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The Official Newspaper of the American Association for Thoracic Surgery
Novel metabolic biomarkers linked to CHD
ANAHEIM, CALIF. – Low levels of four phosphatidylcholines – essential components of cell membranes – predict the risk of incident coronary heart disease about as well as body mass index does, according to an analysis presented at the American Heart Association scientific sessions.
The findings come from the BiomarCaRE consortium (Biomarker for Cardiovascular Risk Assessment in Europe), a European Union–funded effort to evaluate the predictive value of new and existing biomarkers for cardiovascular disease.
The new findings “demonstrate the value of metabolomics for biomarker discovery and improved risk stratification,” said lead investigator Tanja Zeller, PhD, of the department of general and interventional cardiology, University Heart Center Hamburg (Germany).
A total of 141 metabolites were detected by mass spectrometry using the Biocrates Absolute IDQ p180 assay. After adjustment for body mass index, blood pressure, cholesterol level, hypertension, and other known coronary heart disease (CHD) risk factors, four metabolites – all phosphatidylcholines (PCs) – showed independent predictive value for incident CHD, with low levels associated with higher CHD risk. The effect was greatest among women.
Phosphatidylcholines are a class of phospholipids derived from egg yolks, soybeans, and other foods that play an essential role in cell membrane function, among other things. They are thought to have anti-inflammatory effects, Dr. Zeller said.
The investigators found that lower levels of four in particular – PC ae C40:6; PC ae C38:6; PC aa C38:5; and PC aa C38:6 – increase the risk of incident CHD, with statistically significant hazard ratios ranging from 1.09 to 1.13, similar to body mass index, but lower than for diabetes and total cholesterol level.
Dr. Zeller said the team couldn’t adjust for lipid-lowering medications and diet, both of which might have affected levels, because information was not available for the subjects. There have been suggestions in the literature that higher levels of PCs are associated with a lower risk of Alzheimer’s disease, cognitive impairment, diabetes, and other diseases, but supplementation trials have been mostly negative.
BiomarCaRE is funded by the European Union. The investigators had no relevant financial disclosures.
BiomarCaRE and other studies offer us a unique opportunity to integrate metabolomics with genetic and other biomarkers to really understand the systems biology of disease.
But there are many questions to answer before we start measuring phosphatidylcholines. How do these biomarkers add to clinical risk prediction in our patients? While the magnitude of effect was good for a biomarker, it did not meet the strength of strong cardiovascular risk factors, including total cholesterol. Also, the investigators were careful to adjust for confounders and were able to show independent association, but they did not address incremental risk prediction.
And would measuring these metabolites change what we do for our patients? Are these pathways modifiable? In the absence of something to modify the pathway, risk prediction may be less significant.
Even so, metabolomics holds great promise in identifying biological pathways and understanding heterogeneity in medication and other effects, and advancing our efforts in precision medicine and patient care.
Svati Shah, MD , is with the department of cardiology at Duke University, Durham, N.C. She holds a patent on an unrelated metabolomics finding, and a research grant from Bristol-Myers Squibb. She also is an adviser for Biosense Webster. Dr. Shah was the discussant for the study presentation.
BiomarCaRE and other studies offer us a unique opportunity to integrate metabolomics with genetic and other biomarkers to really understand the systems biology of disease.
But there are many questions to answer before we start measuring phosphatidylcholines. How do these biomarkers add to clinical risk prediction in our patients? While the magnitude of effect was good for a biomarker, it did not meet the strength of strong cardiovascular risk factors, including total cholesterol. Also, the investigators were careful to adjust for confounders and were able to show independent association, but they did not address incremental risk prediction.
And would measuring these metabolites change what we do for our patients? Are these pathways modifiable? In the absence of something to modify the pathway, risk prediction may be less significant.
Even so, metabolomics holds great promise in identifying biological pathways and understanding heterogeneity in medication and other effects, and advancing our efforts in precision medicine and patient care.
Svati Shah, MD , is with the department of cardiology at Duke University, Durham, N.C. She holds a patent on an unrelated metabolomics finding, and a research grant from Bristol-Myers Squibb. She also is an adviser for Biosense Webster. Dr. Shah was the discussant for the study presentation.
BiomarCaRE and other studies offer us a unique opportunity to integrate metabolomics with genetic and other biomarkers to really understand the systems biology of disease.
But there are many questions to answer before we start measuring phosphatidylcholines. How do these biomarkers add to clinical risk prediction in our patients? While the magnitude of effect was good for a biomarker, it did not meet the strength of strong cardiovascular risk factors, including total cholesterol. Also, the investigators were careful to adjust for confounders and were able to show independent association, but they did not address incremental risk prediction.
And would measuring these metabolites change what we do for our patients? Are these pathways modifiable? In the absence of something to modify the pathway, risk prediction may be less significant.
Even so, metabolomics holds great promise in identifying biological pathways and understanding heterogeneity in medication and other effects, and advancing our efforts in precision medicine and patient care.
Svati Shah, MD , is with the department of cardiology at Duke University, Durham, N.C. She holds a patent on an unrelated metabolomics finding, and a research grant from Bristol-Myers Squibb. She also is an adviser for Biosense Webster. Dr. Shah was the discussant for the study presentation.
