Diana Mahoney

BOSTON — Many women with newly diagnosed ductal carcinoma in situ harbor grossly inaccurate perceptions of the breast cancer risks they face, which can influence their decision making and health behaviors as well as psychosocial outcomes, reported Ann H. Partridge, M.D.

The most common type of noninvasive breast cancer, ductal carcinoma in situ (DCIS) is a relatively low-risk disease. With early detection, the 5-year survival rate is nearly 100%, “thus it has a very small impact on a woman's overall survival,” Dr. Partridge said in a presentation at a breast cancer meeting sponsored by Harvard Medical School.

In contrast, a longitudinal study has shown the perception of risk among women diagnosed with the condition to be “substantial,” she said.

In a cohort of 499 women newly diagnosed with DCIS participating in a study of psychosocial concerns, risk perceptions, and health behaviors, 55% believed that it was at least moderately likely the disease would recur within 5 years. Additionally, 68% of the women reported a moderate or greater likelihood of lifetime recurrence; 38% thought they were at risk for invasive disease in the next 5 years; 53% perceived a greater lifetime risk of invasive disease; and 28% indicated a moderate or greater likelihood of their breast cancer spreading to other parts of their body, reported Dr. Partridge of the Dana-Farber Cancer Institute in Boston.

A multivariate model showed that anxiety at baseline, as measured by the Hospitalized Anxiety and Depression Scale and the Revised Impact of Event Scale, was associated with the belief that DCIS would spread. These perceptions were independent of age, race, education, marital status, employment, financial status, comorbidity, anxiety, oncology consultation, treatment, and satisfaction with treatment.

Preliminary follow-up indicated that patients' risk perceptions persisted over time, with nearly one-quarter of those surveyed at 18 months believing there was a moderate or greater chance that DCIS would spread to other parts of their body. “Some patients' perception of risk increased over time and others' decreased without a consistent trend,” Dr. Partridge said.

Multivariate analysis of the 18-month data showed that nonwhite race, less than full-time employment status, lack of satisfaction with treatment, and having taken tamoxifen were associated with heightened risk perceptions.

Given the possibility that the pervasive risk misperceptions could have a negative impact on psychosocial functioning and health-related decision making, clinicians caring for these patients should encourage them to communicate their fears and provide education and support for dispelling altered risk beliefs, Dr. Partridge said.

In addition, future research should assess the impact of these risk misperceptions on patient outcome and health-related behaviors, she concluded.

BOSTON — Many women with newly diagnosed ductal carcinoma in situ harbor grossly inaccurate perceptions of the breast cancer risks they face, which can influence their decision making and health behaviors as well as psychosocial outcomes, reported Ann H. Partridge, M.D.

The most common type of noninvasive breast cancer, ductal carcinoma in situ (DCIS) is a relatively low-risk disease. With early detection, the 5-year survival rate is nearly 100%, “thus it has a very small impact on a woman's overall survival,” Dr. Partridge said in a presentation at a breast cancer meeting sponsored by Harvard Medical School.

In contrast, a longitudinal study has shown the perception of risk among women diagnosed with the condition to be “substantial,” she said.

In a cohort of 499 women newly diagnosed with DCIS participating in a study of psychosocial concerns, risk perceptions, and health behaviors, 55% believed that it was at least moderately likely the disease would recur within 5 years. Additionally, 68% of the women reported a moderate or greater likelihood of lifetime recurrence; 38% thought they were at risk for invasive disease in the next 5 years; 53% perceived a greater lifetime risk of invasive disease; and 28% indicated a moderate or greater likelihood of their breast cancer spreading to other parts of their body, reported Dr. Partridge of the Dana-Farber Cancer Institute in Boston.

A multivariate model showed that anxiety at baseline, as measured by the Hospitalized Anxiety and Depression Scale and the Revised Impact of Event Scale, was associated with the belief that DCIS would spread. These perceptions were independent of age, race, education, marital status, employment, financial status, comorbidity, anxiety, oncology consultation, treatment, and satisfaction with treatment.

Preliminary follow-up indicated that patients' risk perceptions persisted over time, with nearly one-quarter of those surveyed at 18 months believing there was a moderate or greater chance that DCIS would spread to other parts of their body. “Some patients' perception of risk increased over time and others' decreased without a consistent trend,” Dr. Partridge said.

Multivariate analysis of the 18-month data showed that nonwhite race, less than full-time employment status, lack of satisfaction with treatment, and having taken tamoxifen were associated with heightened risk perceptions.

Given the possibility that the pervasive risk misperceptions could have a negative impact on psychosocial functioning and health-related decision making, clinicians caring for these patients should encourage them to communicate their fears and provide education and support for dispelling altered risk beliefs, Dr. Partridge said.

In addition, future research should assess the impact of these risk misperceptions on patient outcome and health-related behaviors, she concluded.

BOSTON — Many women with newly diagnosed ductal carcinoma in situ harbor grossly inaccurate perceptions of the breast cancer risks they face, which can influence their decision making and health behaviors as well as psychosocial outcomes, reported Ann H. Partridge, M.D.

The most common type of noninvasive breast cancer, ductal carcinoma in situ (DCIS) is a relatively low-risk disease. With early detection, the 5-year survival rate is nearly 100%, “thus it has a very small impact on a woman's overall survival,” Dr. Partridge said in a presentation at a breast cancer meeting sponsored by Harvard Medical School.

In contrast, a longitudinal study has shown the perception of risk among women diagnosed with the condition to be “substantial,” she said.

In a cohort of 499 women newly diagnosed with DCIS participating in a study of psychosocial concerns, risk perceptions, and health behaviors, 55% believed that it was at least moderately likely the disease would recur within 5 years. Additionally, 68% of the women reported a moderate or greater likelihood of lifetime recurrence; 38% thought they were at risk for invasive disease in the next 5 years; 53% perceived a greater lifetime risk of invasive disease; and 28% indicated a moderate or greater likelihood of their breast cancer spreading to other parts of their body, reported Dr. Partridge of the Dana-Farber Cancer Institute in Boston.

A multivariate model showed that anxiety at baseline, as measured by the Hospitalized Anxiety and Depression Scale and the Revised Impact of Event Scale, was associated with the belief that DCIS would spread. These perceptions were independent of age, race, education, marital status, employment, financial status, comorbidity, anxiety, oncology consultation, treatment, and satisfaction with treatment.

Preliminary follow-up indicated that patients' risk perceptions persisted over time, with nearly one-quarter of those surveyed at 18 months believing there was a moderate or greater chance that DCIS would spread to other parts of their body. “Some patients' perception of risk increased over time and others' decreased without a consistent trend,” Dr. Partridge said.

Multivariate analysis of the 18-month data showed that nonwhite race, less than full-time employment status, lack of satisfaction with treatment, and having taken tamoxifen were associated with heightened risk perceptions.

Given the possibility that the pervasive risk misperceptions could have a negative impact on psychosocial functioning and health-related decision making, clinicians caring for these patients should encourage them to communicate their fears and provide education and support for dispelling altered risk beliefs, Dr. Partridge said.

In addition, future research should assess the impact of these risk misperceptions on patient outcome and health-related behaviors, she concluded.

BOSTON — The psychosocial needs of young breast cancer patients should be viewed in a different context than those of older women, said Lidia Schapira, M.D.

“Premenopausal women with breast cancer are at greater risk of psychological distress at diagnosis and during treatment, especially when it coincides with childbearing years or with years spent in active parenting roles,” Dr. Schapira said at a breast cancer meeting sponsored by Harvard Medical School.

Because younger women face such concerns as premature death and the impact that treatment will have on fertility, child rearing, career, finances, and appearance, clinicians must broaden their traditional vertical focus on managing the medical aspects of the disease “and look at the horizontal axis of patients' social functioning as they deal with their diagnosis and treatment,” said Dr. Schapira of Massachusetts General Hospital, Boston.

The nature and extent of a breast cancer patient's psychological distress will vary depending on both the individual and the phase of the disease. The concerns at diagnosis might be different from those experienced during primary treatment or at treatment completion, Dr. Schapira said.

At all points along the disease trajectory, clinicians should address “normal” levels of psychosocial distress and be alert for signs of persistent distress that would benefit from specific mental health intervention. Toward this end, according to guidelines in a 2004 Institute of Medicine report on the psychosocial needs of women with breast cancer, clinicians should:

▸ Clarify and ensure understanding of diagnosis and treatment options and side effects.

▸ Advise that distress is normal and expected and can increase at transition points.

▸ Build trust.

▸ Mobilize resources and direct patients to educational materials and local resources.

▸ Consider medication for symptoms.

▸ Ensure continuity of care.

▸ Monitor and reevaluate for referral to more specialized services if needed.

Additionally, a variety of interventions have been shown to favorably impact psychological status and quality of life, Dr. Schapira said. “Notably, there is strong evidence for the benefit of relaxation, hypnosis, and imagery in early-stage breast cancer, for group interventions in both early and metastatic disease, and for individual interventions primarily in the early setting,” she said.

Finally, clinicians need to be acutely aware of the special issues facing women who are diagnosed during their parenting years. “Being a parent affects preference for adjuvant chemotherapy in women with breast cancer, yet the impact that the side effects of treatment will have on the parenting experience are rarely discussed in the context of a medical encounter,” Dr. Schapira said. “Studies have shown that parents want to know how to talk about the illness with their kids in a developmentally appropriate way,” she said, and that parents need guidance in understanding and dealing with the impact of maternal disease on children's behavior and level of distress.

