ACC 2011

NEW ORLEANS - Carotid intima-media thickness was found to be increased in middle-aged men taking antidepressants in a study reported at the annual scientific sessions of the American College of Cardiology.

"There is a clear association between increased intima-media thickness [IMT] and taking an antidepressant of any kind, and this trend is even stronger when we look at people who are on these medications and are more depressed," said Dr. Amit Shah, a cardiology fellow at Emory University, Atlanta.

Dr. Janet Wright senior vice president of science and quality for the ACC, commented that the study should be viewed as "directional. ... It only tees things up for the next range of studies." Dr. Wright, a cardiologist in Chico, Calif., added that "it does suggest that perhaps a person who is depressed and on an antidepressant may need monitoring."

Carotid IMT and brachial flow-mediated dilation was assessed using B-mode ultrasound in 513 middle-aged male twins from the Vietnam Era Twin Registry. Traditional risk factors for ischemic heart disease were measured. Depression and posttraumatic stress disorder (PTSD) were assessed with the Structured Clinical Interview for the Diagnosis of Psychiatric Disorders, and depressive symptoms were measured via the Beck Depression Inventory. Medication regimens were verified by a clinician. Mixed effects regression models were used to analyze the overall association and to examine differences within twin pairs discordant for antidepressant intake.

Participants were a mean age of 55 years; 95% were white and 16% were taking antidepressants, mainly selective serotonin reuptake inhibitors (60%). In an analysis of the association by type of antidepressant, an increase in IMT was noted regardless of the class of antidepressants.

Antidepressant use was associated with an IMT increase of 37 microns, which represents about a 5% increase from the mean IMT value of 762 microns seen in the population, a significant difference compared with men not taking antidepressants.

The findings emerged from an adjusted analysis that controlled for conventional cardiovascular risk factors and for depressive symptoms, history of major depression and heart disease, alcohol and coffee consumption, statin use, physical activity, education, and employment status.

In an analysis of 59 twin pairs where one brother was taking an antidepressant and the other was not, the antidepressant user had an IMT that was 41 microns thicker (P = .01), he reported.

Each additional year of life is associated with a 10-micron increase in IMT, therefore, the brother on the antidepressant could be considered to be 4 years "older" in terms of atherosclerosis. In previous studies, each 10-micron increase in IMT has been linked to a 1.8% increase in risk, Dr. Shah noted.

Previous studies have linked the presence of depression with an increased risk of cardiovascular disease. In this study, neither depression nor posttraumatic stress disorder significantly predicted an increase in IMT. However, the study did show that subjects taking antidepressants who also reported clinical symptoms of depression had higher IMTs than those taking antidepressants who had fewer symptoms of depression.

"Because we didn’t see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that this is more likely the antidepressants than the actual depression that is behind the association," Dr. Shah said.

History of a previous myocardial infarction, which was noted for 12% of the cohort, was not independently associated with increased IMT, nor was there a differential effect for identical and fraternal twins.

Speculating on the possible mechanism for the association, the investigators suggested that antidepressants may increase IMT through augmented release of vasoconstrictive neuropeptides. "The antidepressants may act synergistically with depressive symptoms to increase vascular disease," he said. "There is a potential interaction between the depressive symptoms, the neurohormonal effects of the depression itself, and the medication."

The findings suggest that the risk/benefit ratio of antidepressants should be considered, especially in patients with pre-existing cardiovascular disease, Dr. Shah said. "While not showing causality, it is important to take studies such as this into account in patient care, especially when the patient may not be deriving much benefit from the antidepressant."

Dr. Shah and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Carotid intima-media thickness was found to be increased in middle-aged men taking antidepressants in a study reported at the annual scientific sessions of the American College of Cardiology.

"There is a clear association between increased intima-media thickness [IMT] and taking an antidepressant of any kind, and this trend is even stronger when we look at people who are on these medications and are more depressed," said Dr. Amit Shah, a cardiology fellow at Emory University, Atlanta.

Dr. Janet Wright senior vice president of science and quality for the ACC, commented that the study should be viewed as "directional. ... It only tees things up for the next range of studies." Dr. Wright, a cardiologist in Chico, Calif., added that "it does suggest that perhaps a person who is depressed and on an antidepressant may need monitoring."

Carotid IMT and brachial flow-mediated dilation was assessed using B-mode ultrasound in 513 middle-aged male twins from the Vietnam Era Twin Registry. Traditional risk factors for ischemic heart disease were measured. Depression and posttraumatic stress disorder (PTSD) were assessed with the Structured Clinical Interview for the Diagnosis of Psychiatric Disorders, and depressive symptoms were measured via the Beck Depression Inventory. Medication regimens were verified by a clinician. Mixed effects regression models were used to analyze the overall association and to examine differences within twin pairs discordant for antidepressant intake.

Participants were a mean age of 55 years; 95% were white and 16% were taking antidepressants, mainly selective serotonin reuptake inhibitors (60%). In an analysis of the association by type of antidepressant, an increase in IMT was noted regardless of the class of antidepressants.

Antidepressant use was associated with an IMT increase of 37 microns, which represents about a 5% increase from the mean IMT value of 762 microns seen in the population, a significant difference compared with men not taking antidepressants.

The findings emerged from an adjusted analysis that controlled for conventional cardiovascular risk factors and for depressive symptoms, history of major depression and heart disease, alcohol and coffee consumption, statin use, physical activity, education, and employment status.

In an analysis of 59 twin pairs where one brother was taking an antidepressant and the other was not, the antidepressant user had an IMT that was 41 microns thicker (P = .01), he reported.

Each additional year of life is associated with a 10-micron increase in IMT, therefore, the brother on the antidepressant could be considered to be 4 years "older" in terms of atherosclerosis. In previous studies, each 10-micron increase in IMT has been linked to a 1.8% increase in risk, Dr. Shah noted.

Previous studies have linked the presence of depression with an increased risk of cardiovascular disease. In this study, neither depression nor posttraumatic stress disorder significantly predicted an increase in IMT. However, the study did show that subjects taking antidepressants who also reported clinical symptoms of depression had higher IMTs than those taking antidepressants who had fewer symptoms of depression.

"Because we didn’t see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that this is more likely the antidepressants than the actual depression that is behind the association," Dr. Shah said.

History of a previous myocardial infarction, which was noted for 12% of the cohort, was not independently associated with increased IMT, nor was there a differential effect for identical and fraternal twins.

Speculating on the possible mechanism for the association, the investigators suggested that antidepressants may increase IMT through augmented release of vasoconstrictive neuropeptides. "The antidepressants may act synergistically with depressive symptoms to increase vascular disease," he said. "There is a potential interaction between the depressive symptoms, the neurohormonal effects of the depression itself, and the medication."

The findings suggest that the risk/benefit ratio of antidepressants should be considered, especially in patients with pre-existing cardiovascular disease, Dr. Shah said. "While not showing causality, it is important to take studies such as this into account in patient care, especially when the patient may not be deriving much benefit from the antidepressant."

Dr. Shah and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Carotid intima-media thickness was found to be increased in middle-aged men taking antidepressants in a study reported at the annual scientific sessions of the American College of Cardiology.

"There is a clear association between increased intima-media thickness [IMT] and taking an antidepressant of any kind, and this trend is even stronger when we look at people who are on these medications and are more depressed," said Dr. Amit Shah, a cardiology fellow at Emory University, Atlanta.

Dr. Janet Wright senior vice president of science and quality for the ACC, commented that the study should be viewed as "directional. ... It only tees things up for the next range of studies." Dr. Wright, a cardiologist in Chico, Calif., added that "it does suggest that perhaps a person who is depressed and on an antidepressant may need monitoring."

Carotid IMT and brachial flow-mediated dilation was assessed using B-mode ultrasound in 513 middle-aged male twins from the Vietnam Era Twin Registry. Traditional risk factors for ischemic heart disease were measured. Depression and posttraumatic stress disorder (PTSD) were assessed with the Structured Clinical Interview for the Diagnosis of Psychiatric Disorders, and depressive symptoms were measured via the Beck Depression Inventory. Medication regimens were verified by a clinician. Mixed effects regression models were used to analyze the overall association and to examine differences within twin pairs discordant for antidepressant intake.

Participants were a mean age of 55 years; 95% were white and 16% were taking antidepressants, mainly selective serotonin reuptake inhibitors (60%). In an analysis of the association by type of antidepressant, an increase in IMT was noted regardless of the class of antidepressants.

Antidepressant use was associated with an IMT increase of 37 microns, which represents about a 5% increase from the mean IMT value of 762 microns seen in the population, a significant difference compared with men not taking antidepressants.

The findings emerged from an adjusted analysis that controlled for conventional cardiovascular risk factors and for depressive symptoms, history of major depression and heart disease, alcohol and coffee consumption, statin use, physical activity, education, and employment status.

In an analysis of 59 twin pairs where one brother was taking an antidepressant and the other was not, the antidepressant user had an IMT that was 41 microns thicker (P = .01), he reported.

Each additional year of life is associated with a 10-micron increase in IMT, therefore, the brother on the antidepressant could be considered to be 4 years "older" in terms of atherosclerosis. In previous studies, each 10-micron increase in IMT has been linked to a 1.8% increase in risk, Dr. Shah noted.

Previous studies have linked the presence of depression with an increased risk of cardiovascular disease. In this study, neither depression nor posttraumatic stress disorder significantly predicted an increase in IMT. However, the study did show that subjects taking antidepressants who also reported clinical symptoms of depression had higher IMTs than those taking antidepressants who had fewer symptoms of depression.

"Because we didn’t see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that this is more likely the antidepressants than the actual depression that is behind the association," Dr. Shah said.

History of a previous myocardial infarction, which was noted for 12% of the cohort, was not independently associated with increased IMT, nor was there a differential effect for identical and fraternal twins.

Speculating on the possible mechanism for the association, the investigators suggested that antidepressants may increase IMT through augmented release of vasoconstrictive neuropeptides. "The antidepressants may act synergistically with depressive symptoms to increase vascular disease," he said. "There is a potential interaction between the depressive symptoms, the neurohormonal effects of the depression itself, and the medication."

The findings suggest that the risk/benefit ratio of antidepressants should be considered, especially in patients with pre-existing cardiovascular disease, Dr. Shah said. "While not showing causality, it is important to take studies such as this into account in patient care, especially when the patient may not be deriving much benefit from the antidepressant."

Dr. Shah and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Carotid intima-media thickness was found to be increased in middle-aged men taking antidepressants in a study reported at the annual scientific sessions of the American College of Cardiology.

"There is a clear association between increased intima-media thickness [IMT] and taking an antidepressant of any kind, and this trend is even stronger when we look at people who are on these medications and are more depressed," said Dr. Amit Shah, a cardiology fellow at Emory University, Atlanta.

Dr. Janet Wright senior vice president of science and quality for the ACC, commented that the study should be viewed as "directional. ... It only tees things up for the next range of studies." Dr. Wright, a cardiologist in Chico, Calif., added that "it does suggest that perhaps a person who is depressed and on an antidepressant may need monitoring."

Carotid IMT and brachial flow-mediated dilation was assessed using B-mode ultrasound in 513 middle-aged male twins from the Vietnam Era Twin Registry. Traditional risk factors for ischemic heart disease were measured. Depression and posttraumatic stress disorder (PTSD) were assessed with the Structured Clinical Interview for the Diagnosis of Psychiatric Disorders, and depressive symptoms were measured via the Beck Depression Inventory. Medication regimens were verified by a clinician. Mixed effects regression models were used to analyze the overall association and to examine differences within twin pairs discordant for antidepressant intake.

Participants were a mean age of 55 years; 95% were white and 16% were taking antidepressants, mainly selective serotonin reuptake inhibitors (60%). In an analysis of the association by type of antidepressant, an increase in IMT was noted regardless of the class of antidepressants.

Antidepressant use was associated with an IMT increase of 37 microns, which represents about a 5% increase from the mean IMT value of 762 microns seen in the population, a significant difference compared with men not taking antidepressants.

The findings emerged from an adjusted analysis that controlled for conventional cardiovascular risk factors and for depressive symptoms, history of major depression and heart disease, alcohol and coffee consumption, statin use, physical activity, education, and employment status.

In an analysis of 59 twin pairs where one brother was taking an antidepressant and the other was not, the antidepressant user had an IMT that was 41 microns thicker (P = .01), he reported.

Each additional year of life is associated with a 10-micron increase in IMT, therefore, the brother on the antidepressant could be considered to be 4 years "older" in terms of atherosclerosis. In previous studies, each 10-micron increase in IMT has been linked to a 1.8% increase in risk, Dr. Shah noted.

Previous studies have linked the presence of depression with an increased risk of cardiovascular disease. In this study, neither depression nor posttraumatic stress disorder significantly predicted an increase in IMT. However, the study did show that subjects taking antidepressants who also reported clinical symptoms of depression had higher IMTs than those taking antidepressants who had fewer symptoms of depression.

"Because we didn’t see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that this is more likely the antidepressants than the actual depression that is behind the association," Dr. Shah said.

History of a previous myocardial infarction, which was noted for 12% of the cohort, was not independently associated with increased IMT, nor was there a differential effect for identical and fraternal twins.