ANAHEIM, CALIF. – Low levels of four phosphatidylcholines – essential components of cell membranes – predict the risk of incident coronary heart disease about as well as body mass index does, according to an analysis presented at the American Heart Association scientific sessions.
The findings come from the BiomarCaRE consortium (Biomarker for Cardiovascular Risk Assessment in Europe), a European Union–funded effort to evaluate the predictive value of new and existing biomarkers for cardiovascular disease.
The new findings “demonstrate the value of metabolomics for biomarker discovery and improved risk stratification,” said lead investigator Tanja Zeller, PhD, of the department of general and interventional cardiology, University Heart Center Hamburg (Germany).
A total of 141 metabolites were detected by mass spectrometry using the Biocrates Absolute IDQ p180 assay. After adjustment for body mass index, blood pressure, cholesterol level, hypertension, and other known coronary heart disease (CHD) risk factors, four metabolites – all phosphatidylcholines (PCs) – showed independent predictive value for incident CHD, with low levels associated with higher CHD risk. The effect was greatest among women.
Phosphatidylcholines are a class of phospholipids derived from egg yolks, soybeans, and other foods that play an essential role in cell membrane function, among other things. They are thought to have anti-inflammatory effects, Dr. Zeller said.
The investigators found that lower levels of four in particular – PC ae C40:6; PC ae C38:6; PC aa C38:5; and PC aa C38:6 – increase the risk of incident CHD, with statistically significant hazard ratios ranging from 1.09 to 1.13, similar to body mass index, but lower than for diabetes and total cholesterol level.
Dr. Zeller said the team couldn’t adjust for lipid-lowering medications and diet, both of which might have affected levels, because information was not available for the subjects. There have been suggestions in the literature that higher levels of PCs are associated with a lower risk of Alzheimer’s disease, cognitive impairment, diabetes, and other diseases, but supplementation trials have been mostly negative.
BiomarCaRE is funded by the European Union. The investigators had no relevant financial disclosures.
ANAHEIM, CALIF. – Low levels of four phosphatidylcholines – essential components of cell membranes – predict the risk of incident coronary heart disease about as well as body mass index does, according to an analysis presented at the American Heart Association scientific sessions.
The findings come from the BiomarCaRE consortium (Biomarker for Cardiovascular Risk Assessment in Europe), a European Union–funded effort to evaluate the predictive value of new and existing biomarkers for cardiovascular disease.
The new findings “demonstrate the value of metabolomics for biomarker discovery and improved risk stratification,” said lead investigator Tanja Zeller, PhD, of the department of general and interventional cardiology, University Heart Center Hamburg (Germany).
A total of 141 metabolites were detected by mass spectrometry using the Biocrates Absolute IDQ p180 assay. After adjustment for body mass index, blood pressure, cholesterol level, hypertension, and other known coronary heart disease (CHD) risk factors, four metabolites – all phosphatidylcholines (PCs) – showed independent predictive value for incident CHD, with low levels associated with higher CHD risk. The effect was greatest among women.
Phosphatidylcholines are a class of phospholipids derived from egg yolks, soybeans, and other foods that play an essential role in cell membrane function, among other things. They are thought to have anti-inflammatory effects, Dr. Zeller said.
The investigators found that lower levels of four in particular – PC ae C40:6; PC ae C38:6; PC aa C38:5; and PC aa C38:6 – increase the risk of incident CHD, with statistically significant hazard ratios ranging from 1.09 to 1.13, similar to body mass index, but lower than for diabetes and total cholesterol level.
Dr. Zeller said the team couldn’t adjust for lipid-lowering medications and diet, both of which might have affected levels, because information was not available for the subjects. There have been suggestions in the literature that higher levels of PCs are associated with a lower risk of Alzheimer’s disease, cognitive impairment, diabetes, and other diseases, but supplementation trials have been mostly negative.
BiomarCaRE is funded by the European Union. The investigators had no relevant financial disclosures.
AT THE AHA SCIENTIFIC SESSIONS
Key clinical point:
Major finding: Lower levels of four in particular – PC ae C40:6; PC ae C38:6; PC aa C38:5; and PC aa C38:6 – increase the risk of incident CHD, with hazard ratios ranging from 1.09 to 1.13.
Data source: More than 10,000 subjects in the BiomarCaRE consortium.
Disclosures: BiomarCaRE is funded by the European Union. The investigators had no relevant financial disclosures.
The 98th AATS Annual Meeting: The Same Great Content Over Four Days
April 28-May 1, 2018
San Diego Convention Center
San Diego, CA
Recognizing the time limitations that most healthcare providers currently face, the 98th AATS Annual Meeting will feature the same number of knowledge-building opportunities that people have come to expect, but the program will take place over the course of four days. Attendees will be able to return to their patients sooner without missing out on the meeting’s lectures, original scientific presentations, and discussion forums, as well as the chances to network and interact with peers, experts and members of the surgical team. Make your plans today to attend the best and most efficient exchange of state-of-the-art information in the field of cardiothoracic surgery.
President
Duke E. Cameron
Program Chairs
John D. Puskas
Luca A. Vricella
Glenn J. Whitman
Stephen C. Yang
To register, reserve housing, or learn more, visit: www.aats.org/annualmeeting.