One example of how such issues might be addressed is a program developed by Paula Rauch, M.D., at Massachusetts General called Parenting at a Challenging Time (PACT). Through PACT, child psychiatrists and psychologists provide free consultations to adult cancer patients or their partners to help them address the needs of their children during treatment, Dr. Schapira said. “The program recommends that clinicians ask patients if they have children, and follow up with questions about the children and discuss the resources that are available to them,” she said.

Clearly, clinicians cannot be the only source of psychosocial support for their younger breast cancer patients; they should be cognizant of the potential for significant distress and be prepared to help these women get the support they need, Dr. Schapira concluded.

BOSTON — The psychosocial needs of young breast cancer patients should be viewed in a different context than those of older women, said Lidia Schapira, M.D.

“Premenopausal women with breast cancer are at greater risk of psychological distress at diagnosis and during treatment, especially when it coincides with childbearing years or with years spent in active parenting roles,” Dr. Schapira said at a breast cancer meeting sponsored by Harvard Medical School.

Because younger women face such concerns as premature death and the impact that treatment will have on fertility, child rearing, career, finances, and appearance, clinicians must broaden their traditional vertical focus on managing the medical aspects of the disease “and look at the horizontal axis of patients' social functioning as they deal with their diagnosis and treatment,” said Dr. Schapira of Massachusetts General Hospital, Boston.

The nature and extent of a breast cancer patient's psychological distress will vary depending on both the individual and the phase of the disease. The concerns at diagnosis might be different from those experienced during primary treatment or at treatment completion, Dr. Schapira said.

At all points along the disease trajectory, clinicians should address “normal” levels of psychosocial distress and be alert for signs of persistent distress that would benefit from specific mental health intervention. Toward this end, according to guidelines in a 2004 Institute of Medicine report on the psychosocial needs of women with breast cancer, clinicians should:

▸ Clarify and ensure understanding of diagnosis and treatment options and side effects.

▸ Advise that distress is normal and expected and can increase at transition points.

▸ Build trust.

▸ Mobilize resources and direct patients to educational materials and local resources.

▸ Consider medication for symptoms.

▸ Ensure continuity of care.

▸ Monitor and reevaluate for referral to more specialized services if needed.

Additionally, a variety of interventions have been shown to favorably impact psychological status and quality of life, Dr. Schapira said. “Notably, there is strong evidence for the benefit of relaxation, hypnosis, and imagery in early-stage breast cancer, for group interventions in both early and metastatic disease, and for individual interventions primarily in the early setting,” she said.

Finally, clinicians need to be acutely aware of the special issues facing women who are diagnosed during their parenting years. “Being a parent affects preference for adjuvant chemotherapy in women with breast cancer, yet the impact that the side effects of treatment will have on the parenting experience are rarely discussed in the context of a medical encounter,” Dr. Schapira said. “Studies have shown that parents want to know how to talk about the illness with their kids in a developmentally appropriate way,” she said, and that parents need guidance in understanding and dealing with the impact of maternal disease on children's behavior and level of distress.

One example of how such issues might be addressed is a program developed by Paula Rauch, M.D., at Massachusetts General called Parenting at a Challenging Time (PACT). Through PACT, child psychiatrists and psychologists provide free consultations to adult cancer patients or their partners to help them address the needs of their children during treatment, Dr. Schapira said. “The program recommends that clinicians ask patients if they have children, and follow up with questions about the children and discuss the resources that are available to them,” she said.

Clearly, clinicians cannot be the only source of psychosocial support for their younger breast cancer patients; they should be cognizant of the potential for significant distress and be prepared to help these women get the support they need, Dr. Schapira concluded.

BOSTON — The psychosocial needs of young breast cancer patients should be viewed in a different context than those of older women, said Lidia Schapira, M.D.

“Premenopausal women with breast cancer are at greater risk of psychological distress at diagnosis and during treatment, especially when it coincides with childbearing years or with years spent in active parenting roles,” Dr. Schapira said at a breast cancer meeting sponsored by Harvard Medical School.

Because younger women face such concerns as premature death and the impact that treatment will have on fertility, child rearing, career, finances, and appearance, clinicians must broaden their traditional vertical focus on managing the medical aspects of the disease “and look at the horizontal axis of patients' social functioning as they deal with their diagnosis and treatment,” said Dr. Schapira of Massachusetts General Hospital, Boston.

The nature and extent of a breast cancer patient's psychological distress will vary depending on both the individual and the phase of the disease. The concerns at diagnosis might be different from those experienced during primary treatment or at treatment completion, Dr. Schapira said.

At all points along the disease trajectory, clinicians should address “normal” levels of psychosocial distress and be alert for signs of persistent distress that would benefit from specific mental health intervention. Toward this end, according to guidelines in a 2004 Institute of Medicine report on the psychosocial needs of women with breast cancer, clinicians should:

▸ Clarify and ensure understanding of diagnosis and treatment options and side effects.

▸ Advise that distress is normal and expected and can increase at transition points.

▸ Build trust.

▸ Mobilize resources and direct patients to educational materials and local resources.

▸ Consider medication for symptoms.

▸ Ensure continuity of care.

▸ Monitor and reevaluate for referral to more specialized services if needed.

Additionally, a variety of interventions have been shown to favorably impact psychological status and quality of life, Dr. Schapira said. “Notably, there is strong evidence for the benefit of relaxation, hypnosis, and imagery in early-stage breast cancer, for group interventions in both early and metastatic disease, and for individual interventions primarily in the early setting,” she said.

Finally, clinicians need to be acutely aware of the special issues facing women who are diagnosed during their parenting years. “Being a parent affects preference for adjuvant chemotherapy in women with breast cancer, yet the impact that the side effects of treatment will have on the parenting experience are rarely discussed in the context of a medical encounter,” Dr. Schapira said. “Studies have shown that parents want to know how to talk about the illness with their kids in a developmentally appropriate way,” she said, and that parents need guidance in understanding and dealing with the impact of maternal disease on children's behavior and level of distress.

One example of how such issues might be addressed is a program developed by Paula Rauch, M.D., at Massachusetts General called Parenting at a Challenging Time (PACT). Through PACT, child psychiatrists and psychologists provide free consultations to adult cancer patients or their partners to help them address the needs of their children during treatment, Dr. Schapira said. “The program recommends that clinicians ask patients if they have children, and follow up with questions about the children and discuss the resources that are available to them,” she said.

Clearly, clinicians cannot be the only source of psychosocial support for their younger breast cancer patients; they should be cognizant of the potential for significant distress and be prepared to help these women get the support they need, Dr. Schapira concluded.

BOSTON — Left atrial function is a sensitive predictor of cardiovascular outcome in patients with stable coronary heart disease, a prospective study has shown.

Of 989 patients with heart disease recruited for the ongoing Heart and Soul Study at the San Francisco Veterans' Affairs Medical Center and the University of California at San Francisco, 8.5% of the 247 patients whose left atrial function index was in the lowest quartile had a cardiac event during the 1-year follow-up period, compared with 4% of the 742 whose indices fell into the upper three quartiles, as reported Pamela Y.F. Hsu, M.D., in a poster presentation at the annual meeting of the American Society of Echocardiography.

“The association between a low index and cardiovascular outcomes persisted after adjusting for smoking, congestive heart failure, other comorbid illnesses, medication use, and left ventricular ejection fraction,” said Dr. Hsu of the Mayo Clinic in Scottsdale, Ariz.

To determine the left atrial function index (LAFI), the investigators calculated the time-velocity integral for the left ventricular outflow tract, the left atrial end systolic volume (LAESV) and end diastolic volume (LAEDV), and the LAESV index measurements by using transthoracic echocardiography.

They also measured biplane left atrial volumes and calculated the left atrial ejection fraction (LAESV/LAEDV). The LAFI represents the left ventricular outflow tract time-velocity integral multiplied by the left atrial ejection fraction over the LAESV index, with the whole multiplied by 10 log 4. Using logistic regression, the investigators evaluated the association between the lowest LAFI quartile and cardiovascular outcomes—including myocardial infarction, hospitalization for congestive heart failure, and coronary disease death—and adjusted for potential confounding variables.

In the lowest quartile, the age-adjusted odds ratio for having any cardiac event within 1 year was 3.3, while the specific odds ratios for myocardial infarction, heart failure, and coronary disease death were 3.3, 4.8, and 4.2, respectively.

In the multivariable adjusted model, the odds ratio for any cardiac event was 2.6 and the respective odds ratios for myocardial infarction, heart failure, and coronary disease death were 3.0, 3.3, and 2.2. All of the associations were statistically significant, Dr. Hsu said.

The findings indicate that the LAFI “is a simple, powerful, and clinically useful tool” for predicting 1-year cardiovascular outcomes in coronary heart disease patients, said Dr. Hsu.

BOSTON — Left atrial function is a sensitive predictor of cardiovascular outcome in patients with stable coronary heart disease, a prospective study has shown.

Of 989 patients with heart disease recruited for the ongoing Heart and Soul Study at the San Francisco Veterans' Affairs Medical Center and the University of California at San Francisco, 8.5% of the 247 patients whose left atrial function index was in the lowest quartile had a cardiac event during the 1-year follow-up period, compared with 4% of the 742 whose indices fell into the upper three quartiles, as reported Pamela Y.F. Hsu, M.D., in a poster presentation at the annual meeting of the American Society of Echocardiography.

“The association between a low index and cardiovascular outcomes persisted after adjusting for smoking, congestive heart failure, other comorbid illnesses, medication use, and left ventricular ejection fraction,” said Dr. Hsu of the Mayo Clinic in Scottsdale, Ariz.

