Recycled Pacemakers: Safe for use in developing world

Recycled pacemakers donated from U.S. funeral homes could offer a safe way to get the heart devices to people in the developing world who otherwise might not be able to afford them, a U.S. study said.

An estimated 1 million to 2 million people around the world die each year because they have no access to a pacemaker, an implanted device that uses electrical pulses to the heart to maintain a normal heartbeat.

One potential, largely untapped source of pacemakers for the world's poor could be the significant number of people in the U.S. who die with a still-functioning device - some 19 per cent of the deceased, according to one survey of morticians in Michigan and Illinois.

The majority of those are buried with the body or, if removed, thrown away as medical waste but a small percentage are donated to developing nations through charities.

"Implantation of donated permanent pacemakers can not only save lives but also improve quality of life of needy poor patients," wrote study leader Bharat Kantharia, of the University of Texas Health Science Center, in the American Journal of Cardiology.

Kantharia and his team collected 122 pacemakers, half of which had enough battery life left - more than three years - to be used again. They were partially sterilized, then sent to a hospital in Mumbai, India, where they were sterilized again and implanted in 53 heart patients.

New pacemakers in India cost $2,200 to $6,600, not including doctor and hospital fees or the cost of the wires connected to the pacemaker.

All of the patients survived the surgery and fared well immediately afterwards, with no cases of infection or pacemaker malfunctions over an average follow-up of nearly two years.

All but two of the 40 patients reported a marked improvement in their symptoms and quality of life. Four died, but their deaths were not linked to the pacemakers.

A number of significant hurdles remain. One of the biggest is simply getting pacemakers from the U.S. to impoverished patients who need them.

Another is the need for further safety studies.

Risk of heart attack in patients

Risk of heart attack in patients

Rheumatoid Arthritis (RA) patients face a two-fold increased risk of suffering a Myocardial Infarction (MI, heart attack) versus the general population, which is comparable to the increased risk of MI seen in diabetes patients, according to results of a new study presented today at EULAR 2010, the Annual Congress of the European League Against Rheumatism in Rome, Italy.

In this Danish, nationwide, 10 year study, RA and diabetes patients were directly compared to assess their individual risk of having an MI over time. In those patients that developed RA, the Incidence Rate Ratio (IRR) of experiencing a MI was increased to 1.65 (95% Confidence Interval (CI) 1.46-1.86), comparable to the increased risk of MI seen in patients developing diabetes mellitus (IRR 1.73 95% CI (1.68-1.79)). Data was further analysed to examine increased risk in certain age groups and researchers found that the risk of MI was increased six-fold in women with RA younger than 50 years (IRR 6.01 95% CI (3.62-9.99)) comparable to diabetic women in the same age range (IRR 6.13 95% CI (4.99-7.54)). Overall, the risk of MI in patients with RA and diabetes was similar for male patients at IRR 1.66 (1.39-1.98) and 1.59 (1.53-1.66) respectively.

“While we already know that RA is an independent risk factor for cardiovascular disease, our data highlight that the increased risk of a heart attack faced by RA patients is of a similar magnitude as that faced by diabetes patients, who in contrast to RA patients are routinely considered for intensive cardiovascular risk management,” said Dr. Jesper Lindhardsen, Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark, and lead author of the study. “This study underlines the importance of implementing EULAR recommendations advocating early detection and management of cardiovascular risk factors, as well as providing sufficient RA treatment in order to reduce the significant burden associated with cardiovascular disease co-morbidity and mortality.”

The study, which was supported by the Danish Rheumatism Association, analysed data from the entire Danish population (n=4,614,840, minimum 10 years old) and monitored for incidence of diabetes and RA between 1997 and 2006 (or the date of patients first MI, whichever came first). A total of 10,547 people developed RA and 132,868 developed diabetes. IRR was calculated and analysed by multiple Poisson regression, a statistical technique utilised for modeling and analyzing several variables in a patient population.