April 28-May 1, 2018
San Diego Convention Center
San Diego, CA
Recognizing the time limitations that most healthcare providers currently face, the 98th AATS Annual Meeting will feature the same number of knowledge-building opportunities that people have come to expect, but the program will take place over the course of four days. Attendees will be able to return to their patients sooner without missing out on the meeting’s lectures, original scientific presentations, and discussion forums, as well as the chances to network and interact with peers, experts and members of the surgical team. Make your plans today to attend the best and most efficient exchange of state-of-the-art information in the field of cardiothoracic surgery.
President
Duke E. Cameron
Program Chairs
John D. Puskas
Luca A. Vricella
Glenn J. Whitman
Stephen C. Yang
To register, reserve housing, or learn more, visit: www.aats.org/annualmeeting.
April 28-May 1, 2018
San Diego Convention Center
San Diego, CA
Recognizing the time limitations that most healthcare providers currently face, the 98th AATS Annual Meeting will feature the same number of knowledge-building opportunities that people have come to expect, but the program will take place over the course of four days. Attendees will be able to return to their patients sooner without missing out on the meeting’s lectures, original scientific presentations, and discussion forums, as well as the chances to network and interact with peers, experts and members of the surgical team. Make your plans today to attend the best and most efficient exchange of state-of-the-art information in the field of cardiothoracic surgery.
President
Duke E. Cameron
Program Chairs
John D. Puskas
Luca A. Vricella
Glenn J. Whitman
Stephen C. Yang
To register, reserve housing, or learn more, visit: www.aats.org/annualmeeting.
Support Your Specialty
“It was a priceless experience getting to observe and learn from physician role models. The respect, care, and level of personal responsibility I observed physicians take on and practice in their everyday interactions with patients and co-workers left a lasting impression and are qualities I hope to emulate in my own future career.”
Quotes, like the one above from recent awardee, Sherry Wu, speak volumes about the impact of giving. When you support the AATS Graham Foundation, you are ensuring that the specialty remains strong and on the cutting edge of state-of-the-art technologies and techniques to enhance patient care.
The end of the fiscal year is fast approaching, and you can help fund another year of successful programs.
This was a year of growth for the Foundation, with expansion of both newly created initiatives, and time-honored programs that have continually served the cardiothoracic surgical specialty since 1973. These programs are possible because of the generous support of donors, leaders, and partners, such as you.
Be assured, 100 percent of individual gifts go directly to programs. To make your contribution, please visit www.AATSGrahamFoundation.org or contact Director of Development, Katie Federico, at 978-252-2200 Ext. 544 or [email protected].
Thank you for your thoughtful consideration at this important time.
“It was a priceless experience getting to observe and learn from physician role models. The respect, care, and level of personal responsibility I observed physicians take on and practice in their everyday interactions with patients and co-workers left a lasting impression and are qualities I hope to emulate in my own future career.”
Quotes, like the one above from recent awardee, Sherry Wu, speak volumes about the impact of giving. When you support the AATS Graham Foundation, you are ensuring that the specialty remains strong and on the cutting edge of state-of-the-art technologies and techniques to enhance patient care.
The end of the fiscal year is fast approaching, and you can help fund another year of successful programs.
This was a year of growth for the Foundation, with expansion of both newly created initiatives, and time-honored programs that have continually served the cardiothoracic surgical specialty since 1973. These programs are possible because of the generous support of donors, leaders, and partners, such as you.
Be assured, 100 percent of individual gifts go directly to programs. To make your contribution, please visit www.AATSGrahamFoundation.org or contact Director of Development, Katie Federico, at 978-252-2200 Ext. 544 or [email protected].
Thank you for your thoughtful consideration at this important time.
“It was a priceless experience getting to observe and learn from physician role models. The respect, care, and level of personal responsibility I observed physicians take on and practice in their everyday interactions with patients and co-workers left a lasting impression and are qualities I hope to emulate in my own future career.”
Quotes, like the one above from recent awardee, Sherry Wu, speak volumes about the impact of giving. When you support the AATS Graham Foundation, you are ensuring that the specialty remains strong and on the cutting edge of state-of-the-art technologies and techniques to enhance patient care.
The end of the fiscal year is fast approaching, and you can help fund another year of successful programs.
This was a year of growth for the Foundation, with expansion of both newly created initiatives, and time-honored programs that have continually served the cardiothoracic surgical specialty since 1973. These programs are possible because of the generous support of donors, leaders, and partners, such as you.
Be assured, 100 percent of individual gifts go directly to programs. To make your contribution, please visit www.AATSGrahamFoundation.org or contact Director of Development, Katie Federico, at 978-252-2200 Ext. 544 or [email protected].
Thank you for your thoughtful consideration at this important time.
It Is Time to Register for the AATS Aortic Symposium
April 26-27, 2018
New York Hilton Midtown
New York, NY
Registration is now open for the AATS Aortic Symposium 2018, a two-day symposium that kicks off AATS Week. Focused on the pathophysiology, diagnosis and treatment of aortic aneurysms and dissections, the symposium is designed for cardiovascular and thoracic surgeons, residents, perfusionists, ICU and OR nurses and those involved with the care of individuals with aortic disease. Register today for the opportunity to interact with world leaders in this field as they share their experiences regarding difficult problems in aortic disease.