To determine the left atrial function index (LAFI), the investigators calculated the time-velocity integral for the left ventricular outflow tract, the left atrial end systolic volume (LAESV) and end diastolic volume (LAEDV), and the LAESV index measurements by using transthoracic echocardiography.

They also measured biplane left atrial volumes and calculated the left atrial ejection fraction (LAESV/LAEDV). The LAFI represents the left ventricular outflow tract time-velocity integral multiplied by the left atrial ejection fraction over the LAESV index, with the whole multiplied by 10 log 4. Using logistic regression, the investigators evaluated the association between the lowest LAFI quartile and cardiovascular outcomes—including myocardial infarction, hospitalization for congestive heart failure, and coronary disease death—and adjusted for potential confounding variables.

In the lowest quartile, the age-adjusted odds ratio for having any cardiac event within 1 year was 3.3, while the specific odds ratios for myocardial infarction, heart failure, and coronary disease death were 3.3, 4.8, and 4.2, respectively.

In the multivariable adjusted model, the odds ratio for any cardiac event was 2.6 and the respective odds ratios for myocardial infarction, heart failure, and coronary disease death were 3.0, 3.3, and 2.2. All of the associations were statistically significant, Dr. Hsu said.

The findings indicate that the LAFI “is a simple, powerful, and clinically useful tool” for predicting 1-year cardiovascular outcomes in coronary heart disease patients, said Dr. Hsu.

BOSTON — Left atrial function is a sensitive predictor of cardiovascular outcome in patients with stable coronary heart disease, a prospective study has shown.

Of 989 patients with heart disease recruited for the ongoing Heart and Soul Study at the San Francisco Veterans' Affairs Medical Center and the University of California at San Francisco, 8.5% of the 247 patients whose left atrial function index was in the lowest quartile had a cardiac event during the 1-year follow-up period, compared with 4% of the 742 whose indices fell into the upper three quartiles, as reported Pamela Y.F. Hsu, M.D., in a poster presentation at the annual meeting of the American Society of Echocardiography.

“The association between a low index and cardiovascular outcomes persisted after adjusting for smoking, congestive heart failure, other comorbid illnesses, medication use, and left ventricular ejection fraction,” said Dr. Hsu of the Mayo Clinic in Scottsdale, Ariz.

To determine the left atrial function index (LAFI), the investigators calculated the time-velocity integral for the left ventricular outflow tract, the left atrial end systolic volume (LAESV) and end diastolic volume (LAEDV), and the LAESV index measurements by using transthoracic echocardiography.

They also measured biplane left atrial volumes and calculated the left atrial ejection fraction (LAESV/LAEDV). The LAFI represents the left ventricular outflow tract time-velocity integral multiplied by the left atrial ejection fraction over the LAESV index, with the whole multiplied by 10 log 4. Using logistic regression, the investigators evaluated the association between the lowest LAFI quartile and cardiovascular outcomes—including myocardial infarction, hospitalization for congestive heart failure, and coronary disease death—and adjusted for potential confounding variables.

In the lowest quartile, the age-adjusted odds ratio for having any cardiac event within 1 year was 3.3, while the specific odds ratios for myocardial infarction, heart failure, and coronary disease death were 3.3, 4.8, and 4.2, respectively.

In the multivariable adjusted model, the odds ratio for any cardiac event was 2.6 and the respective odds ratios for myocardial infarction, heart failure, and coronary disease death were 3.0, 3.3, and 2.2. All of the associations were statistically significant, Dr. Hsu said.

The findings indicate that the LAFI “is a simple, powerful, and clinically useful tool” for predicting 1-year cardiovascular outcomes in coronary heart disease patients, said Dr. Hsu.

BOSTON — A novel risk score, comprising measures of wall motion and myocardial perfusion from contrast echocardiography and clinical variables, is a sensitive predictor of 1-year outcome in patients presenting to the emergency department with chest pain prior to obtaining troponin data, reported William Foster, M.D.

In the risk score development model and a subsequent validation model, the tool proved to be more effective for risk stratification than did the use of cardiac troponin measures and clinical variables without the ultrasound data, said Dr. Foster in a poster presentation at the annual meeting of the American Society of Echocardiography.

Dr. Foster and colleagues at the University of Virginia in Charlottesville developed the risk score using clinical and myocardial imaging data from 973 patients presenting to the emergency department (ED) with chest pain that could not easily be attributed to a noncardiac cause and who did not have ST-segment elevation on their admission ECG.

The risk score stratifies the likelihood of developing primary or secondary events within 1 year of chest pain presentation in the ED. Primary events include all cause mortality and myocardial infarction; secondary events include unstable angina, revascularization, and heart failure.

The clinical predictive factors considered in the risk score include age older than 60 years, the presence of three or more coronary disease risk factors, known coronary luminal diameter narrowing of more than 50%, ST-segment deviation on electrocardiogram, two or more angina events in the previous 24 hours, and aspirin use in the previous 7 days. (See box.)

With respect to echocardiographic variables for risk prediction, regional function was characterized as normal or abnormal using a 14-segment model, including 6 segments in each of the basal and midpapillary muscle levels and 2 segments in the apex. Myocardial perfusion was evaluated using the same segmented model and was deemed abnormal if there was no evidence of maximal opacification within a segment by five cardiac cycles. An echocardiographic study was considered abnormal if at least one segment was abnormal for either regional function or myocardial perfusion, Dr. Foster noted.

Each of these predictors is associated with a score between 0 and 100, based on estimates developed using logistic regression models. “The total risk score is the sum of all of these scores,” said Dr. Foster.

Among the 973 patients in the development sample, the model showed “excellent discriminatory capacity,” with an 86% probability of correct prediction, said Dr. Foster. Approximately 60% of those with total risk scores of 200 or higher, and 30% of those with scores of 150–199, experienced a primary or secondary cardiac event at 1 year. About 17% of patients with scores of 100–149, 7% of those with scores of 50–99, and 4% of those with scores of 0–49 had events within 1 year.

To validate the sensitivity of the scores as potential prognostic indicators, the investigators applied the risk score model prospectively in 232 patients who were followed for up to 1 year.

“We saw the same pattern in the validation sample, with a similar prognostic discriminatory capacity between the validation and development samples,” said Dr. Foster. In fact, the discriminatory capacity of the risk score “was greater than clinical variables plus serum cardiac troponin,” he said.

The ability to formulate prognoses prior to obtaining troponin data could streamline the management of chest pain patients in the ED, Dr. Foster concluded.

In this contrast-enhanced image from the apical four-chamber view, arrows show a resting perfusion defect in the mid- and distal septum of a patient with chest pain. Courtesy Dr. Kevin S. Wei

BOSTON — A novel risk score, comprising measures of wall motion and myocardial perfusion from contrast echocardiography and clinical variables, is a sensitive predictor of 1-year outcome in patients presenting to the emergency department with chest pain prior to obtaining troponin data, reported William Foster, M.D.

In the risk score development model and a subsequent validation model, the tool proved to be more effective for risk stratification than did the use of cardiac troponin measures and clinical variables without the ultrasound data, said Dr. Foster in a poster presentation at the annual meeting of the American Society of Echocardiography.

Dr. Foster and colleagues at the University of Virginia in Charlottesville developed the risk score using clinical and myocardial imaging data from 973 patients presenting to the emergency department (ED) with chest pain that could not easily be attributed to a noncardiac cause and who did not have ST-segment elevation on their admission ECG.

The risk score stratifies the likelihood of developing primary or secondary events within 1 year of chest pain presentation in the ED. Primary events include all cause mortality and myocardial infarction; secondary events include unstable angina, revascularization, and heart failure.

The clinical predictive factors considered in the risk score include age older than 60 years, the presence of three or more coronary disease risk factors, known coronary luminal diameter narrowing of more than 50%, ST-segment deviation on electrocardiogram, two or more angina events in the previous 24 hours, and aspirin use in the previous 7 days. (See box.)

With respect to echocardiographic variables for risk prediction, regional function was characterized as normal or abnormal using a 14-segment model, including 6 segments in each of the basal and midpapillary muscle levels and 2 segments in the apex. Myocardial perfusion was evaluated using the same segmented model and was deemed abnormal if there was no evidence of maximal opacification within a segment by five cardiac cycles. An echocardiographic study was considered abnormal if at least one segment was abnormal for either regional function or myocardial perfusion, Dr. Foster noted.

Each of these predictors is associated with a score between 0 and 100, based on estimates developed using logistic regression models. “The total risk score is the sum of all of these scores,” said Dr. Foster.

Among the 973 patients in the development sample, the model showed “excellent discriminatory capacity,” with an 86% probability of correct prediction, said Dr. Foster. Approximately 60% of those with total risk scores of 200 or higher, and 30% of those with scores of 150–199, experienced a primary or secondary cardiac event at 1 year. About 17% of patients with scores of 100–149, 7% of those with scores of 50–99, and 4% of those with scores of 0–49 had events within 1 year.

To validate the sensitivity of the scores as potential prognostic indicators, the investigators applied the risk score model prospectively in 232 patients who were followed for up to 1 year.

“We saw the same pattern in the validation sample, with a similar prognostic discriminatory capacity between the validation and development samples,” said Dr. Foster. In fact, the discriminatory capacity of the risk score “was greater than clinical variables plus serum cardiac troponin,” he said.

The ability to formulate prognoses prior to obtaining troponin data could streamline the management of chest pain patients in the ED, Dr. Foster concluded.