Speculating on the possible mechanism for the association, the investigators suggested that antidepressants may increase IMT through augmented release of vasoconstrictive neuropeptides. "The antidepressants may act synergistically with depressive symptoms to increase vascular disease," he said. "There is a potential interaction between the depressive symptoms, the neurohormonal effects of the depression itself, and the medication."

The findings suggest that the risk/benefit ratio of antidepressants should be considered, especially in patients with pre-existing cardiovascular disease, Dr. Shah said. "While not showing causality, it is important to take studies such as this into account in patient care, especially when the patient may not be deriving much benefit from the antidepressant."

Dr. Shah and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Carotid intima-media thickness was found to be increased in middle-aged men taking antidepressants in a study reported at the annual scientific sessions of the American College of Cardiology.

"There is a clear association between increased intima-media thickness [IMT] and taking an antidepressant of any kind, and this trend is even stronger when we look at people who are on these medications and are more depressed," said Dr. Amit Shah, a cardiology fellow at Emory University, Atlanta.

Dr. Janet Wright senior vice president of science and quality for the ACC, commented that the study should be viewed as "directional. ... It only tees things up for the next range of studies." Dr. Wright, a cardiologist in Chico, Calif., added that "it does suggest that perhaps a person who is depressed and on an antidepressant may need monitoring."

Carotid IMT and brachial flow-mediated dilation was assessed using B-mode ultrasound in 513 middle-aged male twins from the Vietnam Era Twin Registry. Traditional risk factors for ischemic heart disease were measured. Depression and posttraumatic stress disorder (PTSD) were assessed with the Structured Clinical Interview for the Diagnosis of Psychiatric Disorders, and depressive symptoms were measured via the Beck Depression Inventory. Medication regimens were verified by a clinician. Mixed effects regression models were used to analyze the overall association and to examine differences within twin pairs discordant for antidepressant intake.

Participants were a mean age of 55 years; 95% were white and 16% were taking antidepressants, mainly selective serotonin reuptake inhibitors (60%). In an analysis of the association by type of antidepressant, an increase in IMT was noted regardless of the class of antidepressants.

Antidepressant use was associated with an IMT increase of 37 microns, which represents about a 5% increase from the mean IMT value of 762 microns seen in the population, a significant difference compared with men not taking antidepressants.

The findings emerged from an adjusted analysis that controlled for conventional cardiovascular risk factors and for depressive symptoms, history of major depression and heart disease, alcohol and coffee consumption, statin use, physical activity, education, and employment status.

In an analysis of 59 twin pairs where one brother was taking an antidepressant and the other was not, the antidepressant user had an IMT that was 41 microns thicker (P = .01), he reported.

Each additional year of life is associated with a 10-micron increase in IMT, therefore, the brother on the antidepressant could be considered to be 4 years "older" in terms of atherosclerosis. In previous studies, each 10-micron increase in IMT has been linked to a 1.8% increase in risk, Dr. Shah noted.

Previous studies have linked the presence of depression with an increased risk of cardiovascular disease. In this study, neither depression nor posttraumatic stress disorder significantly predicted an increase in IMT. However, the study did show that subjects taking antidepressants who also reported clinical symptoms of depression had higher IMTs than those taking antidepressants who had fewer symptoms of depression.

"Because we didn’t see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that this is more likely the antidepressants than the actual depression that is behind the association," Dr. Shah said.

History of a previous myocardial infarction, which was noted for 12% of the cohort, was not independently associated with increased IMT, nor was there a differential effect for identical and fraternal twins.

Speculating on the possible mechanism for the association, the investigators suggested that antidepressants may increase IMT through augmented release of vasoconstrictive neuropeptides. "The antidepressants may act synergistically with depressive symptoms to increase vascular disease," he said. "There is a potential interaction between the depressive symptoms, the neurohormonal effects of the depression itself, and the medication."

The findings suggest that the risk/benefit ratio of antidepressants should be considered, especially in patients with pre-existing cardiovascular disease, Dr. Shah said. "While not showing causality, it is important to take studies such as this into account in patient care, especially when the patient may not be deriving much benefit from the antidepressant."

Dr. Shah and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Carotid intima-media thickness was found to be increased in middle-aged men taking antidepressants in a study reported at the annual scientific sessions of the American College of Cardiology.

"There is a clear association between increased intima-media thickness [IMT] and taking an antidepressant of any kind, and this trend is even stronger when we look at people who are on these medications and are more depressed," said Dr. Amit Shah, a cardiology fellow at Emory University, Atlanta.

Dr. Janet Wright senior vice president of science and quality for the ACC, commented that the study should be viewed as "directional. ... It only tees things up for the next range of studies." Dr. Wright, a cardiologist in Chico, Calif., added that "it does suggest that perhaps a person who is depressed and on an antidepressant may need monitoring."

Carotid IMT and brachial flow-mediated dilation was assessed using B-mode ultrasound in 513 middle-aged male twins from the Vietnam Era Twin Registry. Traditional risk factors for ischemic heart disease were measured. Depression and posttraumatic stress disorder (PTSD) were assessed with the Structured Clinical Interview for the Diagnosis of Psychiatric Disorders, and depressive symptoms were measured via the Beck Depression Inventory. Medication regimens were verified by a clinician. Mixed effects regression models were used to analyze the overall association and to examine differences within twin pairs discordant for antidepressant intake.

Participants were a mean age of 55 years; 95% were white and 16% were taking antidepressants, mainly selective serotonin reuptake inhibitors (60%). In an analysis of the association by type of antidepressant, an increase in IMT was noted regardless of the class of antidepressants.

Antidepressant use was associated with an IMT increase of 37 microns, which represents about a 5% increase from the mean IMT value of 762 microns seen in the population, a significant difference compared with men not taking antidepressants.

The findings emerged from an adjusted analysis that controlled for conventional cardiovascular risk factors and for depressive symptoms, history of major depression and heart disease, alcohol and coffee consumption, statin use, physical activity, education, and employment status.

In an analysis of 59 twin pairs where one brother was taking an antidepressant and the other was not, the antidepressant user had an IMT that was 41 microns thicker (P = .01), he reported.

Each additional year of life is associated with a 10-micron increase in IMT, therefore, the brother on the antidepressant could be considered to be 4 years "older" in terms of atherosclerosis. In previous studies, each 10-micron increase in IMT has been linked to a 1.8% increase in risk, Dr. Shah noted.

Previous studies have linked the presence of depression with an increased risk of cardiovascular disease. In this study, neither depression nor posttraumatic stress disorder significantly predicted an increase in IMT. However, the study did show that subjects taking antidepressants who also reported clinical symptoms of depression had higher IMTs than those taking antidepressants who had fewer symptoms of depression.

"Because we didn’t see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that this is more likely the antidepressants than the actual depression that is behind the association," Dr. Shah said.

History of a previous myocardial infarction, which was noted for 12% of the cohort, was not independently associated with increased IMT, nor was there a differential effect for identical and fraternal twins.

Speculating on the possible mechanism for the association, the investigators suggested that antidepressants may increase IMT through augmented release of vasoconstrictive neuropeptides. "The antidepressants may act synergistically with depressive symptoms to increase vascular disease," he said. "There is a potential interaction between the depressive symptoms, the neurohormonal effects of the depression itself, and the medication."

The findings suggest that the risk/benefit ratio of antidepressants should be considered, especially in patients with pre-existing cardiovascular disease, Dr. Shah said. "While not showing causality, it is important to take studies such as this into account in patient care, especially when the patient may not be deriving much benefit from the antidepressant."

Dr. Shah and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Carotid intima-media thickness was found to be increased in middle-aged men taking antidepressants in a study reported at the annual scientific sessions of the American College of Cardiology.

"There is a clear association between increased intima-media thickness [IMT] and taking an antidepressant of any kind, and this trend is even stronger when we look at people who are on these medications and are more depressed," said Dr. Amit Shah, a cardiology fellow at Emory University, Atlanta.

Dr. Janet Wright senior vice president of science and quality for the ACC, commented that the study should be viewed as "directional. ... It only tees things up for the next range of studies." Dr. Wright, a cardiologist in Chico, Calif., added that "it does suggest that perhaps a person who is depressed and on an antidepressant may need monitoring."

Carotid IMT and brachial flow-mediated dilation was assessed using B-mode ultrasound in 513 middle-aged male twins from the Vietnam Era Twin Registry. Traditional risk factors for ischemic heart disease were measured. Depression and posttraumatic stress disorder (PTSD) were assessed with the Structured Clinical Interview for the Diagnosis of Psychiatric Disorders, and depressive symptoms were measured via the Beck Depression Inventory. Medication regimens were verified by a clinician. Mixed effects regression models were used to analyze the overall association and to examine differences within twin pairs discordant for antidepressant intake.

Participants were a mean age of 55 years; 95% were white and 16% were taking antidepressants, mainly selective serotonin reuptake inhibitors (60%). In an analysis of the association by type of antidepressant, an increase in IMT was noted regardless of the class of antidepressants.

Antidepressant use was associated with an IMT increase of 37 microns, which represents about a 5% increase from the mean IMT value of 762 microns seen in the population, a significant difference compared with men not taking antidepressants.

The findings emerged from an adjusted analysis that controlled for conventional cardiovascular risk factors and for depressive symptoms, history of major depression and heart disease, alcohol and coffee consumption, statin use, physical activity, education, and employment status.

In an analysis of 59 twin pairs where one brother was taking an antidepressant and the other was not, the antidepressant user had an IMT that was 41 microns thicker (P = .01), he reported.

Each additional year of life is associated with a 10-micron increase in IMT, therefore, the brother on the antidepressant could be considered to be 4 years "older" in terms of atherosclerosis. In previous studies, each 10-micron increase in IMT has been linked to a 1.8% increase in risk, Dr. Shah noted.

Previous studies have linked the presence of depression with an increased risk of cardiovascular disease. In this study, neither depression nor posttraumatic stress disorder significantly predicted an increase in IMT. However, the study did show that subjects taking antidepressants who also reported clinical symptoms of depression had higher IMTs than those taking antidepressants who had fewer symptoms of depression.

"Because we didn’t see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that this is more likely the antidepressants than the actual depression that is behind the association," Dr. Shah said.

History of a previous myocardial infarction, which was noted for 12% of the cohort, was not independently associated with increased IMT, nor was there a differential effect for identical and fraternal twins.

Speculating on the possible mechanism for the association, the investigators suggested that antidepressants may increase IMT through augmented release of vasoconstrictive neuropeptides. "The antidepressants may act synergistically with depressive symptoms to increase vascular disease," he said. "There is a potential interaction between the depressive symptoms, the neurohormonal effects of the depression itself, and the medication."

The findings suggest that the risk/benefit ratio of antidepressants should be considered, especially in patients with pre-existing cardiovascular disease, Dr. Shah said. "While not showing causality, it is important to take studies such as this into account in patient care, especially when the patient may not be deriving much benefit from the antidepressant."

Dr. Shah and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Carotid intima-media thickness was found to be increased in middle-aged men taking antidepressants in a study reported at the annual scientific sessions of the American College of Cardiology.

"There is a clear association between increased intima-media thickness [IMT] and taking an antidepressant of any kind, and this trend is even stronger when we look at people who are on these medications and are more depressed," said Dr. Amit Shah, a cardiology fellow at Emory University, Atlanta.

Dr. Janet Wright senior vice president of science and quality for the ACC, commented that the study should be viewed as "directional. ... It only tees things up for the next range of studies." Dr. Wright, a cardiologist in Chico, Calif., added that "it does suggest that perhaps a person who is depressed and on an antidepressant may need monitoring."

Carotid IMT and brachial flow-mediated dilation was assessed using B-mode ultrasound in 513 middle-aged male twins from the Vietnam Era Twin Registry. Traditional risk factors for ischemic heart disease were measured. Depression and posttraumatic stress disorder (PTSD) were assessed with the Structured Clinical Interview for the Diagnosis of Psychiatric Disorders, and depressive symptoms were measured via the Beck Depression Inventory. Medication regimens were verified by a clinician. Mixed effects regression models were used to analyze the overall association and to examine differences within twin pairs discordant for antidepressant intake.

Participants were a mean age of 55 years; 95% were white and 16% were taking antidepressants, mainly selective serotonin reuptake inhibitors (60%). In an analysis of the association by type of antidepressant, an increase in IMT was noted regardless of the class of antidepressants.

Antidepressant use was associated with an IMT increase of 37 microns, which represents about a 5% increase from the mean IMT value of 762 microns seen in the population, a significant difference compared with men not taking antidepressants.

The findings emerged from an adjusted analysis that controlled for conventional cardiovascular risk factors and for depressive symptoms, history of major depression and heart disease, alcohol and coffee consumption, statin use, physical activity, education, and employment status.

In an analysis of 59 twin pairs where one brother was taking an antidepressant and the other was not, the antidepressant user had an IMT that was 41 microns thicker (P = .01), he reported.

Each additional year of life is associated with a 10-micron increase in IMT, therefore, the brother on the antidepressant could be considered to be 4 years "older" in terms of atherosclerosis. In previous studies, each 10-micron increase in IMT has been linked to a 1.8% increase in risk, Dr. Shah noted.

Previous studies have linked the presence of depression with an increased risk of cardiovascular disease. In this study, neither depression nor posttraumatic stress disorder significantly predicted an increase in IMT. However, the study did show that subjects taking antidepressants who also reported clinical symptoms of depression had higher IMTs than those taking antidepressants who had fewer symptoms of depression.