Program Directors
Joseph S. Coselli
Steven L. Lansman
Program Committee
Joseph E. Bavaria
Edward P. Chen
Leonard N. Girardi
Thomas G. Gleason
G. Chad Hughes
Eric E. Roselli
David Spielvogel
Thoralf M. Sundt, III
To register, reserve housing, or learn more about the meeting, visit: www.aats.org/aortic.
April 26-27, 2018
New York Hilton Midtown
New York, NY
Registration is now open for the AATS Aortic Symposium 2018, a two-day symposium that kicks off AATS Week. Focused on the pathophysiology, diagnosis and treatment of aortic aneurysms and dissections, the symposium is designed for cardiovascular and thoracic surgeons, residents, perfusionists, ICU and OR nurses and those involved with the care of individuals with aortic disease. Register today for the opportunity to interact with world leaders in this field as they share their experiences regarding difficult problems in aortic disease.
Program Directors
Joseph S. Coselli
Steven L. Lansman
Program Committee
Joseph E. Bavaria
Edward P. Chen
Leonard N. Girardi
Thomas G. Gleason
G. Chad Hughes
Eric E. Roselli
David Spielvogel
Thoralf M. Sundt, III
To register, reserve housing, or learn more about the meeting, visit: www.aats.org/aortic.
April 26-27, 2018
New York Hilton Midtown
New York, NY
Registration is now open for the AATS Aortic Symposium 2018, a two-day symposium that kicks off AATS Week. Focused on the pathophysiology, diagnosis and treatment of aortic aneurysms and dissections, the symposium is designed for cardiovascular and thoracic surgeons, residents, perfusionists, ICU and OR nurses and those involved with the care of individuals with aortic disease. Register today for the opportunity to interact with world leaders in this field as they share their experiences regarding difficult problems in aortic disease.
Program Directors
Joseph S. Coselli
Steven L. Lansman
Program Committee
Joseph E. Bavaria
Edward P. Chen
Leonard N. Girardi
Thomas G. Gleason
G. Chad Hughes
Eric E. Roselli
David Spielvogel
Thoralf M. Sundt, III
To register, reserve housing, or learn more about the meeting, visit: www.aats.org/aortic.
Apply for Award Opportunities
Take a look at the programs that are currently accepting applications, including:
AATS Annual Meeting Travel Award
Deadline: January 15
Available to surgeons from around the world working within under-resourced medical centers, the AATS Annual Meeting Travel Awards aid deserving applicants with the cost of travel to attend the AATS Annual Meeting, which is to take place this year in San Diego, California
Learn from the Masters
Deadline: January 15
Providing a unique educational experience, the Learn from the Masters program pairs awardees who have recently completed their residency or fellowship with leading cardiac surgeons. During their three to six month stay the awardee will work within a full clinical position, which includes full clinical service access.
Graham Surgical Investigator
Deadline: January 15
Supporting innovating clinical or transitional research within the field of cardiothoracic surgery, the Graham Surgical Investigator awards a limited number of proposals to topics of research varying from robotically assisted surgery, minimally invasive surgery, to other applications of new and innovative technologies within cardiothoracic surgery.
For more information on these programs, visit AATSGrahamFoundation.org.
The following programs for medical students and residents are also accepting applications:
AATS Member for a Day Program
Deadline: January 15
North American medical students, general surgery residents, up to third year integrated cardiothoracic surgery residents (I-6) and members of the American Physician Scientists Association (APSA) have an opportunity to accompany an AATS Member Mentor during portions of the 2018 AATS Annual Meeting. The program is designed to offer insight into the cardiothoracic surgery specialty and to provide an opportunity to network and build relationships within the cardiothoracic surgical community.
AATS Perioperative/Team-Based Care Poster Competition
Deadline: January 15th, 2018
Non-MD cardiothoracic surgical team professionals (NPs, PAs, Perfusionists, and RNs) have the opportunity to submit an abstract for consideration to participate in the AATS Perioperative/Team-Based Care Poster Competition at the 2018 AATS Annual Meeting in San Diego, CA, April 28 - May 1. These posters may contain material that has been previously presented.
AATS Summer Intern Scholarship in Cardiothoracic Surgery
Deadline: January 15
Established in 2007 to introduce the field of cardiothoracic surgery to first and second year medical students in a North American medical school, the goal is to broaden awardees’ educational experiences be enabling them to spend eight weeks during the summer (June thru September) working in an AATS member’s cardiothoracic surgery department. The Scholarship is partially funded by Scanlan International Inc., and the AATS Graham Foundation. It provides a grant of $2,500 to the successful applicants for their living expenses during the eight weeks of training at the selected host institution. Additionally, successful applicants receive complimentary registration to the 98th AATS Annual Meeting.