In this contrast-enhanced image from the apical four-chamber view, arrows show a resting perfusion defect in the mid- and distal septum of a patient with chest pain. Courtesy Dr. Kevin S. Wei

BOSTON — A novel risk score, comprising measures of wall motion and myocardial perfusion from contrast echocardiography and clinical variables, is a sensitive predictor of 1-year outcome in patients presenting to the emergency department with chest pain prior to obtaining troponin data, reported William Foster, M.D.

In the risk score development model and a subsequent validation model, the tool proved to be more effective for risk stratification than did the use of cardiac troponin measures and clinical variables without the ultrasound data, said Dr. Foster in a poster presentation at the annual meeting of the American Society of Echocardiography.

Dr. Foster and colleagues at the University of Virginia in Charlottesville developed the risk score using clinical and myocardial imaging data from 973 patients presenting to the emergency department (ED) with chest pain that could not easily be attributed to a noncardiac cause and who did not have ST-segment elevation on their admission ECG.

The risk score stratifies the likelihood of developing primary or secondary events within 1 year of chest pain presentation in the ED. Primary events include all cause mortality and myocardial infarction; secondary events include unstable angina, revascularization, and heart failure.

The clinical predictive factors considered in the risk score include age older than 60 years, the presence of three or more coronary disease risk factors, known coronary luminal diameter narrowing of more than 50%, ST-segment deviation on electrocardiogram, two or more angina events in the previous 24 hours, and aspirin use in the previous 7 days. (See box.)

With respect to echocardiographic variables for risk prediction, regional function was characterized as normal or abnormal using a 14-segment model, including 6 segments in each of the basal and midpapillary muscle levels and 2 segments in the apex. Myocardial perfusion was evaluated using the same segmented model and was deemed abnormal if there was no evidence of maximal opacification within a segment by five cardiac cycles. An echocardiographic study was considered abnormal if at least one segment was abnormal for either regional function or myocardial perfusion, Dr. Foster noted.

Each of these predictors is associated with a score between 0 and 100, based on estimates developed using logistic regression models. “The total risk score is the sum of all of these scores,” said Dr. Foster.

Among the 973 patients in the development sample, the model showed “excellent discriminatory capacity,” with an 86% probability of correct prediction, said Dr. Foster. Approximately 60% of those with total risk scores of 200 or higher, and 30% of those with scores of 150–199, experienced a primary or secondary cardiac event at 1 year. About 17% of patients with scores of 100–149, 7% of those with scores of 50–99, and 4% of those with scores of 0–49 had events within 1 year.

To validate the sensitivity of the scores as potential prognostic indicators, the investigators applied the risk score model prospectively in 232 patients who were followed for up to 1 year.

“We saw the same pattern in the validation sample, with a similar prognostic discriminatory capacity between the validation and development samples,” said Dr. Foster. In fact, the discriminatory capacity of the risk score “was greater than clinical variables plus serum cardiac troponin,” he said.

The ability to formulate prognoses prior to obtaining troponin data could streamline the management of chest pain patients in the ED, Dr. Foster concluded.

In this contrast-enhanced image from the apical four-chamber view, arrows show a resting perfusion defect in the mid- and distal septum of a patient with chest pain. Courtesy Dr. Kevin S. Wei

NEW ORLEANS – A brief, two-question screening instrument is sensitive for identifying depression in patients with coronary heart disease, a study has shown.

Because major depression is associated with adverse outcomes in this patient population, the availability of a quick, effective tool for improving detection and referral rates could improve patient outcomes substantially, David D. McManus, M.D., reported at the annual meeting of the Society of General Internal Medicine.

Using data from the Heart and Soul Study of the University of California, San Francisco, Dr. McManus and his colleagues compared the test characteristics of four depression case-finding instruments with those of the Diagnostic Interview for Depression in 1,024 adults with stable coronary heart disease (CHD) recruited from local outpatient clinics.

The instruments selected for comparison were the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D), the 9-item Patient Health Questionnaire (PHQ-9), the 2-item Patient Health Questionnaire (PHQ-2), and a brief screen that asks patients about depressed mood and anhedonia.

Specifically, the brief screen asks patients, “During the past month, have you often been bothered by feeling down, depressed, or hopeless?” and “During the past month, have you often been bothered by little interest or pleasure in doing things?” Dr. McManus said. An answer of “yes” to either of these questions was considered a positive screen.

Of the 1,024 study participants, 224 had major depression by standard measure (Diagnostic Interview for Depression). The brief, two-question screen was, at 90%, the most sensitive of the four test measures. The sensitivity of the CES-D, the PHQ-9, and the PHQ-2 was 76%, 54%, and 39%, respectively. The specificity of the brief screen was 69%, compared with 79%, 90%, and 92% for the CES-D, the PHQ-9, and the PHQ-2.

“The two-question instrument was a sensitive tool for identifying depression in CHD patients from diverse outpatient care settings,” Dr. McManus said.

The instrument can be easily integrated into outpatient visits, “even in the busiest cardiology practices,” he said. “A negative response to both questions effectively rules out depression, and a positive response to either suggests the patient might benefit from referral or treatment.”

The Heart and Soul Study is an ongoing, prospective cohort study designed to determine how psychosocial factors influence disease progression in patients with CHD.

NEW ORLEANS – A brief, two-question screening instrument is sensitive for identifying depression in patients with coronary heart disease, a study has shown.

Because major depression is associated with adverse outcomes in this patient population, the availability of a quick, effective tool for improving detection and referral rates could improve patient outcomes substantially, David D. McManus, M.D., reported at the annual meeting of the Society of General Internal Medicine.

Using data from the Heart and Soul Study of the University of California, San Francisco, Dr. McManus and his colleagues compared the test characteristics of four depression case-finding instruments with those of the Diagnostic Interview for Depression in 1,024 adults with stable coronary heart disease (CHD) recruited from local outpatient clinics.

The instruments selected for comparison were the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D), the 9-item Patient Health Questionnaire (PHQ-9), the 2-item Patient Health Questionnaire (PHQ-2), and a brief screen that asks patients about depressed mood and anhedonia.

Specifically, the brief screen asks patients, “During the past month, have you often been bothered by feeling down, depressed, or hopeless?” and “During the past month, have you often been bothered by little interest or pleasure in doing things?” Dr. McManus said. An answer of “yes” to either of these questions was considered a positive screen.

Of the 1,024 study participants, 224 had major depression by standard measure (Diagnostic Interview for Depression). The brief, two-question screen was, at 90%, the most sensitive of the four test measures. The sensitivity of the CES-D, the PHQ-9, and the PHQ-2 was 76%, 54%, and 39%, respectively. The specificity of the brief screen was 69%, compared with 79%, 90%, and 92% for the CES-D, the PHQ-9, and the PHQ-2.

“The two-question instrument was a sensitive tool for identifying depression in CHD patients from diverse outpatient care settings,” Dr. McManus said.

The instrument can be easily integrated into outpatient visits, “even in the busiest cardiology practices,” he said. “A negative response to both questions effectively rules out depression, and a positive response to either suggests the patient might benefit from referral or treatment.”

The Heart and Soul Study is an ongoing, prospective cohort study designed to determine how psychosocial factors influence disease progression in patients with CHD.

NEW ORLEANS – A brief, two-question screening instrument is sensitive for identifying depression in patients with coronary heart disease, a study has shown.

Because major depression is associated with adverse outcomes in this patient population, the availability of a quick, effective tool for improving detection and referral rates could improve patient outcomes substantially, David D. McManus, M.D., reported at the annual meeting of the Society of General Internal Medicine.

Using data from the Heart and Soul Study of the University of California, San Francisco, Dr. McManus and his colleagues compared the test characteristics of four depression case-finding instruments with those of the Diagnostic Interview for Depression in 1,024 adults with stable coronary heart disease (CHD) recruited from local outpatient clinics.

The instruments selected for comparison were the 10-item short form of the Center for Epidemiologic Studies Depression Scale (CES-D), the 9-item Patient Health Questionnaire (PHQ-9), the 2-item Patient Health Questionnaire (PHQ-2), and a brief screen that asks patients about depressed mood and anhedonia.

Specifically, the brief screen asks patients, “During the past month, have you often been bothered by feeling down, depressed, or hopeless?” and “During the past month, have you often been bothered by little interest or pleasure in doing things?” Dr. McManus said. An answer of “yes” to either of these questions was considered a positive screen.

Of the 1,024 study participants, 224 had major depression by standard measure (Diagnostic Interview for Depression). The brief, two-question screen was, at 90%, the most sensitive of the four test measures. The sensitivity of the CES-D, the PHQ-9, and the PHQ-2 was 76%, 54%, and 39%, respectively. The specificity of the brief screen was 69%, compared with 79%, 90%, and 92% for the CES-D, the PHQ-9, and the PHQ-2.

“The two-question instrument was a sensitive tool for identifying depression in CHD patients from diverse outpatient care settings,” Dr. McManus said.

The instrument can be easily integrated into outpatient visits, “even in the busiest cardiology practices,” he said. “A negative response to both questions effectively rules out depression, and a positive response to either suggests the patient might benefit from referral or treatment.”

The Heart and Soul Study is an ongoing, prospective cohort study designed to determine how psychosocial factors influence disease progression in patients with CHD.

BOSTON — A novel risk score, comprising measures of wall motion and myocardial perfusion from contrast echocardiography and clinical variables, is a sensitive predictor of 1-year outcome in patients presenting to the emergency department with chest pain prior to obtaining troponin data, reported William Foster, M.D.

In the risk score development model and a subsequent validation model, the tool proved to be more effective for risk stratification than did the use of cardiac troponin measures and clinical variables without the ultrasound data, said Dr. Foster in a poster presentation at the annual meeting of the American Society of Echocardiography.