"Because we didn’t see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that this is more likely the antidepressants than the actual depression that is behind the association," Dr. Shah said.

History of a previous myocardial infarction, which was noted for 12% of the cohort, was not independently associated with increased IMT, nor was there a differential effect for identical and fraternal twins.

Speculating on the possible mechanism for the association, the investigators suggested that antidepressants may increase IMT through augmented release of vasoconstrictive neuropeptides. "The antidepressants may act synergistically with depressive symptoms to increase vascular disease," he said. "There is a potential interaction between the depressive symptoms, the neurohormonal effects of the depression itself, and the medication."

The findings suggest that the risk/benefit ratio of antidepressants should be considered, especially in patients with pre-existing cardiovascular disease, Dr. Shah said. "While not showing causality, it is important to take studies such as this into account in patient care, especially when the patient may not be deriving much benefit from the antidepressant."

Dr. Shah and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Carotid intima-media thickness was found to be increased in middle-aged men taking antidepressants in a study reported at the annual scientific sessions of the American College of Cardiology.

"There is a clear association between increased intima-media thickness [IMT] and taking an antidepressant of any kind, and this trend is even stronger when we look at people who are on these medications and are more depressed," said Dr. Amit Shah, a cardiology fellow at Emory University, Atlanta.

Dr. Janet Wright senior vice president of science and quality for the ACC, commented that the study should be viewed as "directional. ... It only tees things up for the next range of studies." Dr. Wright, a cardiologist in Chico, Calif., added that "it does suggest that perhaps a person who is depressed and on an antidepressant may need monitoring."

Carotid IMT and brachial flow-mediated dilation was assessed using B-mode ultrasound in 513 middle-aged male twins from the Vietnam Era Twin Registry. Traditional risk factors for ischemic heart disease were measured. Depression and posttraumatic stress disorder (PTSD) were assessed with the Structured Clinical Interview for the Diagnosis of Psychiatric Disorders, and depressive symptoms were measured via the Beck Depression Inventory. Medication regimens were verified by a clinician. Mixed effects regression models were used to analyze the overall association and to examine differences within twin pairs discordant for antidepressant intake.

Participants were a mean age of 55 years; 95% were white and 16% were taking antidepressants, mainly selective serotonin reuptake inhibitors (60%). In an analysis of the association by type of antidepressant, an increase in IMT was noted regardless of the class of antidepressants.

Antidepressant use was associated with an IMT increase of 37 microns, which represents about a 5% increase from the mean IMT value of 762 microns seen in the population, a significant difference compared with men not taking antidepressants.

The findings emerged from an adjusted analysis that controlled for conventional cardiovascular risk factors and for depressive symptoms, history of major depression and heart disease, alcohol and coffee consumption, statin use, physical activity, education, and employment status.

In an analysis of 59 twin pairs where one brother was taking an antidepressant and the other was not, the antidepressant user had an IMT that was 41 microns thicker (P = .01), he reported.

Each additional year of life is associated with a 10-micron increase in IMT, therefore, the brother on the antidepressant could be considered to be 4 years "older" in terms of atherosclerosis. In previous studies, each 10-micron increase in IMT has been linked to a 1.8% increase in risk, Dr. Shah noted.

Previous studies have linked the presence of depression with an increased risk of cardiovascular disease. In this study, neither depression nor posttraumatic stress disorder significantly predicted an increase in IMT. However, the study did show that subjects taking antidepressants who also reported clinical symptoms of depression had higher IMTs than those taking antidepressants who had fewer symptoms of depression.

"Because we didn’t see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that this is more likely the antidepressants than the actual depression that is behind the association," Dr. Shah said.

History of a previous myocardial infarction, which was noted for 12% of the cohort, was not independently associated with increased IMT, nor was there a differential effect for identical and fraternal twins.

Speculating on the possible mechanism for the association, the investigators suggested that antidepressants may increase IMT through augmented release of vasoconstrictive neuropeptides. "The antidepressants may act synergistically with depressive symptoms to increase vascular disease," he said. "There is a potential interaction between the depressive symptoms, the neurohormonal effects of the depression itself, and the medication."

The findings suggest that the risk/benefit ratio of antidepressants should be considered, especially in patients with pre-existing cardiovascular disease, Dr. Shah said. "While not showing causality, it is important to take studies such as this into account in patient care, especially when the patient may not be deriving much benefit from the antidepressant."

Dr. Shah and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Carotid intima-media thickness was found to be increased in middle-aged men taking antidepressants in a study reported at the annual scientific sessions of the American College of Cardiology.

"There is a clear association between increased intima-media thickness [IMT] and taking an antidepressant of any kind, and this trend is even stronger when we look at people who are on these medications and are more depressed," said Dr. Amit Shah, a cardiology fellow at Emory University, Atlanta.

Dr. Janet Wright senior vice president of science and quality for the ACC, commented that the study should be viewed as "directional. ... It only tees things up for the next range of studies." Dr. Wright, a cardiologist in Chico, Calif., added that "it does suggest that perhaps a person who is depressed and on an antidepressant may need monitoring."

Carotid IMT and brachial flow-mediated dilation was assessed using B-mode ultrasound in 513 middle-aged male twins from the Vietnam Era Twin Registry. Traditional risk factors for ischemic heart disease were measured. Depression and posttraumatic stress disorder (PTSD) were assessed with the Structured Clinical Interview for the Diagnosis of Psychiatric Disorders, and depressive symptoms were measured via the Beck Depression Inventory. Medication regimens were verified by a clinician. Mixed effects regression models were used to analyze the overall association and to examine differences within twin pairs discordant for antidepressant intake.

Participants were a mean age of 55 years; 95% were white and 16% were taking antidepressants, mainly selective serotonin reuptake inhibitors (60%). In an analysis of the association by type of antidepressant, an increase in IMT was noted regardless of the class of antidepressants.

Antidepressant use was associated with an IMT increase of 37 microns, which represents about a 5% increase from the mean IMT value of 762 microns seen in the population, a significant difference compared with men not taking antidepressants.

The findings emerged from an adjusted analysis that controlled for conventional cardiovascular risk factors and for depressive symptoms, history of major depression and heart disease, alcohol and coffee consumption, statin use, physical activity, education, and employment status.

In an analysis of 59 twin pairs where one brother was taking an antidepressant and the other was not, the antidepressant user had an IMT that was 41 microns thicker (P = .01), he reported.

Each additional year of life is associated with a 10-micron increase in IMT, therefore, the brother on the antidepressant could be considered to be 4 years "older" in terms of atherosclerosis. In previous studies, each 10-micron increase in IMT has been linked to a 1.8% increase in risk, Dr. Shah noted.

Previous studies have linked the presence of depression with an increased risk of cardiovascular disease. In this study, neither depression nor posttraumatic stress disorder significantly predicted an increase in IMT. However, the study did show that subjects taking antidepressants who also reported clinical symptoms of depression had higher IMTs than those taking antidepressants who had fewer symptoms of depression.

"Because we didn’t see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that this is more likely the antidepressants than the actual depression that is behind the association," Dr. Shah said.

History of a previous myocardial infarction, which was noted for 12% of the cohort, was not independently associated with increased IMT, nor was there a differential effect for identical and fraternal twins.

Speculating on the possible mechanism for the association, the investigators suggested that antidepressants may increase IMT through augmented release of vasoconstrictive neuropeptides. "The antidepressants may act synergistically with depressive symptoms to increase vascular disease," he said. "There is a potential interaction between the depressive symptoms, the neurohormonal effects of the depression itself, and the medication."

The findings suggest that the risk/benefit ratio of antidepressants should be considered, especially in patients with pre-existing cardiovascular disease, Dr. Shah said. "While not showing causality, it is important to take studies such as this into account in patient care, especially when the patient may not be deriving much benefit from the antidepressant."

Dr. Shah and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Carotid intima-media thickness was found to be increased in middle-aged men taking antidepressants in a study reported at the annual scientific sessions of the American College of Cardiology.

"There is a clear association between increased intima-media thickness [IMT] and taking an antidepressant of any kind, and this trend is even stronger when we look at people who are on these medications and are more depressed," said Dr. Amit Shah, a cardiology fellow at Emory University, Atlanta.

Dr. Janet Wright senior vice president of science and quality for the ACC, commented that the study should be viewed as "directional. ... It only tees things up for the next range of studies." Dr. Wright, a cardiologist in Chico, Calif., added that "it does suggest that perhaps a person who is depressed and on an antidepressant may need monitoring."

Carotid IMT and brachial flow-mediated dilation was assessed using B-mode ultrasound in 513 middle-aged male twins from the Vietnam Era Twin Registry. Traditional risk factors for ischemic heart disease were measured. Depression and posttraumatic stress disorder (PTSD) were assessed with the Structured Clinical Interview for the Diagnosis of Psychiatric Disorders, and depressive symptoms were measured via the Beck Depression Inventory. Medication regimens were verified by a clinician. Mixed effects regression models were used to analyze the overall association and to examine differences within twin pairs discordant for antidepressant intake.

Participants were a mean age of 55 years; 95% were white and 16% were taking antidepressants, mainly selective serotonin reuptake inhibitors (60%). In an analysis of the association by type of antidepressant, an increase in IMT was noted regardless of the class of antidepressants.

Antidepressant use was associated with an IMT increase of 37 microns, which represents about a 5% increase from the mean IMT value of 762 microns seen in the population, a significant difference compared with men not taking antidepressants.

The findings emerged from an adjusted analysis that controlled for conventional cardiovascular risk factors and for depressive symptoms, history of major depression and heart disease, alcohol and coffee consumption, statin use, physical activity, education, and employment status.

In an analysis of 59 twin pairs where one brother was taking an antidepressant and the other was not, the antidepressant user had an IMT that was 41 microns thicker (P = .01), he reported.

Each additional year of life is associated with a 10-micron increase in IMT, therefore, the brother on the antidepressant could be considered to be 4 years "older" in terms of atherosclerosis. In previous studies, each 10-micron increase in IMT has been linked to a 1.8% increase in risk, Dr. Shah noted.

Previous studies have linked the presence of depression with an increased risk of cardiovascular disease. In this study, neither depression nor posttraumatic stress disorder significantly predicted an increase in IMT. However, the study did show that subjects taking antidepressants who also reported clinical symptoms of depression had higher IMTs than those taking antidepressants who had fewer symptoms of depression.

"Because we didn’t see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that this is more likely the antidepressants than the actual depression that is behind the association," Dr. Shah said.

History of a previous myocardial infarction, which was noted for 12% of the cohort, was not independently associated with increased IMT, nor was there a differential effect for identical and fraternal twins.

Speculating on the possible mechanism for the association, the investigators suggested that antidepressants may increase IMT through augmented release of vasoconstrictive neuropeptides. "The antidepressants may act synergistically with depressive symptoms to increase vascular disease," he said. "There is a potential interaction between the depressive symptoms, the neurohormonal effects of the depression itself, and the medication."

The findings suggest that the risk/benefit ratio of antidepressants should be considered, especially in patients with pre-existing cardiovascular disease, Dr. Shah said. "While not showing causality, it is important to take studies such as this into account in patient care, especially when the patient may not be deriving much benefit from the antidepressant."

Dr. Shah and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Carotid intima-media thickness was found to be increased in middle-aged men taking antidepressants in a study reported at the annual scientific sessions of the American College of Cardiology.

"There is a clear association between increased intima-media thickness [IMT] and taking an antidepressant of any kind, and this trend is even stronger when we look at people who are on these medications and are more depressed," said Dr. Amit Shah, a cardiology fellow at Emory University, Atlanta.

Dr. Janet Wright senior vice president of science and quality for the ACC, commented that the study should be viewed as "directional. ... It only tees things up for the next range of studies." Dr. Wright, a cardiologist in Chico, Calif., added that "it does suggest that perhaps a person who is depressed and on an antidepressant may need monitoring."

Carotid IMT and brachial flow-mediated dilation was assessed using B-mode ultrasound in 513 middle-aged male twins from the Vietnam Era Twin Registry. Traditional risk factors for ischemic heart disease were measured. Depression and posttraumatic stress disorder (PTSD) were assessed with the Structured Clinical Interview for the Diagnosis of Psychiatric Disorders, and depressive symptoms were measured via the Beck Depression Inventory. Medication regimens were verified by a clinician. Mixed effects regression models were used to analyze the overall association and to examine differences within twin pairs discordant for antidepressant intake.

Participants were a mean age of 55 years; 95% were white and 16% were taking antidepressants, mainly selective serotonin reuptake inhibitors (60%). In an analysis of the association by type of antidepressant, an increase in IMT was noted regardless of the class of antidepressants.

Antidepressant use was associated with an IMT increase of 37 microns, which represents about a 5% increase from the mean IMT value of 762 microns seen in the population, a significant difference compared with men not taking antidepressants.

The findings emerged from an adjusted analysis that controlled for conventional cardiovascular risk factors and for depressive symptoms, history of major depression and heart disease, alcohol and coffee consumption, statin use, physical activity, education, and employment status.

In an analysis of 59 twin pairs where one brother was taking an antidepressant and the other was not, the antidepressant user had an IMT that was 41 microns thicker (P = .01), he reported.

Each additional year of life is associated with a 10-micron increase in IMT, therefore, the brother on the antidepressant could be considered to be 4 years "older" in terms of atherosclerosis. In previous studies, each 10-micron increase in IMT has been linked to a 1.8% increase in risk, Dr. Shah noted.

