, following this the walls are then sewn up. The heart is then stimulated by electrical pulses and takes over the circulation and gradually the bypass machine can be taken away.
Additional tubes (drains) are left around the heart to ensure that any excess fluid is drained, and frequently fine pacing wires are sewn on the front surface of the heart (through these an electric current can be given to increase the patients heart rate if it is slow).
On return to the ward, most children will still require help with their breathing by the aid of a ventilator described earlier, and will have the small tubes coming out of their chest to help with draining the fluid from their tiny hearts.
Over the next hours and days these will gradually be removed and the child will leave the Intensive Care Unit (ICU). Many children will need to take several medications following their discharge from hospital. This is routine practice. Frequently over the subsequent weeks and months the medication will/may be reduced following out-patients clinic reviews.
The information for this article was taken from the Heart Children Book and edited by HLHS Awareness UK
Outcomes following pre-natal diagnosis of Hyploplastic Left Heart Syndrome
Hypoplastic Left Heart Syndrome (HLHS) was first described fifty years ago. It is characterised by the underdevelopment of the left ventricle with associated aortic and mitral valve hypoplasia or atresia, and varying degrees of hypoplasia of the aortic arch (Figure 1). In utero a physiological right to left shunt of oxygenated blood through the ductus arteriosus bypasses the obstruction and allows normal faetal growth. Closure of the ductus arteriosus in the post-natal period interrupts systemic blood flow, resulting in rapid deterioration and death. Untreated it is a universally fatal condition, leading to neonatal death within the first few days or weeks of life. Although HLHS affects only one baby in 10,000 and accounts for less than 10% of all congenital heart disease, HLHS is responsible for 25% of all deaths due to congenital cardiac disease occurring within the first week of life.
National UK Statistics for Congenital Heart Defects in Babies
National mortality statistics
In 2001, 811 deaths were recorded in the UK that were due to congenital heart disease (as it is called in the UK).
Just over a third of these deaths were in babies aged less than a year.
One in seven were in children and adolescents (aged 1-19 years).
and the remaining half were in adults (aged 20 years and over).
Data from England and Wales show that the proportion of deaths from congenital heart disease occurring in babies has declined markedly over the last two decades.
In 1986, the death rate was high in infancy, with just under 60% of deaths from congenital heart disease occurring in babies aged less than a year.
By the early 1990’s death from congenital heart disease was most common in adults aged 20 years and over.