Dr. Foster and colleagues at the University of Virginia in Charlottesville developed the risk score using clinical and myocardial imaging data from 973 patients presenting to the emergency department (ED) with chest pain that could not easily be attributed to a noncardiac cause and who did not have ST-segment elevation on their admission ECG.

The risk score stratifies the likelihood of developing primary or secondary events within 1 year of chest pain presentation in the ED. Primary events include all cause mortality and myocardial infarction; secondary events include unstable angina, revascularization, and heart failure.

The clinical predictive factors considered in the risk score include age older than 60 years, the presence of three or more coronary disease risk factors, known coronary luminal diameter narrowing of more than 50%, ST-segment deviation on ECG, two or more angina events in the past 24 hours, and aspirin use in the past 7 days.

The researchers developed an alternative risk score model that includes troponin levels in the clinical variables.

With respect to echocardiographic variables for risk prediction, regional function was characterized as normal or abnormal using a 14-segment model, including 6 segments in each of the basal and midpapillary muscle levels and 2 segments in the apex. Myocardial perfusion was evaluated using the same segmented model and was deemed abnormal if there was no evidence of maximal opacification within a segment by five cardiac cycles. An echocardiographic study was considered abnormal if at least one segment was abnormal for either regional function or myocardial perfusion, Dr. Foster noted.

Each of these predictors is associated with a score between 0 and 100, based on estimates developed using logistic regression models.

Among the 973 patients in the development sample, the model showed “excellent discriminatory capacity,” with an 86% probability of correct prediction, said Dr. Foster.

Approximately 60% of those with total risk scores of 200 or higher, and 30% of those with scores of 150–199, experienced a primary or secondary cardiac event at 1 year. About 17% of patients with scores of 100–149, 7% of those with scores of 50–99, and 4% of those with scores of 0–49 had events within 1 year.

To validate the sensitivity of the scores as potential indicators, Dr. Foster applied the risk score model prospectively in 232 patients who were followed for up to 1 year. “We saw the same pattern in the validation sample, with a similar prognostic discriminatory capacity between the validation and development samples,” said Dr. Foster.

Arrowheads demonstrate presence of a resting perfusion defect in the septum. Courtesy Dr. Kevin S. Wei

BOSTON — A novel risk score, comprising measures of wall motion and myocardial perfusion from contrast echocardiography and clinical variables, is a sensitive predictor of 1-year outcome in patients presenting to the emergency department with chest pain prior to obtaining troponin data, reported William Foster, M.D.

In the risk score development model and a subsequent validation model, the tool proved to be more effective for risk stratification than did the use of cardiac troponin measures and clinical variables without the ultrasound data, said Dr. Foster in a poster presentation at the annual meeting of the American Society of Echocardiography.

Dr. Foster and colleagues at the University of Virginia in Charlottesville developed the risk score using clinical and myocardial imaging data from 973 patients presenting to the emergency department (ED) with chest pain that could not easily be attributed to a noncardiac cause and who did not have ST-segment elevation on their admission ECG.

The risk score stratifies the likelihood of developing primary or secondary events within 1 year of chest pain presentation in the ED. Primary events include all cause mortality and myocardial infarction; secondary events include unstable angina, revascularization, and heart failure.

The clinical predictive factors considered in the risk score include age older than 60 years, the presence of three or more coronary disease risk factors, known coronary luminal diameter narrowing of more than 50%, ST-segment deviation on ECG, two or more angina events in the past 24 hours, and aspirin use in the past 7 days.

The researchers developed an alternative risk score model that includes troponin levels in the clinical variables.

With respect to echocardiographic variables for risk prediction, regional function was characterized as normal or abnormal using a 14-segment model, including 6 segments in each of the basal and midpapillary muscle levels and 2 segments in the apex. Myocardial perfusion was evaluated using the same segmented model and was deemed abnormal if there was no evidence of maximal opacification within a segment by five cardiac cycles. An echocardiographic study was considered abnormal if at least one segment was abnormal for either regional function or myocardial perfusion, Dr. Foster noted.

Each of these predictors is associated with a score between 0 and 100, based on estimates developed using logistic regression models.

Among the 973 patients in the development sample, the model showed “excellent discriminatory capacity,” with an 86% probability of correct prediction, said Dr. Foster.

Approximately 60% of those with total risk scores of 200 or higher, and 30% of those with scores of 150–199, experienced a primary or secondary cardiac event at 1 year. About 17% of patients with scores of 100–149, 7% of those with scores of 50–99, and 4% of those with scores of 0–49 had events within 1 year.

To validate the sensitivity of the scores as potential indicators, Dr. Foster applied the risk score model prospectively in 232 patients who were followed for up to 1 year. “We saw the same pattern in the validation sample, with a similar prognostic discriminatory capacity between the validation and development samples,” said Dr. Foster.

Arrowheads demonstrate presence of a resting perfusion defect in the septum. Courtesy Dr. Kevin S. Wei

BOSTON — A novel risk score, comprising measures of wall motion and myocardial perfusion from contrast echocardiography and clinical variables, is a sensitive predictor of 1-year outcome in patients presenting to the emergency department with chest pain prior to obtaining troponin data, reported William Foster, M.D.

In the risk score development model and a subsequent validation model, the tool proved to be more effective for risk stratification than did the use of cardiac troponin measures and clinical variables without the ultrasound data, said Dr. Foster in a poster presentation at the annual meeting of the American Society of Echocardiography.

Dr. Foster and colleagues at the University of Virginia in Charlottesville developed the risk score using clinical and myocardial imaging data from 973 patients presenting to the emergency department (ED) with chest pain that could not easily be attributed to a noncardiac cause and who did not have ST-segment elevation on their admission ECG.

The risk score stratifies the likelihood of developing primary or secondary events within 1 year of chest pain presentation in the ED. Primary events include all cause mortality and myocardial infarction; secondary events include unstable angina, revascularization, and heart failure.

The clinical predictive factors considered in the risk score include age older than 60 years, the presence of three or more coronary disease risk factors, known coronary luminal diameter narrowing of more than 50%, ST-segment deviation on ECG, two or more angina events in the past 24 hours, and aspirin use in the past 7 days.

The researchers developed an alternative risk score model that includes troponin levels in the clinical variables.

With respect to echocardiographic variables for risk prediction, regional function was characterized as normal or abnormal using a 14-segment model, including 6 segments in each of the basal and midpapillary muscle levels and 2 segments in the apex. Myocardial perfusion was evaluated using the same segmented model and was deemed abnormal if there was no evidence of maximal opacification within a segment by five cardiac cycles. An echocardiographic study was considered abnormal if at least one segment was abnormal for either regional function or myocardial perfusion, Dr. Foster noted.

Each of these predictors is associated with a score between 0 and 100, based on estimates developed using logistic regression models.

Among the 973 patients in the development sample, the model showed “excellent discriminatory capacity,” with an 86% probability of correct prediction, said Dr. Foster.

Approximately 60% of those with total risk scores of 200 or higher, and 30% of those with scores of 150–199, experienced a primary or secondary cardiac event at 1 year. About 17% of patients with scores of 100–149, 7% of those with scores of 50–99, and 4% of those with scores of 0–49 had events within 1 year.

To validate the sensitivity of the scores as potential indicators, Dr. Foster applied the risk score model prospectively in 232 patients who were followed for up to 1 year. “We saw the same pattern in the validation sample, with a similar prognostic discriminatory capacity between the validation and development samples,” said Dr. Foster.

Arrowheads demonstrate presence of a resting perfusion defect in the septum. Courtesy Dr. Kevin S. Wei

BOSTON — A novel risk score, comprising measures of wall motion and myocardial perfusion from contrast echocardiography and clinical variables, is a sensitive predictor of 1-year outcome in patients presenting to the emergency department with chest pain prior to obtaining troponin data, reported William Foster, M.D.

In the risk score development model and a subsequent validation model, the tool proved to be more effective for risk stratification than the use of cardiac troponin measures and clinical variables without the ultrasound data, said Dr. Foster in a poster presentation at the annual meeting of the American Society of Echocardiography.

Dr. Foster and colleagues at the University of Virginia in Charlottesville developed the risk score using clinical and myocardial imaging data from 973 patients presenting to the emergency department (ED) with chest pain that could not easily be attributed to a noncardiac cause and who did not have ST-segment elevation on their admission ECG.

The risk score stratifies the likelihood of developing primary or secondary events within 1 year of chest pain presentation in the ED. Primary events include all cause mortality and MI; secondary events include unstable angina, revascularization, and heart failure.

The clinical predictive factors considered in the risk score include age older than 60 years, presence of three or more coronary disease risk factors, known coronary luminal diameter narrowing of more than 50%, ST-segment deviation on ECG, two or more angina events in the previous 24 hours, and aspirin use in the previous 7 days. (See box, Risk Calculator.)

With echocardiography, regional function was characterized as normal or abnormal based on a 14-segment model. Myocardial perfusion was evaluated using the same segmented model and was deemed abnormal if there was no evidence of maximal opacification within a segment by five cardiac cycles. An echocardiographic study was considered abnormal if at least one segment was abnormal for either regional function or myocardial perfusion.

Each of these predictors is associated with a score between 0 and 100, based on estimates developed using logistic regression models. “The total risk score is the sum of all of these scores,” said Dr. Foster.

