You can select your prefered subtitle language by using the  CC  button in the player control bar.

Prolonged heart monitoring detects five times more atrial fibrillation than short-term monitoring after cryptogenic stroke 

MD-FM Thursday June 26th, 2014

 

SARAH:

MD-FM: the latest medical news from around the world, I’m Sarah Maxwell.

 

SEGMENT 1: NEUROLOGY:  Prolonged heart monitoring better than 24h strategy to detect atrial fibrillation after cryptogenic stroke


PETER:

Hello, and I’m Peter Goodwin. To begin with, using prolonged heart monitoring to detect atrial fibrillation after a cryptogenic stroke  (a stroke of unknown cause) appears to be much better than conventional 24 hour or even 48 hour monitoring…

 

SARAH:

Yes, two randomized studies, reported in the New England Journal of Medicine, showed that monitoring the heart for a few weeks picked up subclinical signs of atrial fibrillation that were missed with short-duration monitoring. Lead author of one of the studies, David Gladstone gave MD-FM the details:

 

GLADSTONE:

We found that the prolonged heart monitoring strategy led to a fivefold increase in the detection of atrial fibrillation, compared with the 24-hour protocol. And the prolonged heart monitoring strategy resulted in significantly more patients who were then able to be anticoagulated: there was nearly a doubling in the rate of anticoagulant treatment and anticoagulant therapy has been shown to reduce the risk of stroke in individuals with atrial fibrillation significantly, by approximately two thirds.

 

SARAH:

That was Dr David Gladstone, from the University of Toronto, in Canada. The team is continuing to follow these patients to find out if this strategy could actually result in a reduced risk of stroke, and he’s pretty confident it will.

 

GLADSTONE:

This is really up to guideline committees to now assimilate the evidence, which is accumulating, that supports the need for more intensive heart monitoring in patients who have experienced an unexplained stroke and this is especially for the elderly patients. And we do hope to see prolonged heart monitoring become more widely available… There are rapid advances, and we hope this will become incorporated as part of routine practice. You know, locally, at our institution, we have already adopted this protocol into our routine patient care.


SARAH:

And Dr. Gladstone said that different models of heart monitoring devices are already available on the market to do this. Hooman Kamel wrote an editorial on both of these studies and he also already recommended this strategy for some patients:

 

KAMEL:

A patient comes in and has a cryptogenic stroke... The standard tests are done, they have an EKG, they undergo at least 24 hours of heart rhythm monitoring in the hospital and there’s no atrial fibrillation there… The arteries coming from the heart to the brain are all evaluated and there’s no signs of narrowing or obstruction there –all the typical tests are done and there’s still no answer for why the patient had a stroke. Then I think those patients should undergo at least several weeks of continuous heart rhythm monitoring, to make sure there isn’t atrial fibrillation there.

 

SARAH:

That was Dr. Hooman Kamel, from Weill Cornell University in New York.

 

SEGMENT 2: Offering mammography cut breast cancer deaths by nearly 30 per cent

 

PETER:

Inviting women for breast cancer screening could reduce their risk of dying from the disease by 28 per cent. That’s the finding of a Norwegian population-based study that was carried out during a nationwide screening program, published in the British Medical Journal

 

SARAH:

Yes, investigators followed women for over two decades and compared deaths from breast cancer in those invited for screening, with those who weren’t invited. A clear distinction was made between: breast cancer cases diagnosed before and after the first invitation for screening, and the data suggest that mammography is indeed helpful. Lead study author Dr. Harald Weedon-Fekjær, from Oslo in Norway:

 

WEEDON-FEKJAER:

It reduces the mortality by 28 per cent in the years after you are screened –it doesn’t mean that the whole lifetime risk goes down by 28 per cent if you just screen when you are 50 to 69 years old. But, in this age group, we actually got a 28 per cent reduction and what it translates to in practice is that 368 women need to be invited to screening to save one life.