Previous studies have linked the presence of depression with an increased risk of cardiovascular disease. In this study, neither depression nor posttraumatic stress disorder significantly predicted an increase in IMT. However, the study did show that subjects taking antidepressants who also reported clinical symptoms of depression had higher IMTs than those taking antidepressants who had fewer symptoms of depression.

"Because we didn’t see an association between depression itself and a thickening of the carotid artery, it strengthens the argument that this is more likely the antidepressants than the actual depression that is behind the association," Dr. Shah said.

History of a previous myocardial infarction, which was noted for 12% of the cohort, was not independently associated with increased IMT, nor was there a differential effect for identical and fraternal twins.

Speculating on the possible mechanism for the association, the investigators suggested that antidepressants may increase IMT through augmented release of vasoconstrictive neuropeptides. "The antidepressants may act synergistically with depressive symptoms to increase vascular disease," he said. "There is a potential interaction between the depressive symptoms, the neurohormonal effects of the depression itself, and the medication."

The findings suggest that the risk/benefit ratio of antidepressants should be considered, especially in patients with pre-existing cardiovascular disease, Dr. Shah said. "While not showing causality, it is important to take studies such as this into account in patient care, especially when the patient may not be deriving much benefit from the antidepressant."

Dr. Shah and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS – Practicing yoga can significantly reduce irregular heart beat episodes and improve symptoms of anxiety and depression in patients with paroxysmal atrial fibrillation, according to a study of 49 patients.

“This drives home the point that yoga used as a supplement and complement to existing therapies could make a dramatic difference in the quality of life of people, bring down anxiety and bring down arrhythmia burden in a cumulative fashion,” said Dr. Dhanunjaya Lakkireddy, lead author and associate professor of medicine at University of Kansas Hospital, Kansas City, at the annual scientific sessions of the American College of Cardiology.

Previous research has shown that heart failure patients can benefit from yoga, and that it yoga has a positive impact on overall health of various types of patients, including those with cancer. But this is the first study to examine the benefits of yoga on patients with atrial fibrillation, said Dr. Lakkireddy and his coinvestigators. “Atrial fibrillation is the bane of cardiologists’ existence,” and the condition also interferes with patients’ lives, leading to anxiety and depression. “It also consumes a lot of health care dollars,” he said.

What prompted Dr. Lakkireddy to conduct the study was seeing the progress in one of his patients who practiced yoga regularly.

Dr. Janet Wright, senior vice president of science and quality at ACC, said that the study was suggested by a patient, and commended Dr. Lakkireddi for “listening to patients and to what works for them, and equipping patients with things they can do to self manage their chronic conditions.”

The investigators conducted a prospective, self-controlled, single-center study on 49 patients with atrial fibrillation who had no physical limitations. For the first 3 months, the control phase, the patients were allowed to engage in their previous physical activities. During the following 3 months, the intervention phase, the patients participated in a supervised yoga program (B.K.S. Iyengar’s conventional yoga program), which included breathing exercises, yoga postures, meditation and relaxation, for an average of 45 minutes, three times a week. They were also given an educational DVD to continue practice at home, depending on their comfort level. All participants were new to yoga.

Episodes of irregular heartbeat were measured during the 6-month study period with portable monitors and patient logs. Patients also completed surveys on anxiety, depression and quality of life.

Episodes of arrhythmia episodes decreased, from a mean of 3.8% in the control phase to 2.1% in the interventional phase. Likewise, asymptomatic episodes came down from 2.6 to 1.4 episodes, while quality of life improved: patients’ anxiety score decreased by 4 points, and their depression score by 5 points. All these differences were statistically significant, said Dr. Lakkireddy.

Here we have another piece of data showing the importance of stress and anxiety on atrial fibrillation events,” said Dr. Ralph Brindis, president of ACC. “The fact that yoga may decrease atrial fibrillation burden is fascinating. I am convinced totally that stress reduction technique would be an important armament for patients for minimizing atrial fibrillation burden and more importantly improving their quality of life.”

Dr. Lakkireddy speculated that yoga affects cardiac autonomic tone by creating a flattening effect and preventing abnormal surges in the autonomic nervous system. Stress and inflammation also play a role in atrial fibrillation, he said. “Yoga improves all of these things.”

The authors said that yoga can be considered in the treatment strategy for atrial fibrillation and other complex heart rhythm disorders, given that it is noninvasive, low cost, “with minimal side effects and reasonable safety and efficacy.” Dr. Lakkireddy said he prescribes yoga to his patients with atrial fibrillation. However, “yoga does not treat atrial fibrillation,” he stressed.

One of the main limitations of the study is the small number of participants, said Dr. Lakkireddy, adding that more research with a larger number of patients is needed.

Dr. Lakkireddy had no disclosures. “I practice yoga. That’s my only disclosure,” he said.

NEW ORLEANS – Practicing yoga can significantly reduce irregular heart beat episodes and improve symptoms of anxiety and depression in patients with paroxysmal atrial fibrillation, according to a study of 49 patients.

“This drives home the point that yoga used as a supplement and complement to existing therapies could make a dramatic difference in the quality of life of people, bring down anxiety and bring down arrhythmia burden in a cumulative fashion,” said Dr. Dhanunjaya Lakkireddy, lead author and associate professor of medicine at University of Kansas Hospital, Kansas City, at the annual scientific sessions of the American College of Cardiology.

Previous research has shown that heart failure patients can benefit from yoga, and that it yoga has a positive impact on overall health of various types of patients, including those with cancer. But this is the first study to examine the benefits of yoga on patients with atrial fibrillation, said Dr. Lakkireddy and his coinvestigators. “Atrial fibrillation is the bane of cardiologists’ existence,” and the condition also interferes with patients’ lives, leading to anxiety and depression. “It also consumes a lot of health care dollars,” he said.

What prompted Dr. Lakkireddy to conduct the study was seeing the progress in one of his patients who practiced yoga regularly.

Dr. Janet Wright, senior vice president of science and quality at ACC, said that the study was suggested by a patient, and commended Dr. Lakkireddi for “listening to patients and to what works for them, and equipping patients with things they can do to self manage their chronic conditions.”

The investigators conducted a prospective, self-controlled, single-center study on 49 patients with atrial fibrillation who had no physical limitations. For the first 3 months, the control phase, the patients were allowed to engage in their previous physical activities. During the following 3 months, the intervention phase, the patients participated in a supervised yoga program (B.K.S. Iyengar’s conventional yoga program), which included breathing exercises, yoga postures, meditation and relaxation, for an average of 45 minutes, three times a week. They were also given an educational DVD to continue practice at home, depending on their comfort level. All participants were new to yoga.

Episodes of irregular heartbeat were measured during the 6-month study period with portable monitors and patient logs. Patients also completed surveys on anxiety, depression and quality of life.

Episodes of arrhythmia episodes decreased, from a mean of 3.8% in the control phase to 2.1% in the interventional phase. Likewise, asymptomatic episodes came down from 2.6 to 1.4 episodes, while quality of life improved: patients’ anxiety score decreased by 4 points, and their depression score by 5 points. All these differences were statistically significant, said Dr. Lakkireddy.

Here we have another piece of data showing the importance of stress and anxiety on atrial fibrillation events,” said Dr. Ralph Brindis, president of ACC. “The fact that yoga may decrease atrial fibrillation burden is fascinating. I am convinced totally that stress reduction technique would be an important armament for patients for minimizing atrial fibrillation burden and more importantly improving their quality of life.”

Dr. Lakkireddy speculated that yoga affects cardiac autonomic tone by creating a flattening effect and preventing abnormal surges in the autonomic nervous system. Stress and inflammation also play a role in atrial fibrillation, he said. “Yoga improves all of these things.”

The authors said that yoga can be considered in the treatment strategy for atrial fibrillation and other complex heart rhythm disorders, given that it is noninvasive, low cost, “with minimal side effects and reasonable safety and efficacy.” Dr. Lakkireddy said he prescribes yoga to his patients with atrial fibrillation. However, “yoga does not treat atrial fibrillation,” he stressed.

One of the main limitations of the study is the small number of participants, said Dr. Lakkireddy, adding that more research with a larger number of patients is needed.

Dr. Lakkireddy had no disclosures. “I practice yoga. That’s my only disclosure,” he said.

NEW ORLEANS – Practicing yoga can significantly reduce irregular heart beat episodes and improve symptoms of anxiety and depression in patients with paroxysmal atrial fibrillation, according to a study of 49 patients.

“This drives home the point that yoga used as a supplement and complement to existing therapies could make a dramatic difference in the quality of life of people, bring down anxiety and bring down arrhythmia burden in a cumulative fashion,” said Dr. Dhanunjaya Lakkireddy, lead author and associate professor of medicine at University of Kansas Hospital, Kansas City, at the annual scientific sessions of the American College of Cardiology.

Previous research has shown that heart failure patients can benefit from yoga, and that it yoga has a positive impact on overall health of various types of patients, including those with cancer. But this is the first study to examine the benefits of yoga on patients with atrial fibrillation, said Dr. Lakkireddy and his coinvestigators. “Atrial fibrillation is the bane of cardiologists’ existence,” and the condition also interferes with patients’ lives, leading to anxiety and depression. “It also consumes a lot of health care dollars,” he said.

What prompted Dr. Lakkireddy to conduct the study was seeing the progress in one of his patients who practiced yoga regularly.

Dr. Janet Wright, senior vice president of science and quality at ACC, said that the study was suggested by a patient, and commended Dr. Lakkireddi for “listening to patients and to what works for them, and equipping patients with things they can do to self manage their chronic conditions.”

The investigators conducted a prospective, self-controlled, single-center study on 49 patients with atrial fibrillation who had no physical limitations. For the first 3 months, the control phase, the patients were allowed to engage in their previous physical activities. During the following 3 months, the intervention phase, the patients participated in a supervised yoga program (B.K.S. Iyengar’s conventional yoga program), which included breathing exercises, yoga postures, meditation and relaxation, for an average of 45 minutes, three times a week. They were also given an educational DVD to continue practice at home, depending on their comfort level. All participants were new to yoga.

Episodes of irregular heartbeat were measured during the 6-month study period with portable monitors and patient logs. Patients also completed surveys on anxiety, depression and quality of life.

Episodes of arrhythmia episodes decreased, from a mean of 3.8% in the control phase to 2.1% in the interventional phase. Likewise, asymptomatic episodes came down from 2.6 to 1.4 episodes, while quality of life improved: patients’ anxiety score decreased by 4 points, and their depression score by 5 points. All these differences were statistically significant, said Dr. Lakkireddy.

Here we have another piece of data showing the importance of stress and anxiety on atrial fibrillation events,” said Dr. Ralph Brindis, president of ACC. “The fact that yoga may decrease atrial fibrillation burden is fascinating. I am convinced totally that stress reduction technique would be an important armament for patients for minimizing atrial fibrillation burden and more importantly improving their quality of life.”

Dr. Lakkireddy speculated that yoga affects cardiac autonomic tone by creating a flattening effect and preventing abnormal surges in the autonomic nervous system. Stress and inflammation also play a role in atrial fibrillation, he said. “Yoga improves all of these things.”

The authors said that yoga can be considered in the treatment strategy for atrial fibrillation and other complex heart rhythm disorders, given that it is noninvasive, low cost, “with minimal side effects and reasonable safety and efficacy.” Dr. Lakkireddy said he prescribes yoga to his patients with atrial fibrillation. However, “yoga does not treat atrial fibrillation,” he stressed.

One of the main limitations of the study is the small number of participants, said Dr. Lakkireddy, adding that more research with a larger number of patients is needed.

Dr. Lakkireddy had no disclosures. “I practice yoga. That’s my only disclosure,” he said.

NEW ORLEANS – Practicing yoga can significantly reduce irregular heart beat episodes and improve symptoms of anxiety and depression in patients with paroxysmal atrial fibrillation, according to a study of 49 patients.

“This drives home the point that yoga used as a supplement and complement to existing therapies could make a dramatic difference in the quality of life of people, bring down anxiety and bring down arrhythmia burden in a cumulative fashion,” said Dr. Dhanunjaya Lakkireddy, lead author and associate professor of medicine at University of Kansas Hospital, Kansas City, at the annual scientific sessions of the American College of Cardiology.

Previous research has shown that heart failure patients can benefit from yoga, and that it yoga has a positive impact on overall health of various types of patients, including those with cancer. But this is the first study to examine the benefits of yoga on patients with atrial fibrillation, said Dr. Lakkireddy and his coinvestigators. “Atrial fibrillation is the bane of cardiologists’ existence,” and the condition also interferes with patients’ lives, leading to anxiety and depression. “It also consumes a lot of health care dollars,” he said.

What prompted Dr. Lakkireddy to conduct the study was seeing the progress in one of his patients who practiced yoga regularly.

Dr. Janet Wright, senior vice president of science and quality at ACC, said that the study was suggested by a patient, and commended Dr. Lakkireddi for “listening to patients and to what works for them, and equipping patients with things they can do to self manage their chronic conditions.”