AATS Cardiothoracic Surgery Resident Poster Competition
Deadline: January 31
Providing an opportunity for senior cardiothoracic surgery residents and/or congenital heart surgery fellows from around the world to represent their institution by presenting a scientific poster of their clinical/investigative research at the 2018 AATS Annual Meeting in San Diego, CA April 28th – May 1st, 2018. Once committed, residents/fellows must provide the Cardiothoracic Residents Committee with a brief abstract regarding the research on their posters. Posters may include research that has been previously presented and/or published. This award is limited to one participant per institution.
For more information on these program, visit aats.org.
Take a look at the programs that are currently accepting applications, including:
AATS Annual Meeting Travel Award
Deadline: January 15
Available to surgeons from around the world working within under-resourced medical centers, the AATS Annual Meeting Travel Awards aid deserving applicants with the cost of travel to attend the AATS Annual Meeting, which is to take place this year in San Diego, California
Learn from the Masters
Deadline: January 15
Providing a unique educational experience, the Learn from the Masters program pairs awardees who have recently completed their residency or fellowship with leading cardiac surgeons. During their three to six month stay the awardee will work within a full clinical position, which includes full clinical service access.
Graham Surgical Investigator
Deadline: January 15
Supporting innovating clinical or transitional research within the field of cardiothoracic surgery, the Graham Surgical Investigator awards a limited number of proposals to topics of research varying from robotically assisted surgery, minimally invasive surgery, to other applications of new and innovative technologies within cardiothoracic surgery.
For more information on these programs, visit AATSGrahamFoundation.org.
The following programs for medical students and residents are also accepting applications:
AATS Member for a Day Program
Deadline: January 15
North American medical students, general surgery residents, up to third year integrated cardiothoracic surgery residents (I-6) and members of the American Physician Scientists Association (APSA) have an opportunity to accompany an AATS Member Mentor during portions of the 2018 AATS Annual Meeting. The program is designed to offer insight into the cardiothoracic surgery specialty and to provide an opportunity to network and build relationships within the cardiothoracic surgical community.
AATS Perioperative/Team-Based Care Poster Competition
Deadline: January 15th, 2018
Non-MD cardiothoracic surgical team professionals (NPs, PAs, Perfusionists, and RNs) have the opportunity to submit an abstract for consideration to participate in the AATS Perioperative/Team-Based Care Poster Competition at the 2018 AATS Annual Meeting in San Diego, CA, April 28 - May 1. These posters may contain material that has been previously presented.
AATS Summer Intern Scholarship in Cardiothoracic Surgery
Deadline: January 15
Established in 2007 to introduce the field of cardiothoracic surgery to first and second year medical students in a North American medical school, the goal is to broaden awardees’ educational experiences be enabling them to spend eight weeks during the summer (June thru September) working in an AATS member’s cardiothoracic surgery department. The Scholarship is partially funded by Scanlan International Inc., and the AATS Graham Foundation. It provides a grant of $2,500 to the successful applicants for their living expenses during the eight weeks of training at the selected host institution. Additionally, successful applicants receive complimentary registration to the 98th AATS Annual Meeting.
AATS Cardiothoracic Surgery Resident Poster Competition
Deadline: January 31
Providing an opportunity for senior cardiothoracic surgery residents and/or congenital heart surgery fellows from around the world to represent their institution by presenting a scientific poster of their clinical/investigative research at the 2018 AATS Annual Meeting in San Diego, CA April 28th – May 1st, 2018. Once committed, residents/fellows must provide the Cardiothoracic Residents Committee with a brief abstract regarding the research on their posters. Posters may include research that has been previously presented and/or published. This award is limited to one participant per institution.
For more information on these program, visit aats.org.
Take a look at the programs that are currently accepting applications, including:
AATS Annual Meeting Travel Award
Deadline: January 15
Available to surgeons from around the world working within under-resourced medical centers, the AATS Annual Meeting Travel Awards aid deserving applicants with the cost of travel to attend the AATS Annual Meeting, which is to take place this year in San Diego, California
Learn from the Masters
Deadline: January 15
Providing a unique educational experience, the Learn from the Masters program pairs awardees who have recently completed their residency or fellowship with leading cardiac surgeons. During their three to six month stay the awardee will work within a full clinical position, which includes full clinical service access.
Graham Surgical Investigator
Deadline: January 15
Supporting innovating clinical or transitional research within the field of cardiothoracic surgery, the Graham Surgical Investigator awards a limited number of proposals to topics of research varying from robotically assisted surgery, minimally invasive surgery, to other applications of new and innovative technologies within cardiothoracic surgery.
For more information on these programs, visit AATSGrahamFoundation.org.
The following programs for medical students and residents are also accepting applications:
AATS Member for a Day Program
Deadline: January 15
North American medical students, general surgery residents, up to third year integrated cardiothoracic surgery residents (I-6) and members of the American Physician Scientists Association (APSA) have an opportunity to accompany an AATS Member Mentor during portions of the 2018 AATS Annual Meeting. The program is designed to offer insight into the cardiothoracic surgery specialty and to provide an opportunity to network and build relationships within the cardiothoracic surgical community.
AATS Perioperative/Team-Based Care Poster Competition
Deadline: January 15th, 2018
Non-MD cardiothoracic surgical team professionals (NPs, PAs, Perfusionists, and RNs) have the opportunity to submit an abstract for consideration to participate in the AATS Perioperative/Team-Based Care Poster Competition at the 2018 AATS Annual Meeting in San Diego, CA, April 28 - May 1. These posters may contain material that has been previously presented.