 

SARAH:

In light of recent advances in cancer treatments, experts have been debating the true benefits of mammography screening on disease outcomes. In an accompanying editorial, one specialist said the benefits seen are modest at best, and calls for women to be given balanced information including the screening harms of overdiagnosis, psychological stress, and high healthcare costs. Dr Weedon-Fekjær gave MD-FM his conclusions:

 

WEEDON-FEKJAER:

You can always debate which age group should be used and we have not looked into the negative sides of this diagnostic. That is something that we want to do in the future. It will always be a balance between positive and negative things, but we at least find quite a large mortality reduction.

 

SARAH:

Harald Weedon-Fekjær, from Oslo University.

 

 

SEGMENT 3: Adding tomosynthesis to mammography increased breast cancer detection

 

PETER:

And, the proportion of patients called back for additional imaging apparently decreased with in women who also had tomosynthesis as an extension to their mammography. And, most importantly, this also increased breast cancer detection rates. That’s according to a study reported in JAMA that compared the outcomes of more than 450,000 examinations using digital mammography alone or both techniques. The results support the potential benefits of tomosynthesis as a high-resolution screening tool, but its clinical benefit still needs to be assessed.

 

 

SEGMENT 4: Calcium and vitamin D improved metabolic profile in gestational diabetes

 

PETER:

Taking calcium and vitamin D supplements improved metabolic profiles in women with gestational diabetes. That was in a randomized study published in the journal Diabetologia…

 

SARAH:

Yes, nearly two months of co-supplementation improved these women’s levels of: fasting glucose, serum insulin and LDL cholesterol, better than giving vitamin D or calcium alone. Senior author Professor Ahmad Esmaillzadeh, from Isfahan University in Iran:

 

ESMAILLZADEH:

Previous publications in the world have assessed the effects of vitamin D supplementation on metabolic profiles of women with gestational diabetes but this is the first one that assesses the effects of calcium + vitamin D. You know vitamin D is very important for calcium absorption so we hypothesized that the addition of calcium to vitamin D supplements might further help women with gestational diabetes to control their metabolic profile.  

 

PETER:

And apparently it did Do we have any idea of how these nutrients affect diabetes?

 

SARAH:

Well, so far we only have hints...

 

ESMAILLZADEH:

Some mechanisms on the effects of vitamin D on insulin secretion, as well as on the effects of calcium intake on lipolysis, have been suggested but the exact mechanisms need to be explored in future studies...

 

SARAH:

That was Ahmad Esmaillzadeh, from Iran again. He noted that all 56 pregnant women in the study were already on carbohydrate restriction and oral hypoglycaemic agents to treat their diabetes.

 

PETER:

So should all women with gestational diabetes take calcium and vitamin D supplements?

 

SARAH:

Well, only if they still present with insufficient levels despite increasing their intake of foods rich in calcium and vitamin D such as dairy products and fish.

 

 

IN BRIEF 1: Using regional rather than general anaesthesia during hip fracture surgery didn’t reduce mortality risk

 

PETER:

Finally, in brief: using regional anaesthesia during hip fracture surgery, instead of general anaesthesia, was not associated with a lower risk of death at 30 days. These are the results of a study published in JAMA, looking at more than 56,000 adults having hip repair. Regional anaesthesia was, however, associated with a half day shorter length of hospital stay.

 

IN BRIEF 2: 2003 warnings on antidepressant use in youths may have caused an increase in suicide attempts

 

PETER:

Widespread media coverage of the United States FDA warnings in 2003, about a potential danger for young people taking antidepressants, might have increased the numbers of suicide attempts. That’s according to a study, published in the British Medical Journal, that found in the year following the warnings, antidepressant prescriptions fell by more than a fifth in young people. And there was a relative increase in suicide attempts by overdose with psychotropic drugs of more than 33 per cent in this population.

 

PETER:

That's all from MDFM for now. Sarah Maxwell and I will be back with more soon, so until then from me, Peter Goodwin, goodbye!

RSS
Twitter
Facebook

Previous editions

Partnership

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
Url
Go to
with
Danone Institute International