The investigators conducted a prospective, self-controlled, single-center study on 49 patients with atrial fibrillation who had no physical limitations. For the first 3 months, the control phase, the patients were allowed to engage in their previous physical activities. During the following 3 months, the intervention phase, the patients participated in a supervised yoga program (B.K.S. Iyengar’s conventional yoga program), which included breathing exercises, yoga postures, meditation and relaxation, for an average of 45 minutes, three times a week. They were also given an educational DVD to continue practice at home, depending on their comfort level. All participants were new to yoga.

Episodes of irregular heartbeat were measured during the 6-month study period with portable monitors and patient logs. Patients also completed surveys on anxiety, depression and quality of life.

Episodes of arrhythmia episodes decreased, from a mean of 3.8% in the control phase to 2.1% in the interventional phase. Likewise, asymptomatic episodes came down from 2.6 to 1.4 episodes, while quality of life improved: patients’ anxiety score decreased by 4 points, and their depression score by 5 points. All these differences were statistically significant, said Dr. Lakkireddy.

Here we have another piece of data showing the importance of stress and anxiety on atrial fibrillation events,” said Dr. Ralph Brindis, president of ACC. “The fact that yoga may decrease atrial fibrillation burden is fascinating. I am convinced totally that stress reduction technique would be an important armament for patients for minimizing atrial fibrillation burden and more importantly improving their quality of life.”

Dr. Lakkireddy speculated that yoga affects cardiac autonomic tone by creating a flattening effect and preventing abnormal surges in the autonomic nervous system. Stress and inflammation also play a role in atrial fibrillation, he said. “Yoga improves all of these things.”

The authors said that yoga can be considered in the treatment strategy for atrial fibrillation and other complex heart rhythm disorders, given that it is noninvasive, low cost, “with minimal side effects and reasonable safety and efficacy.” Dr. Lakkireddy said he prescribes yoga to his patients with atrial fibrillation. However, “yoga does not treat atrial fibrillation,” he stressed.

One of the main limitations of the study is the small number of participants, said Dr. Lakkireddy, adding that more research with a larger number of patients is needed.

Dr. Lakkireddy had no disclosures. “I practice yoga. That’s my only disclosure,” he said.

NEW ORLEANS – Practicing yoga can significantly reduce irregular heart beat episodes and improve symptoms of anxiety and depression in patients with paroxysmal atrial fibrillation, according to a study of 49 patients.

“This drives home the point that yoga used as a supplement and complement to existing therapies could make a dramatic difference in the quality of life of people, bring down anxiety and bring down arrhythmia burden in a cumulative fashion,” said Dr. Dhanunjaya Lakkireddy, lead author and associate professor of medicine at University of Kansas Hospital, Kansas City, at the annual scientific sessions of the American College of Cardiology.

Previous research has shown that heart failure patients can benefit from yoga, and that it yoga has a positive impact on overall health of various types of patients, including those with cancer. But this is the first study to examine the benefits of yoga on patients with atrial fibrillation, said Dr. Lakkireddy and his coinvestigators. “Atrial fibrillation is the bane of cardiologists’ existence,” and the condition also interferes with patients’ lives, leading to anxiety and depression. “It also consumes a lot of health care dollars,” he said.

What prompted Dr. Lakkireddy to conduct the study was seeing the progress in one of his patients who practiced yoga regularly.

Dr. Janet Wright, senior vice president of science and quality at ACC, said that the study was suggested by a patient, and commended Dr. Lakkireddi for “listening to patients and to what works for them, and equipping patients with things they can do to self manage their chronic conditions.”

The investigators conducted a prospective, self-controlled, single-center study on 49 patients with atrial fibrillation who had no physical limitations. For the first 3 months, the control phase, the patients were allowed to engage in their previous physical activities. During the following 3 months, the intervention phase, the patients participated in a supervised yoga program (B.K.S. Iyengar’s conventional yoga program), which included breathing exercises, yoga postures, meditation and relaxation, for an average of 45 minutes, three times a week. They were also given an educational DVD to continue practice at home, depending on their comfort level. All participants were new to yoga.

Episodes of irregular heartbeat were measured during the 6-month study period with portable monitors and patient logs. Patients also completed surveys on anxiety, depression and quality of life.

Episodes of arrhythmia episodes decreased, from a mean of 3.8% in the control phase to 2.1% in the interventional phase. Likewise, asymptomatic episodes came down from 2.6 to 1.4 episodes, while quality of life improved: patients’ anxiety score decreased by 4 points, and their depression score by 5 points. All these differences were statistically significant, said Dr. Lakkireddy.

Here we have another piece of data showing the importance of stress and anxiety on atrial fibrillation events,” said Dr. Ralph Brindis, president of ACC. “The fact that yoga may decrease atrial fibrillation burden is fascinating. I am convinced totally that stress reduction technique would be an important armament for patients for minimizing atrial fibrillation burden and more importantly improving their quality of life.”

Dr. Lakkireddy speculated that yoga affects cardiac autonomic tone by creating a flattening effect and preventing abnormal surges in the autonomic nervous system. Stress and inflammation also play a role in atrial fibrillation, he said. “Yoga improves all of these things.”

The authors said that yoga can be considered in the treatment strategy for atrial fibrillation and other complex heart rhythm disorders, given that it is noninvasive, low cost, “with minimal side effects and reasonable safety and efficacy.” Dr. Lakkireddy said he prescribes yoga to his patients with atrial fibrillation. However, “yoga does not treat atrial fibrillation,” he stressed.

One of the main limitations of the study is the small number of participants, said Dr. Lakkireddy, adding that more research with a larger number of patients is needed.

Dr. Lakkireddy had no disclosures. “I practice yoga. That’s my only disclosure,” he said.

NEW ORLEANS – Practicing yoga can significantly reduce irregular heart beat episodes and improve symptoms of anxiety and depression in patients with paroxysmal atrial fibrillation, according to a study of 49 patients.

“This drives home the point that yoga used as a supplement and complement to existing therapies could make a dramatic difference in the quality of life of people, bring down anxiety and bring down arrhythmia burden in a cumulative fashion,” said Dr. Dhanunjaya Lakkireddy, lead author and associate professor of medicine at University of Kansas Hospital, Kansas City, at the annual scientific sessions of the American College of Cardiology.

Previous research has shown that heart failure patients can benefit from yoga, and that it yoga has a positive impact on overall health of various types of patients, including those with cancer. But this is the first study to examine the benefits of yoga on patients with atrial fibrillation, said Dr. Lakkireddy and his coinvestigators. “Atrial fibrillation is the bane of cardiologists’ existence,” and the condition also interferes with patients’ lives, leading to anxiety and depression. “It also consumes a lot of health care dollars,” he said.

What prompted Dr. Lakkireddy to conduct the study was seeing the progress in one of his patients who practiced yoga regularly.

Dr. Janet Wright, senior vice president of science and quality at ACC, said that the study was suggested by a patient, and commended Dr. Lakkireddi for “listening to patients and to what works for them, and equipping patients with things they can do to self manage their chronic conditions.”

The investigators conducted a prospective, self-controlled, single-center study on 49 patients with atrial fibrillation who had no physical limitations. For the first 3 months, the control phase, the patients were allowed to engage in their previous physical activities. During the following 3 months, the intervention phase, the patients participated in a supervised yoga program (B.K.S. Iyengar’s conventional yoga program), which included breathing exercises, yoga postures, meditation and relaxation, for an average of 45 minutes, three times a week. They were also given an educational DVD to continue practice at home, depending on their comfort level. All participants were new to yoga.

Episodes of irregular heartbeat were measured during the 6-month study period with portable monitors and patient logs. Patients also completed surveys on anxiety, depression and quality of life.

Episodes of arrhythmia episodes decreased, from a mean of 3.8% in the control phase to 2.1% in the interventional phase. Likewise, asymptomatic episodes came down from 2.6 to 1.4 episodes, while quality of life improved: patients’ anxiety score decreased by 4 points, and their depression score by 5 points. All these differences were statistically significant, said Dr. Lakkireddy.

Here we have another piece of data showing the importance of stress and anxiety on atrial fibrillation events,” said Dr. Ralph Brindis, president of ACC. “The fact that yoga may decrease atrial fibrillation burden is fascinating. I am convinced totally that stress reduction technique would be an important armament for patients for minimizing atrial fibrillation burden and more importantly improving their quality of life.”

Dr. Lakkireddy speculated that yoga affects cardiac autonomic tone by creating a flattening effect and preventing abnormal surges in the autonomic nervous system. Stress and inflammation also play a role in atrial fibrillation, he said. “Yoga improves all of these things.”

The authors said that yoga can be considered in the treatment strategy for atrial fibrillation and other complex heart rhythm disorders, given that it is noninvasive, low cost, “with minimal side effects and reasonable safety and efficacy.” Dr. Lakkireddy said he prescribes yoga to his patients with atrial fibrillation. However, “yoga does not treat atrial fibrillation,” he stressed.

One of the main limitations of the study is the small number of participants, said Dr. Lakkireddy, adding that more research with a larger number of patients is needed.

Dr. Lakkireddy had no disclosures. “I practice yoga. That’s my only disclosure,” he said.

NEW ORLEANS – Practicing yoga can significantly reduce irregular heart beat episodes and improve symptoms of anxiety and depression in patients with paroxysmal atrial fibrillation, according to a study of 49 patients.

“This drives home the point that yoga used as a supplement and complement to existing therapies could make a dramatic difference in the quality of life of people, bring down anxiety and bring down arrhythmia burden in a cumulative fashion,” said Dr. Dhanunjaya Lakkireddy, lead author and associate professor of medicine at University of Kansas Hospital, Kansas City, at the annual scientific sessions of the American College of Cardiology.

Photo credit: Elsevier Global Medical News Image Library.

Previous research has shown that heart failure patients can benefit from yoga, and that it yoga has a positive impact on overall health of various types of patients, including those with cancer. But this is the first study to examine the benefits of yoga on patients with atrial fibrillation, said Dr. Lakkireddy and his coinvestigators. “Atrial fibrillation is the bane of cardiologists’ existence,” and the condition also interferes with patients’ lives, leading to anxiety and depression. “It also consumes a lot of health care dollars,” he said.

What prompted Dr. Lakkireddy to conduct the study was seeing the progress in one of his patients who practiced yoga regularly.

Dr. Janet Wright, senior vice president of science and quality at ACC, said that the study was suggested by a patient, and commended Dr. Lakkireddi for “listening to patients and to what works for them, and equipping patients with things they can do to self manage their chronic conditions.”

The investigators conducted a prospective, self-controlled, single-center study on 49 patients with atrial fibrillation who had no physical limitations. For the first 3 months, the control phase, the patients were allowed to engage in their previous physical activities. During the following 3 months, the intervention phase, the patients participated in a supervised yoga program (B.K.S. Iyengar’s conventional yoga program), which included breathing exercises, yoga postures, meditation and relaxation, for an average of 45 minutes, three times a week. They were also given an educational DVD to continue practice at home, depending on their comfort level. All participants were new to yoga.

Episodes of irregular heartbeat were measured during the 6-month study period with portable monitors and patient logs. Patients also completed surveys on anxiety, depression and quality of life.

Episodes of arrhythmia episodes decreased, from a mean of 3.8% in the control phase to 2.1% in the interventional phase. Likewise, asymptomatic episodes came down from 2.6 to 1.4 episodes, while quality of life improved: patients’ anxiety score decreased by 4 points, and their depression score by 5 points. All these differences were statistically significant, said Dr. Lakkireddy.

Here we have another piece of data showing the importance of stress and anxiety on atrial fibrillation events,” said Dr. Ralph Brindis, president of ACC. “The fact that yoga may decrease atrial fibrillation burden is fascinating. I am convinced totally that stress reduction technique would be an important armament for patients for minimizing atrial fibrillation burden and more importantly improving their quality of life.”

Dr. Lakkireddy speculated that yoga affects cardiac autonomic tone by creating a flattening effect and preventing abnormal surges in the autonomic nervous system. Stress and inflammation also play a role in atrial fibrillation, he said. “Yoga improves all of these things.”

The authors said that yoga can be considered in the treatment strategy for atrial fibrillation and other complex heart rhythm disorders, given that it is noninvasive, low cost, “with minimal side effects and reasonable safety and efficacy.” Dr. Lakkireddy said he prescribes yoga to his patients with atrial fibrillation. However, “yoga does not treat atrial fibrillation,” he stressed.

One of the main limitations of the study is the small number of participants, said Dr. Lakkireddy, adding that more research with a larger number of patients is needed.

Dr. Lakkireddy had no disclosures. “I practice yoga. That’s my only disclosure,” he said.

NEW ORLEANS – Practicing yoga can significantly reduce irregular heart beat episodes and improve symptoms of anxiety and depression in patients with paroxysmal atrial fibrillation, according to a study of 49 patients.

“This drives home the point that yoga used as a supplement and complement to existing therapies could make a dramatic difference in the quality of life of people, bring down anxiety and bring down arrhythmia burden in a cumulative fashion,” said Dr. Dhanunjaya Lakkireddy, lead author and associate professor of medicine at University of Kansas Hospital, Kansas City, at the annual scientific sessions of the American College of Cardiology.

Photo credit: Elsevier Global Medical News Image Library.

Previous research has shown that heart failure patients can benefit from yoga, and that it yoga has a positive impact on overall health of various types of patients, including those with cancer. But this is the first study to examine the benefits of yoga on patients with atrial fibrillation, said Dr. Lakkireddy and his coinvestigators. “Atrial fibrillation is the bane of cardiologists’ existence,” and the condition also interferes with patients’ lives, leading to anxiety and depression. “It also consumes a lot of health care dollars,” he said.