Among the 973 patients in the development sample, the model showed “excellent discriminatory capacity,” with an 86% probability of correct prediction, Dr. Foster said. About 60% of those with total risk scores of 200 or higher and 30% of those with scores of 150–199 had a primary or secondary cardiac event at 1 year. About 17% of patients with scores of 100–149, 7% of those with scores of 50–99, and 4% of those with scores of 0–49 had events within 1 year.

To validate the sensitivity of the scores as potential prognostic indicators, the investigators applied the risk score model prospectively in 232 patients followed for up to 1 year. “We saw the same pattern in the validation sample,” Dr. Foster said. In fact, the discriminatory capacity of the risk score “was greater than clinical variables plus serum cardiac troponin,” he said. The ability to formulate prognoses before obtaining troponin data could streamline the management of chest pain patients in the ED, Dr. Foster concluded.

Source: Dr. Gordon

In this contrast-enhanced image from the apical four-chamber view, arrows show a resting perfusion defect in the mid and distal septum of a patient with chest pain. Courtesy Dr. Kevin S. Wei

BOSTON — A novel risk score, comprising measures of wall motion and myocardial perfusion from contrast echocardiography and clinical variables, is a sensitive predictor of 1-year outcome in patients presenting to the emergency department with chest pain prior to obtaining troponin data, reported William Foster, M.D.

In the risk score development model and a subsequent validation model, the tool proved to be more effective for risk stratification than the use of cardiac troponin measures and clinical variables without the ultrasound data, said Dr. Foster in a poster presentation at the annual meeting of the American Society of Echocardiography.

Dr. Foster and colleagues at the University of Virginia in Charlottesville developed the risk score using clinical and myocardial imaging data from 973 patients presenting to the emergency department (ED) with chest pain that could not easily be attributed to a noncardiac cause and who did not have ST-segment elevation on their admission ECG.

The risk score stratifies the likelihood of developing primary or secondary events within 1 year of chest pain presentation in the ED. Primary events include all cause mortality and MI; secondary events include unstable angina, revascularization, and heart failure.

The clinical predictive factors considered in the risk score include age older than 60 years, presence of three or more coronary disease risk factors, known coronary luminal diameter narrowing of more than 50%, ST-segment deviation on ECG, two or more angina events in the previous 24 hours, and aspirin use in the previous 7 days. (See box, Risk Calculator.)

With echocardiography, regional function was characterized as normal or abnormal based on a 14-segment model. Myocardial perfusion was evaluated using the same segmented model and was deemed abnormal if there was no evidence of maximal opacification within a segment by five cardiac cycles. An echocardiographic study was considered abnormal if at least one segment was abnormal for either regional function or myocardial perfusion.

Each of these predictors is associated with a score between 0 and 100, based on estimates developed using logistic regression models. “The total risk score is the sum of all of these scores,” said Dr. Foster.

Among the 973 patients in the development sample, the model showed “excellent discriminatory capacity,” with an 86% probability of correct prediction, Dr. Foster said. About 60% of those with total risk scores of 200 or higher and 30% of those with scores of 150–199 had a primary or secondary cardiac event at 1 year. About 17% of patients with scores of 100–149, 7% of those with scores of 50–99, and 4% of those with scores of 0–49 had events within 1 year.

To validate the sensitivity of the scores as potential prognostic indicators, the investigators applied the risk score model prospectively in 232 patients followed for up to 1 year. “We saw the same pattern in the validation sample,” Dr. Foster said. In fact, the discriminatory capacity of the risk score “was greater than clinical variables plus serum cardiac troponin,” he said. The ability to formulate prognoses before obtaining troponin data could streamline the management of chest pain patients in the ED, Dr. Foster concluded.

Source: Dr. Gordon

In this contrast-enhanced image from the apical four-chamber view, arrows show a resting perfusion defect in the mid and distal septum of a patient with chest pain. Courtesy Dr. Kevin S. Wei

BOSTON — A novel risk score, comprising measures of wall motion and myocardial perfusion from contrast echocardiography and clinical variables, is a sensitive predictor of 1-year outcome in patients presenting to the emergency department with chest pain prior to obtaining troponin data, reported William Foster, M.D.

In the risk score development model and a subsequent validation model, the tool proved to be more effective for risk stratification than the use of cardiac troponin measures and clinical variables without the ultrasound data, said Dr. Foster in a poster presentation at the annual meeting of the American Society of Echocardiography.

Dr. Foster and colleagues at the University of Virginia in Charlottesville developed the risk score using clinical and myocardial imaging data from 973 patients presenting to the emergency department (ED) with chest pain that could not easily be attributed to a noncardiac cause and who did not have ST-segment elevation on their admission ECG.

The risk score stratifies the likelihood of developing primary or secondary events within 1 year of chest pain presentation in the ED. Primary events include all cause mortality and MI; secondary events include unstable angina, revascularization, and heart failure.

The clinical predictive factors considered in the risk score include age older than 60 years, presence of three or more coronary disease risk factors, known coronary luminal diameter narrowing of more than 50%, ST-segment deviation on ECG, two or more angina events in the previous 24 hours, and aspirin use in the previous 7 days. (See box, Risk Calculator.)

With echocardiography, regional function was characterized as normal or abnormal based on a 14-segment model. Myocardial perfusion was evaluated using the same segmented model and was deemed abnormal if there was no evidence of maximal opacification within a segment by five cardiac cycles. An echocardiographic study was considered abnormal if at least one segment was abnormal for either regional function or myocardial perfusion.

Each of these predictors is associated with a score between 0 and 100, based on estimates developed using logistic regression models. “The total risk score is the sum of all of these scores,” said Dr. Foster.

Among the 973 patients in the development sample, the model showed “excellent discriminatory capacity,” with an 86% probability of correct prediction, Dr. Foster said. About 60% of those with total risk scores of 200 or higher and 30% of those with scores of 150–199 had a primary or secondary cardiac event at 1 year. About 17% of patients with scores of 100–149, 7% of those with scores of 50–99, and 4% of those with scores of 0–49 had events within 1 year.

To validate the sensitivity of the scores as potential prognostic indicators, the investigators applied the risk score model prospectively in 232 patients followed for up to 1 year. “We saw the same pattern in the validation sample,” Dr. Foster said. In fact, the discriminatory capacity of the risk score “was greater than clinical variables plus serum cardiac troponin,” he said. The ability to formulate prognoses before obtaining troponin data could streamline the management of chest pain patients in the ED, Dr. Foster concluded.

Source: Dr. Gordon

In this contrast-enhanced image from the apical four-chamber view, arrows show a resting perfusion defect in the mid and distal septum of a patient with chest pain. Courtesy Dr. Kevin S. Wei

NEW ORLEANS — Depressed heart patients are less likely than their nondepressed peers to follow risk-reduction behaviors after acute coronary syndromes, and they are less likely to adhere to their heart medications, two studies have shown.

The findings may help explain previous findings linking depression to increased mortality in patients with heart disease, according to Ian M. Kronish, M.D., of Mount Sinai Medical School in New York.

The studies enrolled 421 patients at three university hospitals who had experienced an acute coronary syndrome (ACS) in the week prior to their enrollment. Of these, 355 patients completed the study's 3-month follow-up.

The investigators used the Beck Depression Inventory (BDI) to assess depressive symptoms in the hospital and at 3 months. A BDI score of 10 or higher indicated depression of at least mild to moderate severity.

They also assessed risk-factor-modification behavior, as reported by the patient, at 3 months. The risk-reduction behaviors that were considered were smoking cessation, medication compliance, exercise, cardiac rehabilitation, and diet modification, Dr. Kronish reported at the annual meeting of the Society of General Internal Medicine.

The investigators compared differences in risk-reduction behaviors in patients who had BDI scores of less than 10 both at hospitalization and at 3 months (never depressed), those who had BDI scores of 10 or more at hospitalization and less than 10 at 3 months (remitted depressed), and those who had BDI scores of 10 or more at both time points (persistently depressed).

Compared with never-depressed patients, both remitted-depressed and persistently depressed patients reported significantly lower adherence to smoking cessation, medications, exercise, cardiac rehabilitation, and diet modification. In addition, patients with persistent depression were significantly less likely than those with remitted depression to quit smoking, exercise, or participate in cardiac rehabilitation.

The average age of patients in the study was 61 years. Socioeconomic status, severity of cardiac disease, and comorbidities were similar across the comparison groups.

“Adherence to these preventive behaviors reduces the risk of subsequent cardiac events. The fact that depressed patients were significantly less likely to participate in risk-reducing activities may in part explain why depression predicts mortality post ACS,” Dr. Kronish said.

Results from another investigation, the Heart and Soul Study (conducted at the University of California, San Francisco) echo the findings of the Mount Sinai study with regard to medication adherence. Mary A. Whooley, M.D., and colleagues performed a cross-sectional study of 940 outpatients with stable coronary heart disease who were taking a cardiac medication (β-blocker, renin-angiotensin system inhibitor, aspirin, or statin).

The investigators assessed current major depression using the Diagnostic Interview Schedule and asked all the participants the question, “Overall, in the past month, how often did you take your medications as the doctor prescribed?” Patients who said they took their medication all the time or nearly all the time were considered adherent. Those who reported taking their medication most of the time, about half the time, or less than half the time were considered nonadherent.

Of the 940 patients, 204 had current depression. Of these, 28 patients (14%) were nonadherent, compared with 40 (5%) of the 736 nondepressed patients. Logistic regression showed that the odds ratio for nonadherence among depressed individuals was 2.8, and this persisted after adjustment for potential confounding variables, including age, ethnicity, education, cognitive function, and measures of cardiac disease severity, Dr. Whooley reported.