AATS Summer Intern Scholarship in Cardiothoracic Surgery
Deadline: January 15
Established in 2007 to introduce the field of cardiothoracic surgery to first and second year medical students in a North American medical school, the goal is to broaden awardees’ educational experiences be enabling them to spend eight weeks during the summer (June thru September) working in an AATS member’s cardiothoracic surgery department. The Scholarship is partially funded by Scanlan International Inc., and the AATS Graham Foundation. It provides a grant of $2,500 to the successful applicants for their living expenses during the eight weeks of training at the selected host institution. Additionally, successful applicants receive complimentary registration to the 98th AATS Annual Meeting.
AATS Cardiothoracic Surgery Resident Poster Competition
Deadline: January 31
Providing an opportunity for senior cardiothoracic surgery residents and/or congenital heart surgery fellows from around the world to represent their institution by presenting a scientific poster of their clinical/investigative research at the 2018 AATS Annual Meeting in San Diego, CA April 28th – May 1st, 2018. Once committed, residents/fellows must provide the Cardiothoracic Residents Committee with a brief abstract regarding the research on their posters. Posters may include research that has been previously presented and/or published. This award is limited to one participant per institution.
For more information on these program, visit aats.org.
MedPAC: Ditch meaningful use, patient measures under MIPS
WASHINGTON – Population-level outcomes measures are the key focus of a proposed program to replace the Merit-Based Incentive Payment System (MIPS) track in the Medicare Quality Payment Program.
The proposal, under consideration by the Medicare Payment Advisory Commission, also would forgo patient-level outcomes measures, practice-improvement measures, and all measures of the meaningful use of electronic health records.
The Centers for Medicare & Medicaid Services is estimating that the reporting burden for the MIPS program is $1 billion in 2017 alone, MedPAC staff member Kate Blonairz said at a Dec. 7 MedPAC meeting.
The decision to move to outcomes also would take away any reporting on process measures, leaving physicians with more freedom to choose how they reach the outcomes.
Certain previously discussed provisions remain in the proposal, such as withholding a percentage of Medicare fee-for-service payments for clinicians who are not part of an advanced Alternative Payment Model (APM) practice, and giving them the opportunity to earn the funds back via the new Voluntary Value Program (VVP).
The proposal also would remove certain income and beneficiary thresholds in the APM track to expand eligibility and improve retention.
The proposal, which is slated to be refined a little more before being voted on in a January meeting, continued to receive near consensus support from MedPAC commissioners, but concerns were raised.
In particular, the move to a population-based reporting scheme as the way to track and reward performance creates a scaling problem, noted Commissioner David Nerenz, PhD, of the Henry Ford Health System of Detroit.
Virtual reporting groups would be created, and the physicians would be rewarded or penalized based on the numbers reported by that group. However, to get meaningful differences in the reported populations outcomes, Dr. Nerenz noted that the groups will have to be very large.
For example, to detect a 13% difference in readmission rates, you would need 200 cases for each group, he pointed out.
“If I have 200 cases, I can detect a difference of 13% and 0 or I can detect a difference between 13% and 26%, but I sure as heck can’t detect a difference, say, between 13% and 16%,” Dr. Nerenz said, noting that if he wanted to get the difference between 13% and 16%, he would need approximately 7,000 discharges in each group.
The size of the virtual groups, the kinds of outcomes measures, and other fine details would be left to the Centers for Medicare & Medicaid Services to decide via rule making under the current MedPAC proposal.
Commissioner Alice Coombs, MD, of South Shore Hospital, Weymouth, Mass., continued to voice her objection to even the idea of repealing MIPS, noting that the APM reporting model might not line up with value-based purchasing, and process measures would still be in play for APMs; some process measures are actually good in improving quality of care, she argued.
Rita Redberg, MD, of the University of California, San Francisco, called for speedy action on the proposal.
“The time to get rid of MIPS is now because ... as I listen to people, the only thing people say is, well, they have already started getting ready for MIPS,” Dr. Redberg said. “It is not a good reason to continue a terrible system, but the longer it goes on, the more we will hear that.”
WASHINGTON – Population-level outcomes measures are the key focus of a proposed program to replace the Merit-Based Incentive Payment System (MIPS) track in the Medicare Quality Payment Program.
The proposal, under consideration by the Medicare Payment Advisory Commission, also would forgo patient-level outcomes measures, practice-improvement measures, and all measures of the meaningful use of electronic health records.
The Centers for Medicare & Medicaid Services is estimating that the reporting burden for the MIPS program is $1 billion in 2017 alone, MedPAC staff member Kate Blonairz said at a Dec. 7 MedPAC meeting.
The decision to move to outcomes also would take away any reporting on process measures, leaving physicians with more freedom to choose how they reach the outcomes.
Certain previously discussed provisions remain in the proposal, such as withholding a percentage of Medicare fee-for-service payments for clinicians who are not part of an advanced Alternative Payment Model (APM) practice, and giving them the opportunity to earn the funds back via the new Voluntary Value Program (VVP).