What prompted Dr. Lakkireddy to conduct the study was seeing the progress in one of his patients who practiced yoga regularly.

Dr. Janet Wright, senior vice president of science and quality at ACC, said that the study was suggested by a patient, and commended Dr. Lakkireddi for “listening to patients and to what works for them, and equipping patients with things they can do to self manage their chronic conditions.”

The investigators conducted a prospective, self-controlled, single-center study on 49 patients with atrial fibrillation who had no physical limitations. For the first 3 months, the control phase, the patients were allowed to engage in their previous physical activities. During the following 3 months, the intervention phase, the patients participated in a supervised yoga program (B.K.S. Iyengar’s conventional yoga program), which included breathing exercises, yoga postures, meditation and relaxation, for an average of 45 minutes, three times a week. They were also given an educational DVD to continue practice at home, depending on their comfort level. All participants were new to yoga.

Episodes of irregular heartbeat were measured during the 6-month study period with portable monitors and patient logs. Patients also completed surveys on anxiety, depression and quality of life.

Episodes of arrhythmia episodes decreased, from a mean of 3.8% in the control phase to 2.1% in the interventional phase. Likewise, asymptomatic episodes came down from 2.6 to 1.4 episodes, while quality of life improved: patients’ anxiety score decreased by 4 points, and their depression score by 5 points. All these differences were statistically significant, said Dr. Lakkireddy.

Here we have another piece of data showing the importance of stress and anxiety on atrial fibrillation events,” said Dr. Ralph Brindis, president of ACC. “The fact that yoga may decrease atrial fibrillation burden is fascinating. I am convinced totally that stress reduction technique would be an important armament for patients for minimizing atrial fibrillation burden and more importantly improving their quality of life.”

Dr. Lakkireddy speculated that yoga affects cardiac autonomic tone by creating a flattening effect and preventing abnormal surges in the autonomic nervous system. Stress and inflammation also play a role in atrial fibrillation, he said. “Yoga improves all of these things.”

The authors said that yoga can be considered in the treatment strategy for atrial fibrillation and other complex heart rhythm disorders, given that it is noninvasive, low cost, “with minimal side effects and reasonable safety and efficacy.” Dr. Lakkireddy said he prescribes yoga to his patients with atrial fibrillation. However, “yoga does not treat atrial fibrillation,” he stressed.

One of the main limitations of the study is the small number of participants, said Dr. Lakkireddy, adding that more research with a larger number of patients is needed.

Dr. Lakkireddy had no disclosures. “I practice yoga. That’s my only disclosure,” he said.

NEW ORLEANS – Practicing yoga can significantly reduce irregular heart beat episodes and improve symptoms of anxiety and depression in patients with paroxysmal atrial fibrillation, according to a study of 49 patients.

“This drives home the point that yoga used as a supplement and complement to existing therapies could make a dramatic difference in the quality of life of people, bring down anxiety and bring down arrhythmia burden in a cumulative fashion,” said Dr. Dhanunjaya Lakkireddy, lead author and associate professor of medicine at University of Kansas Hospital, Kansas City, at the annual scientific sessions of the American College of Cardiology.

Photo credit: Elsevier Global Medical News Image Library.

Previous research has shown that heart failure patients can benefit from yoga, and that it yoga has a positive impact on overall health of various types of patients, including those with cancer. But this is the first study to examine the benefits of yoga on patients with atrial fibrillation, said Dr. Lakkireddy and his coinvestigators. “Atrial fibrillation is the bane of cardiologists’ existence,” and the condition also interferes with patients’ lives, leading to anxiety and depression. “It also consumes a lot of health care dollars,” he said.

What prompted Dr. Lakkireddy to conduct the study was seeing the progress in one of his patients who practiced yoga regularly.

Dr. Janet Wright, senior vice president of science and quality at ACC, said that the study was suggested by a patient, and commended Dr. Lakkireddi for “listening to patients and to what works for them, and equipping patients with things they can do to self manage their chronic conditions.”

The investigators conducted a prospective, self-controlled, single-center study on 49 patients with atrial fibrillation who had no physical limitations. For the first 3 months, the control phase, the patients were allowed to engage in their previous physical activities. During the following 3 months, the intervention phase, the patients participated in a supervised yoga program (B.K.S. Iyengar’s conventional yoga program), which included breathing exercises, yoga postures, meditation and relaxation, for an average of 45 minutes, three times a week. They were also given an educational DVD to continue practice at home, depending on their comfort level. All participants were new to yoga.

Episodes of irregular heartbeat were measured during the 6-month study period with portable monitors and patient logs. Patients also completed surveys on anxiety, depression and quality of life.

Episodes of arrhythmia episodes decreased, from a mean of 3.8% in the control phase to 2.1% in the interventional phase. Likewise, asymptomatic episodes came down from 2.6 to 1.4 episodes, while quality of life improved: patients’ anxiety score decreased by 4 points, and their depression score by 5 points. All these differences were statistically significant, said Dr. Lakkireddy.

Here we have another piece of data showing the importance of stress and anxiety on atrial fibrillation events,” said Dr. Ralph Brindis, president of ACC. “The fact that yoga may decrease atrial fibrillation burden is fascinating. I am convinced totally that stress reduction technique would be an important armament for patients for minimizing atrial fibrillation burden and more importantly improving their quality of life.”

Dr. Lakkireddy speculated that yoga affects cardiac autonomic tone by creating a flattening effect and preventing abnormal surges in the autonomic nervous system. Stress and inflammation also play a role in atrial fibrillation, he said. “Yoga improves all of these things.”

The authors said that yoga can be considered in the treatment strategy for atrial fibrillation and other complex heart rhythm disorders, given that it is noninvasive, low cost, “with minimal side effects and reasonable safety and efficacy.” Dr. Lakkireddy said he prescribes yoga to his patients with atrial fibrillation. However, “yoga does not treat atrial fibrillation,” he stressed.

One of the main limitations of the study is the small number of participants, said Dr. Lakkireddy, adding that more research with a larger number of patients is needed.

Dr. Lakkireddy had no disclosures. “I practice yoga. That’s my only disclosure,” he said.

NEW ORLEANS - Patients with suspected ST-elevation myocardial infarction who called an ambulance received lifesaving care in half the time as patients who got to the hospital by other means, according to a study conducted at two San Francisco hospitals.

"Patients who take an ambulance get a prehospital ECG," said lead investigator Dr. James M. McCabe of the University of California, San Francisco, at the annual scientific sessions of the American College of Cardiology. "These patients move through the emergency room and get to the cath lab much faster."

"We found that almost half of patients referred for a potential heart attack don’t take an ambulance but come in on their own, and it turns out they are doing themselves a great disservice," Dr. McCabe said.

The study analyzed 356 consecutive patients referred for emergent cardiac catheterization for a suspected STEMI by emergency physicians at a tertiary care hospital and a county hospital in 2009. Of the 356 patients, 199 (56%) arrived by ambulance and 157 (44%) did not.

Variables affecting the time interval from the inciting ECG to STEMI pager activation, and door-to-balloon time, were analyzed in univariate and step-wise multivariate regression models.

All components of care were affected.

"The ultimate metric, door-to-balloon time, was reduced by 26% in patients taken by ambulance," Dr. McCabe reported. This highly significant finding is important because studies show mortality risks are higher when door-to-balloon times exceed 90 minutes, he added.

The investigators then broke down the door-to-balloon time into its various components and compared the groups. After adjusting for demographic factors, traditional cardiovascular risk factors, severity of illness and extent of ECG changes, merely not presenting by ambulance to the emergency department (ED), and therefore not receiving a prehospital ECG, significantly lengthened by 62% the total time in the ED before undergoing catheterization.

Among patients arriving by ambulance, "each interval that occurred within the emergency room was reduced by more than 50%," he reported.

The procedural time for revascularization, however, did not vary based on how the patient arrived at the hospital. This finding supports the conclusion that care was made more efficient prior to the catheterization itself, he said.

The one observable difference was that patients arriving by ambulance were more critically ill. They had more cardiac arrests, and required more cardiopulmonary resuscitation and intubation.

"That’s interesting, because while these patients are sicker and require more care in the ER, they are still getting through the ER faster, after adjusting for multiple risk factors and elements in the decision-making process," Dr. McCabe noted. "Taking the ambulance results in efficiency, and this translates into faster ER throughput and shorter door-to-balloon times."

Of some concern to the researchers was that calling 911 did not assure that patients with suspected STEMI arrived at the hospital with ECG results in hand. Among the 356 patients in the study, 68% did not receive an ECG, either because they did not travel by ambulance or because, in 43% of the cases, they were not given an ECG en route.

Dr. McCabe suspects that patients who did not receive an ECG in the ambulance may have had vague presenting symptoms when paramedics arrived. Of patients with symptoms more indicative of an MI, 78% got an ECG in the ambulance, he said.

"Our community is diverse, and we feel that barriers in communication with non-English speakers may also have played a role," he added.

He further noted that in San Francisco paramedics did not have the technology to forward the ECGs electronically to the receiving hospital. San Francisco will be implementing citywide remote transmission of ECGs soon, and the investigators plan to study whether this makes for even more efficient transfer of STEMI patients to the cath lab.

"These data suggest better triage systems may be necessary for patients with likely STEMIs, particularly for [more than] 40% of patients who do not arrive by ambulance," Dr. McCabe concluded.

Dr. Janet Wright, ACC senior vice president of science and quality, commented on the findings. "This is a safety message for patients: ‘Your local ER wants you to come by ambulance!’ And for physicians and health care systems, the message is that there are critical intervals within the overall pattern of care that need scrutiny," said Dr. Wright, a cardiologist in Chico, Calif.

"The person who arrives by private transportation may languish within those time intervals unnecessarily in a way that is unsafe," she said. "The message is to focus on every hand-off. They accumulate in precious minutes."

Dr. McCabe and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Patients with suspected ST-elevation myocardial infarction who called an ambulance received lifesaving care in half the time as patients who got to the hospital by other means, according to a study conducted at two San Francisco hospitals.

"Patients who take an ambulance get a prehospital ECG," said lead investigator Dr. James M. McCabe of the University of California, San Francisco, at the annual scientific sessions of the American College of Cardiology. "These patients move through the emergency room and get to the cath lab much faster."

"We found that almost half of patients referred for a potential heart attack don’t take an ambulance but come in on their own, and it turns out they are doing themselves a great disservice," Dr. McCabe said.

The study analyzed 356 consecutive patients referred for emergent cardiac catheterization for a suspected STEMI by emergency physicians at a tertiary care hospital and a county hospital in 2009. Of the 356 patients, 199 (56%) arrived by ambulance and 157 (44%) did not.

Variables affecting the time interval from the inciting ECG to STEMI pager activation, and door-to-balloon time, were analyzed in univariate and step-wise multivariate regression models.

All components of care were affected.

"The ultimate metric, door-to-balloon time, was reduced by 26% in patients taken by ambulance," Dr. McCabe reported. This highly significant finding is important because studies show mortality risks are higher when door-to-balloon times exceed 90 minutes, he added.

The investigators then broke down the door-to-balloon time into its various components and compared the groups. After adjusting for demographic factors, traditional cardiovascular risk factors, severity of illness and extent of ECG changes, merely not presenting by ambulance to the emergency department (ED), and therefore not receiving a prehospital ECG, significantly lengthened by 62% the total time in the ED before undergoing catheterization.

Among patients arriving by ambulance, "each interval that occurred within the emergency room was reduced by more than 50%," he reported.

The procedural time for revascularization, however, did not vary based on how the patient arrived at the hospital. This finding supports the conclusion that care was made more efficient prior to the catheterization itself, he said.

The one observable difference was that patients arriving by ambulance were more critically ill. They had more cardiac arrests, and required more cardiopulmonary resuscitation and intubation.

"That’s interesting, because while these patients are sicker and require more care in the ER, they are still getting through the ER faster, after adjusting for multiple risk factors and elements in the decision-making process," Dr. McCabe noted. "Taking the ambulance results in efficiency, and this translates into faster ER throughput and shorter door-to-balloon times."

Of some concern to the researchers was that calling 911 did not assure that patients with suspected STEMI arrived at the hospital with ECG results in hand. Among the 356 patients in the study, 68% did not receive an ECG, either because they did not travel by ambulance or because, in 43% of the cases, they were not given an ECG en route.

Dr. McCabe suspects that patients who did not receive an ECG in the ambulance may have had vague presenting symptoms when paramedics arrived. Of patients with symptoms more indicative of an MI, 78% got an ECG in the ambulance, he said.

"Our community is diverse, and we feel that barriers in communication with non-English speakers may also have played a role," he added.

He further noted that in San Francisco paramedics did not have the technology to forward the ECGs electronically to the receiving hospital. San Francisco will be implementing citywide remote transmission of ECGs soon, and the investigators plan to study whether this makes for even more efficient transfer of STEMI patients to the cath lab.

"These data suggest better triage systems may be necessary for patients with likely STEMIs, particularly for [more than] 40% of patients who do not arrive by ambulance," Dr. McCabe concluded.

Dr. Janet Wright, ACC senior vice president of science and quality, commented on the findings. "This is a safety message for patients: ‘Your local ER wants you to come by ambulance!’ And for physicians and health care systems, the message is that there are critical intervals within the overall pattern of care that need scrutiny," said Dr. Wright, a cardiologist in Chico, Calif.