“This association was similar in users and nonusers of aspirin, renin-angiotensin system inhibitors, and statins, but differed in users and nonusers of statins,” she said. Depression was “strongly associated” with medication nonadherence in the 590 participants taking β-blockers but not in the participants not taking them, she said.

Depression-related medication nonadherence may contribute to adverse cardiovascular outcomes, and patients prescribed β-blockers might be particularly vulnerable, Dr. Whooley said.

NEW ORLEANS — Depressed heart patients are less likely than their nondepressed peers to follow risk-reduction behaviors after acute coronary syndromes, and they are less likely to adhere to their heart medications, two studies have shown.

The findings may help explain previous findings linking depression to increased mortality in patients with heart disease, according to Ian M. Kronish, M.D., of Mount Sinai Medical School in New York.

The studies enrolled 421 patients at three university hospitals who had experienced an acute coronary syndrome (ACS) in the week prior to their enrollment. Of these, 355 patients completed the study's 3-month follow-up.

The investigators used the Beck Depression Inventory (BDI) to assess depressive symptoms in the hospital and at 3 months. A BDI score of 10 or higher indicated depression of at least mild to moderate severity.

They also assessed risk-factor-modification behavior, as reported by the patient, at 3 months. The risk-reduction behaviors that were considered were smoking cessation, medication compliance, exercise, cardiac rehabilitation, and diet modification, Dr. Kronish reported at the annual meeting of the Society of General Internal Medicine.

The investigators compared differences in risk-reduction behaviors in patients who had BDI scores of less than 10 both at hospitalization and at 3 months (never depressed), those who had BDI scores of 10 or more at hospitalization and less than 10 at 3 months (remitted depressed), and those who had BDI scores of 10 or more at both time points (persistently depressed).

Compared with never-depressed patients, both remitted-depressed and persistently depressed patients reported significantly lower adherence to smoking cessation, medications, exercise, cardiac rehabilitation, and diet modification. In addition, patients with persistent depression were significantly less likely than those with remitted depression to quit smoking, exercise, or participate in cardiac rehabilitation.

The average age of patients in the study was 61 years. Socioeconomic status, severity of cardiac disease, and comorbidities were similar across the comparison groups.

“Adherence to these preventive behaviors reduces the risk of subsequent cardiac events. The fact that depressed patients were significantly less likely to participate in risk-reducing activities may in part explain why depression predicts mortality post ACS,” Dr. Kronish said.

Results from another investigation, the Heart and Soul Study (conducted at the University of California, San Francisco) echo the findings of the Mount Sinai study with regard to medication adherence. Mary A. Whooley, M.D., and colleagues performed a cross-sectional study of 940 outpatients with stable coronary heart disease who were taking a cardiac medication (β-blocker, renin-angiotensin system inhibitor, aspirin, or statin).

The investigators assessed current major depression using the Diagnostic Interview Schedule and asked all the participants the question, “Overall, in the past month, how often did you take your medications as the doctor prescribed?” Patients who said they took their medication all the time or nearly all the time were considered adherent. Those who reported taking their medication most of the time, about half the time, or less than half the time were considered nonadherent.

Of the 940 patients, 204 had current depression. Of these, 28 patients (14%) were nonadherent, compared with 40 (5%) of the 736 nondepressed patients. Logistic regression showed that the odds ratio for nonadherence among depressed individuals was 2.8, and this persisted after adjustment for potential confounding variables, including age, ethnicity, education, cognitive function, and measures of cardiac disease severity, Dr. Whooley reported.

“This association was similar in users and nonusers of aspirin, renin-angiotensin system inhibitors, and statins, but differed in users and nonusers of statins,” she said. Depression was “strongly associated” with medication nonadherence in the 590 participants taking β-blockers but not in the participants not taking them, she said.

Depression-related medication nonadherence may contribute to adverse cardiovascular outcomes, and patients prescribed β-blockers might be particularly vulnerable, Dr. Whooley said.

NEW ORLEANS — Depressed heart patients are less likely than their nondepressed peers to follow risk-reduction behaviors after acute coronary syndromes, and they are less likely to adhere to their heart medications, two studies have shown.

The findings may help explain previous findings linking depression to increased mortality in patients with heart disease, according to Ian M. Kronish, M.D., of Mount Sinai Medical School in New York.

The studies enrolled 421 patients at three university hospitals who had experienced an acute coronary syndrome (ACS) in the week prior to their enrollment. Of these, 355 patients completed the study's 3-month follow-up.

The investigators used the Beck Depression Inventory (BDI) to assess depressive symptoms in the hospital and at 3 months. A BDI score of 10 or higher indicated depression of at least mild to moderate severity.

They also assessed risk-factor-modification behavior, as reported by the patient, at 3 months. The risk-reduction behaviors that were considered were smoking cessation, medication compliance, exercise, cardiac rehabilitation, and diet modification, Dr. Kronish reported at the annual meeting of the Society of General Internal Medicine.

The investigators compared differences in risk-reduction behaviors in patients who had BDI scores of less than 10 both at hospitalization and at 3 months (never depressed), those who had BDI scores of 10 or more at hospitalization and less than 10 at 3 months (remitted depressed), and those who had BDI scores of 10 or more at both time points (persistently depressed).

Compared with never-depressed patients, both remitted-depressed and persistently depressed patients reported significantly lower adherence to smoking cessation, medications, exercise, cardiac rehabilitation, and diet modification. In addition, patients with persistent depression were significantly less likely than those with remitted depression to quit smoking, exercise, or participate in cardiac rehabilitation.

The average age of patients in the study was 61 years. Socioeconomic status, severity of cardiac disease, and comorbidities were similar across the comparison groups.

“Adherence to these preventive behaviors reduces the risk of subsequent cardiac events. The fact that depressed patients were significantly less likely to participate in risk-reducing activities may in part explain why depression predicts mortality post ACS,” Dr. Kronish said.

Results from another investigation, the Heart and Soul Study (conducted at the University of California, San Francisco) echo the findings of the Mount Sinai study with regard to medication adherence. Mary A. Whooley, M.D., and colleagues performed a cross-sectional study of 940 outpatients with stable coronary heart disease who were taking a cardiac medication (β-blocker, renin-angiotensin system inhibitor, aspirin, or statin).

The investigators assessed current major depression using the Diagnostic Interview Schedule and asked all the participants the question, “Overall, in the past month, how often did you take your medications as the doctor prescribed?” Patients who said they took their medication all the time or nearly all the time were considered adherent. Those who reported taking their medication most of the time, about half the time, or less than half the time were considered nonadherent.

Of the 940 patients, 204 had current depression. Of these, 28 patients (14%) were nonadherent, compared with 40 (5%) of the 736 nondepressed patients. Logistic regression showed that the odds ratio for nonadherence among depressed individuals was 2.8, and this persisted after adjustment for potential confounding variables, including age, ethnicity, education, cognitive function, and measures of cardiac disease severity, Dr. Whooley reported.

“This association was similar in users and nonusers of aspirin, renin-angiotensin system inhibitors, and statins, but differed in users and nonusers of statins,” she said. Depression was “strongly associated” with medication nonadherence in the 590 participants taking β-blockers but not in the participants not taking them, she said.

Depression-related medication nonadherence may contribute to adverse cardiovascular outcomes, and patients prescribed β-blockers might be particularly vulnerable, Dr. Whooley said.

BOSTON — For acute heart failure patients with neither a history of coronary disease nor evidence of acute MI, myocardial contrast echocardiography can distinguish ischemic from nonischemic etiology, a study has shown.

The ability to identify underlying coronary artery disease in such patients has therapeutic and prognostic implications, reported Rajesh Janardhanan, M.D., in a poster presentation at the annual meeting of the American Society of Echocardiography.

A noninvasive bedside technique for evaluating acute coronary syndromes, myocardial contrast echocardiography (MCE) provides a simultaneous assessment of regional wall motion and myocardial perfusion using microbubble contrast agents.

To assess the sensitivity and specificity of the imaging tool in the evaluation of acute heart failure, Dr. Janardhanan of Brigham and Women's Hospital in Boston, and investigators at Northwick Park Hospital in Harrow, England, reviewed the imaging results from 52 consecutive patients with acute heart failure with no prior history of coronary artery disease (CAD) and no clinical evidence of acute MI on hospital admission.

All the patients in the study underwent echocardiography and MCE at rest and following dipyridamole stress. Additionally, all patients underwent coronary arteriography prior to hospital discharge. On coronary arteriography, 22 of the 52 patients had evidence of CAD, defined as more than 50% luminal diameter narrowing, Dr. Janardhanan said.

The sensitivity and specificity of MCE for detecting CAD in the 22 patients were 82% and 97%, respectively, with a positive predictive value of 95% and a negative predictive value of 88%. Among the various markers of CAD, including MCE, clinical variables, ECG, biochemical measures, and resting echocardiographic results, MCE “was the only [statistically significant] independent predictor of CAD,” said Dr. Janardhanan.

Both myocardial blood flow reserve and myocardial blood velocity reserve decreased relative to increasing CAD severity, suggesting quantitative MCE data may be an effective tool for stratifying risk in patients with acute heart failure, Dr. Janardhanan concluded.

BOSTON — For acute heart failure patients with neither a history of coronary disease nor evidence of acute MI, myocardial contrast echocardiography can distinguish ischemic from nonischemic etiology, a study has shown.

The ability to identify underlying coronary artery disease in such patients has therapeutic and prognostic implications, reported Rajesh Janardhanan, M.D., in a poster presentation at the annual meeting of the American Society of Echocardiography.