The proposal also would remove certain income and beneficiary thresholds in the APM track to expand eligibility and improve retention.
The proposal, which is slated to be refined a little more before being voted on in a January meeting, continued to receive near consensus support from MedPAC commissioners, but concerns were raised.
In particular, the move to a population-based reporting scheme as the way to track and reward performance creates a scaling problem, noted Commissioner David Nerenz, PhD, of the Henry Ford Health System of Detroit.
Virtual reporting groups would be created, and the physicians would be rewarded or penalized based on the numbers reported by that group. However, to get meaningful differences in the reported populations outcomes, Dr. Nerenz noted that the groups will have to be very large.
For example, to detect a 13% difference in readmission rates, you would need 200 cases for each group, he pointed out.
“If I have 200 cases, I can detect a difference of 13% and 0 or I can detect a difference between 13% and 26%, but I sure as heck can’t detect a difference, say, between 13% and 16%,” Dr. Nerenz said, noting that if he wanted to get the difference between 13% and 16%, he would need approximately 7,000 discharges in each group.
The size of the virtual groups, the kinds of outcomes measures, and other fine details would be left to the Centers for Medicare & Medicaid Services to decide via rule making under the current MedPAC proposal.
Commissioner Alice Coombs, MD, of South Shore Hospital, Weymouth, Mass., continued to voice her objection to even the idea of repealing MIPS, noting that the APM reporting model might not line up with value-based purchasing, and process measures would still be in play for APMs; some process measures are actually good in improving quality of care, she argued.
Rita Redberg, MD, of the University of California, San Francisco, called for speedy action on the proposal.
“The time to get rid of MIPS is now because ... as I listen to people, the only thing people say is, well, they have already started getting ready for MIPS,” Dr. Redberg said. “It is not a good reason to continue a terrible system, but the longer it goes on, the more we will hear that.”
WASHINGTON – Population-level outcomes measures are the key focus of a proposed program to replace the Merit-Based Incentive Payment System (MIPS) track in the Medicare Quality Payment Program.
The proposal, under consideration by the Medicare Payment Advisory Commission, also would forgo patient-level outcomes measures, practice-improvement measures, and all measures of the meaningful use of electronic health records.
The Centers for Medicare & Medicaid Services is estimating that the reporting burden for the MIPS program is $1 billion in 2017 alone, MedPAC staff member Kate Blonairz said at a Dec. 7 MedPAC meeting.
The decision to move to outcomes also would take away any reporting on process measures, leaving physicians with more freedom to choose how they reach the outcomes.
Certain previously discussed provisions remain in the proposal, such as withholding a percentage of Medicare fee-for-service payments for clinicians who are not part of an advanced Alternative Payment Model (APM) practice, and giving them the opportunity to earn the funds back via the new Voluntary Value Program (VVP).
The proposal also would remove certain income and beneficiary thresholds in the APM track to expand eligibility and improve retention.
The proposal, which is slated to be refined a little more before being voted on in a January meeting, continued to receive near consensus support from MedPAC commissioners, but concerns were raised.
In particular, the move to a population-based reporting scheme as the way to track and reward performance creates a scaling problem, noted Commissioner David Nerenz, PhD, of the Henry Ford Health System of Detroit.
Virtual reporting groups would be created, and the physicians would be rewarded or penalized based on the numbers reported by that group. However, to get meaningful differences in the reported populations outcomes, Dr. Nerenz noted that the groups will have to be very large.
For example, to detect a 13% difference in readmission rates, you would need 200 cases for each group, he pointed out.
“If I have 200 cases, I can detect a difference of 13% and 0 or I can detect a difference between 13% and 26%, but I sure as heck can’t detect a difference, say, between 13% and 16%,” Dr. Nerenz said, noting that if he wanted to get the difference between 13% and 16%, he would need approximately 7,000 discharges in each group.
The size of the virtual groups, the kinds of outcomes measures, and other fine details would be left to the Centers for Medicare & Medicaid Services to decide via rule making under the current MedPAC proposal.
Commissioner Alice Coombs, MD, of South Shore Hospital, Weymouth, Mass., continued to voice her objection to even the idea of repealing MIPS, noting that the APM reporting model might not line up with value-based purchasing, and process measures would still be in play for APMs; some process measures are actually good in improving quality of care, she argued.
Rita Redberg, MD, of the University of California, San Francisco, called for speedy action on the proposal.
“The time to get rid of MIPS is now because ... as I listen to people, the only thing people say is, well, they have already started getting ready for MIPS,” Dr. Redberg said. “It is not a good reason to continue a terrible system, but the longer it goes on, the more we will hear that.”
REPORTING FROM A MEDPAC MEETING
Medicare pay cut may loom in wake of tax bill passage
requiring that any spending increases be offset by other spending cuts.
At issue is the Senate bill’s repeal of the Affordable Care Act requirement that every individual have health insurance – the individual mandate.
In a Nov. 14 letter to the majority and minority leaders of the both the House and Senate, the American Medical Association, the American Academy of Family Physicians, the American Hospital Association, and the Federation of American Hospitals called on Congress to maintain the individual mandate. The four health provider groups were joined in the letter by America’s Health Insurance Plans and the Blue Cross Blue Shield Association.