Email: eularpressoffice@uk.cohnwolfe.com

About EULAR
The European League Against Rheumatism (EULAR) is the organisation which represents the patient, health professional and scientific societies of rheumatology of all the European nations.

In line with The European Union of Medical Specialists (UEMS), EULAR defines rheumatology as including rheumatic diseases of the connective tissue, locomotor and musculoskeletal systems.

The aims of EULAR are to stimulate, promote, and support the research, prevention, treatment and rehabilitation of rheumatic diseases. To this end, EULAR fosters excellence in education and research in the field of rheumatology. It promotes the translation of research advances into daily care and fights for the recognition of the needs of people with rheumatic diseases.

EULAR 2010 is set to be the biggest rheumatology event in Europe with over 15,000 scientists, physicians, allied health professionals, and related audiences in attendance from over 100 countries. Over the course of the congress, almost 300 oral and more than 1600 poster abstract presentations will be featured, with 300 invited speaker lectures taking place in more than 140 sessions.

To find out more about the activities of EULAR, visit: http://www.eular.org/

Serious Medical Concerns over Daily Aspirin

Healthy people taking aspirin to prevent heart attacks could be doing themselves more harm than good, experts have concluded.

Millions of Britons are believed to be taking a daily dose of the drug in the hope that it acts as an insurance against heart trouble

Its routine use for the prevention of vascular problems "cannot be supported", UK professors from the Aspirin for Asymptomatic Atherosclerosis (AAA) said.

Professor Peter Weissberg, of the British Heart Foundation which part-funded the research, said: "We know that patients with symptoms of artery disease, such as angina, heart attack or stroke, can reduce their risk of further problems by taking a small dose of aspirin each day.

"The findings of this study agree with our current advice that people who do not have symptomatic or diagnosed artery or heart disease should not take aspirin, because the risks of bleeding may outweigh the benefits."

Reducing the risk of cardiovascular problems had to be set against the increased risk of internal bleeding, the study said.

In patients who have already had a heart attack, the risk of a second is so much higher that the balance is in favour of taking aspirin, Professor Gerry Fowkes, from the Wolfson Unit for Prevention of Peripheral Vascular Diseases in Edinburgh, added.

Better Blood Tests Can Confirm Heart Attacks

LOS ANGELES (AP) — A new generation of blood tests can quickly and reliably show if a person is having a heart attack, very soon after the severe chest pains start. Currently, tests are not sufficiently definitive.

The newer, sensitive tests give a much better way to tell who needs help fast. Each year, 15 million people in Europe and the United States go to emergency rooms (A&E) with symptoms of a heart attack, but most are suffering from other complaints.

Those who are truly having a heart attack need to have blocked arteries cleared or opened quickly, to limit the damage to the heart muscle, caused by the lack of blood flow.

Currently Doctors have two main ways of diagnosing a heart attack. 1) They can use an electrocardiogram, or ECG, to measure the electrical activity of the heartbeat for abnormalities. Unfortunately, that test is not always conclusive and relies on the calibration of the instrument and the expertise of the operator.

2) Doctors can also use blood tests to detect elevated levels of a heart muscle protein known as troponin, this is a sign of heart muscle injury. The problem with the old troponin test is its lack of sensitivity. It takes longer to detect increased troponin levels and by that time, heart damage may have already occurred.

Greater Accuracy

In extensive test cases, the accuracy of the newer tests was 94 to 96% accurate, compared with 85 to 90% for the older tests.

Mayo Clinic cardiologist Dr. Allan Jaffe advocates using the newer tests. Several doctors said the new tests do not cost more than the older versions they are replacing, and are usually covered by insurance.

"You diagnose heart attacks faster and more accurately. You detect more people who are acctually having heart attacks and you can give them the priority they need," said Jaffe, who is independant of the studies and has no role in them.

He does agree that further studies are needed to determine if earlier detection of heart injury results in more lives being saved, but this is certainly a big step forward.