A noninvasive bedside technique for evaluating acute coronary syndromes, myocardial contrast echocardiography (MCE) provides a simultaneous assessment of regional wall motion and myocardial perfusion using microbubble contrast agents.

To assess the sensitivity and specificity of the imaging tool in the evaluation of acute heart failure, Dr. Janardhanan of Brigham and Women's Hospital in Boston, and investigators at Northwick Park Hospital in Harrow, England, reviewed the imaging results from 52 consecutive patients with acute heart failure with no prior history of coronary artery disease (CAD) and no clinical evidence of acute MI on hospital admission.

All the patients in the study underwent echocardiography and MCE at rest and following dipyridamole stress. Additionally, all patients underwent coronary arteriography prior to hospital discharge. On coronary arteriography, 22 of the 52 patients had evidence of CAD, defined as more than 50% luminal diameter narrowing, Dr. Janardhanan said.

The sensitivity and specificity of MCE for detecting CAD in the 22 patients were 82% and 97%, respectively, with a positive predictive value of 95% and a negative predictive value of 88%. Among the various markers of CAD, including MCE, clinical variables, ECG, biochemical measures, and resting echocardiographic results, MCE “was the only [statistically significant] independent predictor of CAD,” said Dr. Janardhanan.

Both myocardial blood flow reserve and myocardial blood velocity reserve decreased relative to increasing CAD severity, suggesting quantitative MCE data may be an effective tool for stratifying risk in patients with acute heart failure, Dr. Janardhanan concluded.

BOSTON — For acute heart failure patients with neither a history of coronary disease nor evidence of acute MI, myocardial contrast echocardiography can distinguish ischemic from nonischemic etiology, a study has shown.

The ability to identify underlying coronary artery disease in such patients has therapeutic and prognostic implications, reported Rajesh Janardhanan, M.D., in a poster presentation at the annual meeting of the American Society of Echocardiography.

A noninvasive bedside technique for evaluating acute coronary syndromes, myocardial contrast echocardiography (MCE) provides a simultaneous assessment of regional wall motion and myocardial perfusion using microbubble contrast agents.

To assess the sensitivity and specificity of the imaging tool in the evaluation of acute heart failure, Dr. Janardhanan of Brigham and Women's Hospital in Boston, and investigators at Northwick Park Hospital in Harrow, England, reviewed the imaging results from 52 consecutive patients with acute heart failure with no prior history of coronary artery disease (CAD) and no clinical evidence of acute MI on hospital admission.

All the patients in the study underwent echocardiography and MCE at rest and following dipyridamole stress. Additionally, all patients underwent coronary arteriography prior to hospital discharge. On coronary arteriography, 22 of the 52 patients had evidence of CAD, defined as more than 50% luminal diameter narrowing, Dr. Janardhanan said.

The sensitivity and specificity of MCE for detecting CAD in the 22 patients were 82% and 97%, respectively, with a positive predictive value of 95% and a negative predictive value of 88%. Among the various markers of CAD, including MCE, clinical variables, ECG, biochemical measures, and resting echocardiographic results, MCE “was the only [statistically significant] independent predictor of CAD,” said Dr. Janardhanan.

Both myocardial blood flow reserve and myocardial blood velocity reserve decreased relative to increasing CAD severity, suggesting quantitative MCE data may be an effective tool for stratifying risk in patients with acute heart failure, Dr. Janardhanan concluded.

BOSTON — Regular use of an alcohol-based hand sanitizer in the home can reduce the spread of gastrointestinal infections among family members, Thomas J. Sandora, M.D., said at the annual meeting of the Infectious Diseases Society of America.

And, the more hand sanitizer used by a given family, the better the chances of reducing the spread of some organisms, according to the findings from the Healthy Hands, Healthy Families Study at Children's Hospital Boston.

Dr. Sandora and his colleagues provided 155 families who had at least one child in day care for 10 hours or more per week with hand sanitizer and hand hygiene educational materials. The researchers instructed the families to place bottles of the sanitizer around the house, including in the bathroom, kitchen, and baby's room, and told them to apply it to their hands after using the toilet, before preparing food, after diaper changes, and at other “key” times.

A control group of 137 day-care families with similar demographics was given materials about basic nutrition only.

The investigators tracked all of the families for 5 months, using biweekly phone calls to inquire about symptoms of respiratory and gastrointestinal illness. The primary outcome measures were the rates of transmission of both types of illnesses, reported as secondary illnesses per susceptible person-year.

During the observation period, 28 of 252 gastrointestinal illnesses recorded were classified as secondary transmissions (time of onset 2–7 days after onset in another family member), as were 443 of 1,802 respiratory illnesses. The use of hand sanitizer reduced the overall secondary transmission of gastrointestinal infections by 59%.

Alcohol-based hand sanitizer is effective at removing surface germs on the skin. The Centers for Disease Control and Prevention recommends routine use of these products by health care workers because they are easier and quicker to use than soap and water and they cause less skin irritation, Dr. Sandora said.

One significant advantage of the alcohol-based product is that it can kill organisms “without [one] worrying about the whole issue of resistance,” he said. “Alcohol doesn't contain antibiotics, and you don't develop resistance to it.”

The product is not being used in most homes despite its wide availability, Dr. Sandora said. “Providers should teach parents about hand sanitizer and its role in reducing the spread of infections in the home.”

GOJO Industries—the manufacturer of the hand sanitizer gel used in the study—funded the study. Dr. Sandora reported having no financial interests in the company.

BOSTON — Regular use of an alcohol-based hand sanitizer in the home can reduce the spread of gastrointestinal infections among family members, Thomas J. Sandora, M.D., said at the annual meeting of the Infectious Diseases Society of America.

And, the more hand sanitizer used by a given family, the better the chances of reducing the spread of some organisms, according to the findings from the Healthy Hands, Healthy Families Study at Children's Hospital Boston.

Dr. Sandora and his colleagues provided 155 families who had at least one child in day care for 10 hours or more per week with hand sanitizer and hand hygiene educational materials. The researchers instructed the families to place bottles of the sanitizer around the house, including in the bathroom, kitchen, and baby's room, and told them to apply it to their hands after using the toilet, before preparing food, after diaper changes, and at other “key” times.

A control group of 137 day-care families with similar demographics was given materials about basic nutrition only.

The investigators tracked all of the families for 5 months, using biweekly phone calls to inquire about symptoms of respiratory and gastrointestinal illness. The primary outcome measures were the rates of transmission of both types of illnesses, reported as secondary illnesses per susceptible person-year.

During the observation period, 28 of 252 gastrointestinal illnesses recorded were classified as secondary transmissions (time of onset 2–7 days after onset in another family member), as were 443 of 1,802 respiratory illnesses. The use of hand sanitizer reduced the overall secondary transmission of gastrointestinal infections by 59%.

Alcohol-based hand sanitizer is effective at removing surface germs on the skin. The Centers for Disease Control and Prevention recommends routine use of these products by health care workers because they are easier and quicker to use than soap and water and they cause less skin irritation, Dr. Sandora said.

One significant advantage of the alcohol-based product is that it can kill organisms “without [one] worrying about the whole issue of resistance,” he said. “Alcohol doesn't contain antibiotics, and you don't develop resistance to it.”

The product is not being used in most homes despite its wide availability, Dr. Sandora said. “Providers should teach parents about hand sanitizer and its role in reducing the spread of infections in the home.”

GOJO Industries—the manufacturer of the hand sanitizer gel used in the study—funded the study. Dr. Sandora reported having no financial interests in the company.

BOSTON — Regular use of an alcohol-based hand sanitizer in the home can reduce the spread of gastrointestinal infections among family members, Thomas J. Sandora, M.D., said at the annual meeting of the Infectious Diseases Society of America.

And, the more hand sanitizer used by a given family, the better the chances of reducing the spread of some organisms, according to the findings from the Healthy Hands, Healthy Families Study at Children's Hospital Boston.

Dr. Sandora and his colleagues provided 155 families who had at least one child in day care for 10 hours or more per week with hand sanitizer and hand hygiene educational materials. The researchers instructed the families to place bottles of the sanitizer around the house, including in the bathroom, kitchen, and baby's room, and told them to apply it to their hands after using the toilet, before preparing food, after diaper changes, and at other “key” times.

A control group of 137 day-care families with similar demographics was given materials about basic nutrition only.

The investigators tracked all of the families for 5 months, using biweekly phone calls to inquire about symptoms of respiratory and gastrointestinal illness. The primary outcome measures were the rates of transmission of both types of illnesses, reported as secondary illnesses per susceptible person-year.

During the observation period, 28 of 252 gastrointestinal illnesses recorded were classified as secondary transmissions (time of onset 2–7 days after onset in another family member), as were 443 of 1,802 respiratory illnesses. The use of hand sanitizer reduced the overall secondary transmission of gastrointestinal infections by 59%.

Alcohol-based hand sanitizer is effective at removing surface germs on the skin. The Centers for Disease Control and Prevention recommends routine use of these products by health care workers because they are easier and quicker to use than soap and water and they cause less skin irritation, Dr. Sandora said.

One significant advantage of the alcohol-based product is that it can kill organisms “without [one] worrying about the whole issue of resistance,” he said. “Alcohol doesn't contain antibiotics, and you don't develop resistance to it.”

The product is not being used in most homes despite its wide availability, Dr. Sandora said. “Providers should teach parents about hand sanitizer and its role in reducing the spread of infections in the home.”

GOJO Industries—the manufacturer of the hand sanitizer gel used in the study—funded the study. Dr. Sandora reported having no financial interests in the company.