"The person who arrives by private transportation may languish within those time intervals unnecessarily in a way that is unsafe," she said. "The message is to focus on every hand-off. They accumulate in precious minutes."

Dr. McCabe and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Patients with suspected ST-elevation myocardial infarction who called an ambulance received lifesaving care in half the time as patients who got to the hospital by other means, according to a study conducted at two San Francisco hospitals.

"Patients who take an ambulance get a prehospital ECG," said lead investigator Dr. James M. McCabe of the University of California, San Francisco, at the annual scientific sessions of the American College of Cardiology. "These patients move through the emergency room and get to the cath lab much faster."

"We found that almost half of patients referred for a potential heart attack don’t take an ambulance but come in on their own, and it turns out they are doing themselves a great disservice," Dr. McCabe said.

The study analyzed 356 consecutive patients referred for emergent cardiac catheterization for a suspected STEMI by emergency physicians at a tertiary care hospital and a county hospital in 2009. Of the 356 patients, 199 (56%) arrived by ambulance and 157 (44%) did not.

Variables affecting the time interval from the inciting ECG to STEMI pager activation, and door-to-balloon time, were analyzed in univariate and step-wise multivariate regression models.

All components of care were affected.

"The ultimate metric, door-to-balloon time, was reduced by 26% in patients taken by ambulance," Dr. McCabe reported. This highly significant finding is important because studies show mortality risks are higher when door-to-balloon times exceed 90 minutes, he added.

The investigators then broke down the door-to-balloon time into its various components and compared the groups. After adjusting for demographic factors, traditional cardiovascular risk factors, severity of illness and extent of ECG changes, merely not presenting by ambulance to the emergency department (ED), and therefore not receiving a prehospital ECG, significantly lengthened by 62% the total time in the ED before undergoing catheterization.

Among patients arriving by ambulance, "each interval that occurred within the emergency room was reduced by more than 50%," he reported.

The procedural time for revascularization, however, did not vary based on how the patient arrived at the hospital. This finding supports the conclusion that care was made more efficient prior to the catheterization itself, he said.

The one observable difference was that patients arriving by ambulance were more critically ill. They had more cardiac arrests, and required more cardiopulmonary resuscitation and intubation.

"That’s interesting, because while these patients are sicker and require more care in the ER, they are still getting through the ER faster, after adjusting for multiple risk factors and elements in the decision-making process," Dr. McCabe noted. "Taking the ambulance results in efficiency, and this translates into faster ER throughput and shorter door-to-balloon times."

Of some concern to the researchers was that calling 911 did not assure that patients with suspected STEMI arrived at the hospital with ECG results in hand. Among the 356 patients in the study, 68% did not receive an ECG, either because they did not travel by ambulance or because, in 43% of the cases, they were not given an ECG en route.

Dr. McCabe suspects that patients who did not receive an ECG in the ambulance may have had vague presenting symptoms when paramedics arrived. Of patients with symptoms more indicative of an MI, 78% got an ECG in the ambulance, he said.

"Our community is diverse, and we feel that barriers in communication with non-English speakers may also have played a role," he added.

He further noted that in San Francisco paramedics did not have the technology to forward the ECGs electronically to the receiving hospital. San Francisco will be implementing citywide remote transmission of ECGs soon, and the investigators plan to study whether this makes for even more efficient transfer of STEMI patients to the cath lab.

"These data suggest better triage systems may be necessary for patients with likely STEMIs, particularly for [more than] 40% of patients who do not arrive by ambulance," Dr. McCabe concluded.

Dr. Janet Wright, ACC senior vice president of science and quality, commented on the findings. "This is a safety message for patients: ‘Your local ER wants you to come by ambulance!’ And for physicians and health care systems, the message is that there are critical intervals within the overall pattern of care that need scrutiny," said Dr. Wright, a cardiologist in Chico, Calif.

"The person who arrives by private transportation may languish within those time intervals unnecessarily in a way that is unsafe," she said. "The message is to focus on every hand-off. They accumulate in precious minutes."

Dr. McCabe and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Patients with suspected ST-elevation myocardial infarction who called an ambulance received lifesaving care in half the time as patients who got to the hospital by other means, according to a study conducted at two San Francisco hospitals.

"Patients who take an ambulance get a prehospital ECG," said lead investigator Dr. James M. McCabe of the University of California, San Francisco, at the annual scientific sessions of the American College of Cardiology. "These patients move through the emergency room and get to the cath lab much faster."

"We found that almost half of patients referred for a potential heart attack don’t take an ambulance but come in on their own, and it turns out they are doing themselves a great disservice," Dr. McCabe said.

The study analyzed 356 consecutive patients referred for emergent cardiac catheterization for a suspected STEMI by emergency physicians at a tertiary care hospital and a county hospital in 2009. Of the 356 patients, 199 (56%) arrived by ambulance and 157 (44%) did not.

Variables affecting the time interval from the inciting ECG to STEMI pager activation, and door-to-balloon time, were analyzed in univariate and step-wise multivariate regression models.

All components of care were affected.

"The ultimate metric, door-to-balloon time, was reduced by 26% in patients taken by ambulance," Dr. McCabe reported. This highly significant finding is important because studies show mortality risks are higher when door-to-balloon times exceed 90 minutes, he added.

The investigators then broke down the door-to-balloon time into its various components and compared the groups. After adjusting for demographic factors, traditional cardiovascular risk factors, severity of illness and extent of ECG changes, merely not presenting by ambulance to the emergency department (ED), and therefore not receiving a prehospital ECG, significantly lengthened by 62% the total time in the ED before undergoing catheterization.

Among patients arriving by ambulance, "each interval that occurred within the emergency room was reduced by more than 50%," he reported.

The procedural time for revascularization, however, did not vary based on how the patient arrived at the hospital. This finding supports the conclusion that care was made more efficient prior to the catheterization itself, he said.

The one observable difference was that patients arriving by ambulance were more critically ill. They had more cardiac arrests, and required more cardiopulmonary resuscitation and intubation.

"That’s interesting, because while these patients are sicker and require more care in the ER, they are still getting through the ER faster, after adjusting for multiple risk factors and elements in the decision-making process," Dr. McCabe noted. "Taking the ambulance results in efficiency, and this translates into faster ER throughput and shorter door-to-balloon times."

Of some concern to the researchers was that calling 911 did not assure that patients with suspected STEMI arrived at the hospital with ECG results in hand. Among the 356 patients in the study, 68% did not receive an ECG, either because they did not travel by ambulance or because, in 43% of the cases, they were not given an ECG en route.

Dr. McCabe suspects that patients who did not receive an ECG in the ambulance may have had vague presenting symptoms when paramedics arrived. Of patients with symptoms more indicative of an MI, 78% got an ECG in the ambulance, he said.

"Our community is diverse, and we feel that barriers in communication with non-English speakers may also have played a role," he added.

He further noted that in San Francisco paramedics did not have the technology to forward the ECGs electronically to the receiving hospital. San Francisco will be implementing citywide remote transmission of ECGs soon, and the investigators plan to study whether this makes for even more efficient transfer of STEMI patients to the cath lab.

"These data suggest better triage systems may be necessary for patients with likely STEMIs, particularly for [more than] 40% of patients who do not arrive by ambulance," Dr. McCabe concluded.

Dr. Janet Wright, ACC senior vice president of science and quality, commented on the findings. "This is a safety message for patients: ‘Your local ER wants you to come by ambulance!’ And for physicians and health care systems, the message is that there are critical intervals within the overall pattern of care that need scrutiny," said Dr. Wright, a cardiologist in Chico, Calif.

"The person who arrives by private transportation may languish within those time intervals unnecessarily in a way that is unsafe," she said. "The message is to focus on every hand-off. They accumulate in precious minutes."

Dr. McCabe and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Patients with suspected ST-elevation myocardial infarction who called an ambulance received lifesaving care in half the time as patients who got to the hospital by other means, according to a study conducted at two San Francisco hospitals.

"Patients who take an ambulance get a prehospital ECG," said lead investigator Dr. James M. McCabe of the University of California, San Francisco, at the annual scientific sessions of the American College of Cardiology. "These patients move through the emergency room and get to the cath lab much faster."

"We found that almost half of patients referred for a potential heart attack don’t take an ambulance but come in on their own, and it turns out they are doing themselves a great disservice," Dr. McCabe said.

The study analyzed 356 consecutive patients referred for emergent cardiac catheterization for a suspected STEMI by emergency physicians at a tertiary care hospital and a county hospital in 2009. Of the 356 patients, 199 (56%) arrived by ambulance and 157 (44%) did not.

Variables affecting the time interval from the inciting ECG to STEMI pager activation, and door-to-balloon time, were analyzed in univariate and step-wise multivariate regression models.

All components of care were affected.

"The ultimate metric, door-to-balloon time, was reduced by 26% in patients taken by ambulance," Dr. McCabe reported. This highly significant finding is important because studies show mortality risks are higher when door-to-balloon times exceed 90 minutes, he added.

The investigators then broke down the door-to-balloon time into its various components and compared the groups. After adjusting for demographic factors, traditional cardiovascular risk factors, severity of illness and extent of ECG changes, merely not presenting by ambulance to the emergency department (ED), and therefore not receiving a prehospital ECG, significantly lengthened by 62% the total time in the ED before undergoing catheterization.

Among patients arriving by ambulance, "each interval that occurred within the emergency room was reduced by more than 50%," he reported.

The procedural time for revascularization, however, did not vary based on how the patient arrived at the hospital. This finding supports the conclusion that care was made more efficient prior to the catheterization itself, he said.

The one observable difference was that patients arriving by ambulance were more critically ill. They had more cardiac arrests, and required more cardiopulmonary resuscitation and intubation.

"That’s interesting, because while these patients are sicker and require more care in the ER, they are still getting through the ER faster, after adjusting for multiple risk factors and elements in the decision-making process," Dr. McCabe noted. "Taking the ambulance results in efficiency, and this translates into faster ER throughput and shorter door-to-balloon times."

Of some concern to the researchers was that calling 911 did not assure that patients with suspected STEMI arrived at the hospital with ECG results in hand. Among the 356 patients in the study, 68% did not receive an ECG, either because they did not travel by ambulance or because, in 43% of the cases, they were not given an ECG en route.

Dr. McCabe suspects that patients who did not receive an ECG in the ambulance may have had vague presenting symptoms when paramedics arrived. Of patients with symptoms more indicative of an MI, 78% got an ECG in the ambulance, he said.

"Our community is diverse, and we feel that barriers in communication with non-English speakers may also have played a role," he added.

He further noted that in San Francisco paramedics did not have the technology to forward the ECGs electronically to the receiving hospital. San Francisco will be implementing citywide remote transmission of ECGs soon, and the investigators plan to study whether this makes for even more efficient transfer of STEMI patients to the cath lab.

"These data suggest better triage systems may be necessary for patients with likely STEMIs, particularly for [more than] 40% of patients who do not arrive by ambulance," Dr. McCabe concluded.

Dr. Janet Wright, ACC senior vice president of science and quality, commented on the findings. "This is a safety message for patients: ‘Your local ER wants you to come by ambulance!’ And for physicians and health care systems, the message is that there are critical intervals within the overall pattern of care that need scrutiny," said Dr. Wright, a cardiologist in Chico, Calif.

"The person who arrives by private transportation may languish within those time intervals unnecessarily in a way that is unsafe," she said. "The message is to focus on every hand-off. They accumulate in precious minutes."

Dr. McCabe and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Patients with suspected ST-elevation myocardial infarction who called an ambulance received lifesaving care in half the time as patients who got to the hospital by other means, according to a study conducted at two San Francisco hospitals.

"Patients who take an ambulance get a prehospital ECG," said lead investigator Dr. James M. McCabe of the University of California, San Francisco, at the annual scientific sessions of the American College of Cardiology. "These patients move through the emergency room and get to the cath lab much faster."

"We found that almost half of patients referred for a potential heart attack don’t take an ambulance but come in on their own, and it turns out they are doing themselves a great disservice," Dr. McCabe said.

The study analyzed 356 consecutive patients referred for emergent cardiac catheterization for a suspected STEMI by emergency physicians at a tertiary care hospital and a county hospital in 2009. Of the 356 patients, 199 (56%) arrived by ambulance and 157 (44%) did not.

Variables affecting the time interval from the inciting ECG to STEMI pager activation, and door-to-balloon time, were analyzed in univariate and step-wise multivariate regression models.

All components of care were affected.

"The ultimate metric, door-to-balloon time, was reduced by 26% in patients taken by ambulance," Dr. McCabe reported. This highly significant finding is important because studies show mortality risks are higher when door-to-balloon times exceed 90 minutes, he added.

The investigators then broke down the door-to-balloon time into its various components and compared the groups. After adjusting for demographic factors, traditional cardiovascular risk factors, severity of illness and extent of ECG changes, merely not presenting by ambulance to the emergency department (ED), and therefore not receiving a prehospital ECG, significantly lengthened by 62% the total time in the ED before undergoing catheterization.

Among patients arriving by ambulance, "each interval that occurred within the emergency room was reduced by more than 50%," he reported.

The procedural time for revascularization, however, did not vary based on how the patient arrived at the hospital. This finding supports the conclusion that care was made more efficient prior to the catheterization itself, he said.

The one observable difference was that patients arriving by ambulance were more critically ill. They had more cardiac arrests, and required more cardiopulmonary resuscitation and intubation.

"That’s interesting, because while these patients are sicker and require more care in the ER, they are still getting through the ER faster, after adjusting for multiple risk factors and elements in the decision-making process," Dr. McCabe noted. "Taking the ambulance results in efficiency, and this translates into faster ER throughput and shorter door-to-balloon times."

Of some concern to the researchers was that calling 911 did not assure that patients with suspected STEMI arrived at the hospital with ECG results in hand. Among the 356 patients in the study, 68% did not receive an ECG, either because they did not travel by ambulance or because, in 43% of the cases, they were not given an ECG en route.

Dr. McCabe suspects that patients who did not receive an ECG in the ambulance may have had vague presenting symptoms when paramedics arrived. Of patients with symptoms more indicative of an MI, 78% got an ECG in the ambulance, he said.

"Our community is diverse, and we feel that barriers in communication with non-English speakers may also have played a role," he added.

He further noted that in San Francisco paramedics did not have the technology to forward the ECGs electronically to the receiving hospital. San Francisco will be implementing citywide remote transmission of ECGs soon, and the investigators plan to study whether this makes for even more efficient transfer of STEMI patients to the cath lab.

"These data suggest better triage systems may be necessary for patients with likely STEMIs, particularly for [more than] 40% of patients who do not arrive by ambulance," Dr. McCabe concluded.

Dr. Janet Wright, ACC senior vice president of science and quality, commented on the findings. "This is a safety message for patients: ‘Your local ER wants you to come by ambulance!’ And for physicians and health care systems, the message is that there are critical intervals within the overall pattern of care that need scrutiny," said Dr. Wright, a cardiologist in Chico, Calif.

"The person who arrives by private transportation may languish within those time intervals unnecessarily in a way that is unsafe," she said. "The message is to focus on every hand-off. They accumulate in precious minutes."

Dr. McCabe and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Patients with suspected ST-elevation myocardial infarction who called an ambulance received lifesaving care in half the time as patients who got to the hospital by other means, according to a study conducted at two San Francisco hospitals.

"Patients who take an ambulance get a prehospital ECG," said lead investigator Dr. James M. McCabe of the University of California, San Francisco, at the annual scientific sessions of the American College of Cardiology. "These patients move through the emergency room and get to the cath lab much faster."

"We found that almost half of patients referred for a potential heart attack don’t take an ambulance but come in on their own, and it turns out they are doing themselves a great disservice," Dr. McCabe said.

The study analyzed 356 consecutive patients referred for emergent cardiac catheterization for a suspected STEMI by emergency physicians at a tertiary care hospital and a county hospital in 2009. Of the 356 patients, 199 (56%) arrived by ambulance and 157 (44%) did not.

Variables affecting the time interval from the inciting ECG to STEMI pager activation, and door-to-balloon time, were analyzed in univariate and step-wise multivariate regression models.

All components of care were affected.

"The ultimate metric, door-to-balloon time, was reduced by 26% in patients taken by ambulance," Dr. McCabe reported. This highly significant finding is important because studies show mortality risks are higher when door-to-balloon times exceed 90 minutes, he added.

The investigators then broke down the door-to-balloon time into its various components and compared the groups. After adjusting for demographic factors, traditional cardiovascular risk factors, severity of illness and extent of ECG changes, merely not presenting by ambulance to the emergency department (ED), and therefore not receiving a prehospital ECG, significantly lengthened by 62% the total time in the ED before undergoing catheterization.

Among patients arriving by ambulance, "each interval that occurred within the emergency room was reduced by more than 50%," he reported.

The procedural time for revascularization, however, did not vary based on how the patient arrived at the hospital. This finding supports the conclusion that care was made more efficient prior to the catheterization itself, he said.

The one observable difference was that patients arriving by ambulance were more critically ill. They had more cardiac arrests, and required more cardiopulmonary resuscitation and intubation.

"That’s interesting, because while these patients are sicker and require more care in the ER, they are still getting through the ER faster, after adjusting for multiple risk factors and elements in the decision-making process," Dr. McCabe noted. "Taking the ambulance results in efficiency, and this translates into faster ER throughput and shorter door-to-balloon times."

Of some concern to the researchers was that calling 911 did not assure that patients with suspected STEMI arrived at the hospital with ECG results in hand. Among the 356 patients in the study, 68% did not receive an ECG, either because they did not travel by ambulance or because, in 43% of the cases, they were not given an ECG en route.

Dr. McCabe suspects that patients who did not receive an ECG in the ambulance may have had vague presenting symptoms when paramedics arrived. Of patients with symptoms more indicative of an MI, 78% got an ECG in the ambulance, he said.

"Our community is diverse, and we feel that barriers in communication with non-English speakers may also have played a role," he added.

He further noted that in San Francisco paramedics did not have the technology to forward the ECGs electronically to the receiving hospital. San Francisco will be implementing citywide remote transmission of ECGs soon, and the investigators plan to study whether this makes for even more efficient transfer of STEMI patients to the cath lab.

"These data suggest better triage systems may be necessary for patients with likely STEMIs, particularly for [more than] 40% of patients who do not arrive by ambulance," Dr. McCabe concluded.

Dr. Janet Wright, ACC senior vice president of science and quality, commented on the findings. "This is a safety message for patients: ‘Your local ER wants you to come by ambulance!’ And for physicians and health care systems, the message is that there are critical intervals within the overall pattern of care that need scrutiny," said Dr. Wright, a cardiologist in Chico, Calif.

"The person who arrives by private transportation may languish within those time intervals unnecessarily in a way that is unsafe," she said. "The message is to focus on every hand-off. They accumulate in precious minutes."

Dr. McCabe and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Patients with suspected ST-elevation myocardial infarction who called an ambulance received lifesaving care in half the time as patients who got to the hospital by other means, according to a study conducted at two San Francisco hospitals.

"Patients who take an ambulance get a prehospital ECG," said lead investigator Dr. James M. McCabe of the University of California, San Francisco, at the annual scientific sessions of the American College of Cardiology. "These patients move through the emergency room and get to the cath lab much faster."

"We found that almost half of patients referred for a potential heart attack don’t take an ambulance but come in on their own, and it turns out they are doing themselves a great disservice," Dr. McCabe said.

The study analyzed 356 consecutive patients referred for emergent cardiac catheterization for a suspected STEMI by emergency physicians at a tertiary care hospital and a county hospital in 2009. Of the 356 patients, 199 (56%) arrived by ambulance and 157 (44%) did not.

Variables affecting the time interval from the inciting ECG to STEMI pager activation, and door-to-balloon time, were analyzed in univariate and step-wise multivariate regression models.

All components of care were affected.

"The ultimate metric, door-to-balloon time, was reduced by 26% in patients taken by ambulance," Dr. McCabe reported. This highly significant finding is important because studies show mortality risks are higher when door-to-balloon times exceed 90 minutes, he added.

The investigators then broke down the door-to-balloon time into its various components and compared the groups. After adjusting for demographic factors, traditional cardiovascular risk factors, severity of illness and extent of ECG changes, merely not presenting by ambulance to the emergency department (ED), and therefore not receiving a prehospital ECG, significantly lengthened by 62% the total time in the ED before undergoing catheterization.

Among patients arriving by ambulance, "each interval that occurred within the emergency room was reduced by more than 50%," he reported.

The procedural time for revascularization, however, did not vary based on how the patient arrived at the hospital. This finding supports the conclusion that care was made more efficient prior to the catheterization itself, he said.

The one observable difference was that patients arriving by ambulance were more critically ill. They had more cardiac arrests, and required more cardiopulmonary resuscitation and intubation.

"That’s interesting, because while these patients are sicker and require more care in the ER, they are still getting through the ER faster, after adjusting for multiple risk factors and elements in the decision-making process," Dr. McCabe noted. "Taking the ambulance results in efficiency, and this translates into faster ER throughput and shorter door-to-balloon times."

Of some concern to the researchers was that calling 911 did not assure that patients with suspected STEMI arrived at the hospital with ECG results in hand. Among the 356 patients in the study, 68% did not receive an ECG, either because they did not travel by ambulance or because, in 43% of the cases, they were not given an ECG en route.

Dr. McCabe suspects that patients who did not receive an ECG in the ambulance may have had vague presenting symptoms when paramedics arrived. Of patients with symptoms more indicative of an MI, 78% got an ECG in the ambulance, he said.

"Our community is diverse, and we feel that barriers in communication with non-English speakers may also have played a role," he added.

He further noted that in San Francisco paramedics did not have the technology to forward the ECGs electronically to the receiving hospital. San Francisco will be implementing citywide remote transmission of ECGs soon, and the investigators plan to study whether this makes for even more efficient transfer of STEMI patients to the cath lab.

"These data suggest better triage systems may be necessary for patients with likely STEMIs, particularly for [more than] 40% of patients who do not arrive by ambulance," Dr. McCabe concluded.

Dr. Janet Wright, ACC senior vice president of science and quality, commented on the findings. "This is a safety message for patients: ‘Your local ER wants you to come by ambulance!’ And for physicians and health care systems, the message is that there are critical intervals within the overall pattern of care that need scrutiny," said Dr. Wright, a cardiologist in Chico, Calif.

"The person who arrives by private transportation may languish within those time intervals unnecessarily in a way that is unsafe," she said. "The message is to focus on every hand-off. They accumulate in precious minutes."

Dr. McCabe and Dr. Wright reported no relevant conflicts of interest.

NEW ORLEANS - Patients with suspected ST-elevation myocardial infarction who called an ambulance received lifesaving care in half the time as patients who got to the hospital by other means, according to a study conducted at two San Francisco hospitals.

"Patients who take an ambulance get a prehospital ECG," said lead investigator Dr. James M. McCabe of the University of California, San Francisco, at the annual scientific sessions of the American College of Cardiology. "These patients move through the emergency room and get to the cath lab much faster."

"We found that almost half of patients referred for a potential heart attack don’t take an ambulance but come in on their own, and it turns out they are doing themselves a great disservice," Dr. McCabe said.

The study analyzed 356 consecutive patients referred for emergent cardiac catheterization for a suspected STEMI by emergency physicians at a tertiary care hospital and a county hospital in 2009. Of the 356 patients, 199 (56%) arrived by ambulance and 157 (44%) did not.

Variables affecting the time interval from the inciting ECG to STEMI pager activation, and door-to-balloon time, were analyzed in univariate and step-wise multivariate regression models.

All components of care were affected.

"The ultimate metric, door-to-balloon time, was reduced by 26% in patients taken by ambulance," Dr. McCabe reported. This highly significant finding is important because studies show mortality risks are higher when door-to-balloon times exceed 90 minutes, he added.

The investigators then broke down the door-to-balloon time into its various components and compared the groups. After adjusting for demographic factors, traditional cardiovascular risk factors, severity of illness and extent of ECG changes, merely not presenting by ambulance to the emergency department (ED), and therefore not receiving a prehospital ECG, significantly lengthened by 62% the total time in the ED before undergoing catheterization.

Among patients arriving by ambulance, "each interval that occurred within the emergency room was reduced by more than 50%," he reported.

The procedural time for revascularization, however, did not vary based on how the patient arrived at the hospital. This finding supports the conclusion that care was made more efficient prior to the catheterization itself, he said.

The one observable difference was that patients arriving by ambulance were more critically ill. They had more cardiac arrests, and required more cardiopulmonary resuscitation and intubation.

"That’s interesting, because while these patients are sicker and require more care in the ER, they are still getting through the ER faster, after adjusting for multiple risk factors and elements in the decision-making process," Dr. McCabe noted. "Taking the ambulance results in efficiency, and this translates into faster ER throughput and shorter door-to-balloon times."

Of some concern to the researchers was that calling 911 did not assure that patients with suspected STEMI arrived at the hospital with ECG results in hand. Among the 356 patients in the study, 68% did not receive an ECG, either because they did not travel by ambulance or because, in 43% of the cases, they were not given an ECG en route.

Dr. McCabe suspects that patients who did not receive an ECG in the ambulance may have had vague presenting symptoms when paramedics arrived. Of patients with symptoms more indicative of an MI, 78% got an ECG in the ambulance, he said.

"Our community is diverse, and we feel that barriers in communication with non-English speakers may also have played a role," he added.

He further noted that in San Francisco paramedics did not have the technology to forward the ECGs electronically to the receiving hospital. San Francisco will be implementing citywide remote transmission of ECGs soon, and the investigators plan to study whether this makes for even more efficient transfer of STEMI patients to the cath lab.

"These data suggest better triage systems may be necessary for patients with likely STEMIs, particularly for [more than] 40% of patients who do not arrive by ambulance," Dr. McCabe concluded.

Dr. Janet Wright, ACC senior vice president of science and quality, commented on the findings. "This is a safety message for patients: ‘Your local ER wants you to come by ambulance!’ And for physicians and health care systems, the message is that there are critical intervals within the overall pattern of care that need scrutiny," said Dr. Wright, a cardiologist in Chico, Calif.

"The person who arrives by private transportation may languish within those time intervals unnecessarily in a way that is unsafe," she said. "The message is to focus on every hand-off. They accumulate in precious minutes."

Dr. McCabe and Dr. Wright reported no relevant conflicts of interest.