“Eliminating the individual mandate by itself likely will result in a significant increase in premiums, which would in turn substantially increase the number of uninsured Americans,” the organizations warned.
The American College of Physicians also urged the Senate to not end the individual mandate, after the bill was passed out of the Senate Finance Committee along party lines.
“We are concerned that the bill approved by the Senate Budget Committee on a party-line vote would repeal the Affordable Care Act’s requirement that persons purchase qualified health insurance coverage. ... which will destabilize the individual insurance market and lead to 13 million Americans losing coverage, double-digit premium increases, and insurers dropping out of the individual insurance market, according to the Congressional Budget Office and other independent analyses,” the American College of Physicians wrote in a Nov. 30 letter to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Charles Schumer (D-N.Y.).
ACP leaders also voiced concern about the looming cuts to Medicare that could result from the bill, noting that the Congressional Budget Office estimated that $25 billion will be cut from Medicare as part of a larger sequestration – a 4% pay cut to the fee schedule – that would result if offsets are not found to keep the deficit from increasing.
The ACP noted that, along with other pay cuts on the books from other legislative action, physicians would be losing nearly 7% of their pay from the fee schedule, beginning in 2018.
The next step in the process is for a House and Senate conference committee to resolve differences between the two versions of the tax reform bills. Both chambers would then vote on a compromise bill. At some point, there would to be a vote to waive the pay-as-you-go rules to prevent the Medicare cuts from going into effect. However, such a vote requires 60 votes in the Senate and a simple majority in the House, neither of which are guaranteed.
“It’s hard to say right now whether or not that can be worked out,” Julius Hobson, a Washington-based health care lobbyist, said in an interview. “There is desire on the part of the Republican leadership in the two chambers, and I suspect it might pass the Senate. The problem may well be in the House with the conservatives, particularly the House Freedom Caucus, and whether they will go along with that.”
Mr. Hobson noted that GOP leadership has said they plan to move on to entitlement reform after tax reform is finished. So, even if the cuts are spared by a pay-as-you-go rules waiver, they could still come into effect in some way when GOP tackles Medicare, Medicaid, and Social Security reform.
“It looks interesting to be saving cuts in Medicare on the one hand, but on the other hand, reform really means cuts,” he said.
requiring that any spending increases be offset by other spending cuts.
At issue is the Senate bill’s repeal of the Affordable Care Act requirement that every individual have health insurance – the individual mandate.
In a Nov. 14 letter to the majority and minority leaders of the both the House and Senate, the American Medical Association, the American Academy of Family Physicians, the American Hospital Association, and the Federation of American Hospitals called on Congress to maintain the individual mandate. The four health provider groups were joined in the letter by America’s Health Insurance Plans and the Blue Cross Blue Shield Association.
“Eliminating the individual mandate by itself likely will result in a significant increase in premiums, which would in turn substantially increase the number of uninsured Americans,” the organizations warned.
The American College of Physicians also urged the Senate to not end the individual mandate, after the bill was passed out of the Senate Finance Committee along party lines.
“We are concerned that the bill approved by the Senate Budget Committee on a party-line vote would repeal the Affordable Care Act’s requirement that persons purchase qualified health insurance coverage. ... which will destabilize the individual insurance market and lead to 13 million Americans losing coverage, double-digit premium increases, and insurers dropping out of the individual insurance market, according to the Congressional Budget Office and other independent analyses,” the American College of Physicians wrote in a Nov. 30 letter to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Charles Schumer (D-N.Y.).
ACP leaders also voiced concern about the looming cuts to Medicare that could result from the bill, noting that the Congressional Budget Office estimated that $25 billion will be cut from Medicare as part of a larger sequestration – a 4% pay cut to the fee schedule – that would result if offsets are not found to keep the deficit from increasing.
The ACP noted that, along with other pay cuts on the books from other legislative action, physicians would be losing nearly 7% of their pay from the fee schedule, beginning in 2018.
The next step in the process is for a House and Senate conference committee to resolve differences between the two versions of the tax reform bills. Both chambers would then vote on a compromise bill. At some point, there would to be a vote to waive the pay-as-you-go rules to prevent the Medicare cuts from going into effect. However, such a vote requires 60 votes in the Senate and a simple majority in the House, neither of which are guaranteed.
“It’s hard to say right now whether or not that can be worked out,” Julius Hobson, a Washington-based health care lobbyist, said in an interview. “There is desire on the part of the Republican leadership in the two chambers, and I suspect it might pass the Senate. The problem may well be in the House with the conservatives, particularly the House Freedom Caucus, and whether they will go along with that.”
Mr. Hobson noted that GOP leadership has said they plan to move on to entitlement reform after tax reform is finished. So, even if the cuts are spared by a pay-as-you-go rules waiver, they could still come into effect in some way when GOP tackles Medicare, Medicaid, and Social Security reform.
“It looks interesting to be saving cuts in Medicare on the one hand, but on the other hand, reform really means cuts,” he said.
requiring that any spending increases be offset by other spending cuts.
At issue is the Senate bill’s repeal of the Affordable Care Act requirement that every individual have health insurance – the individual mandate.
In a Nov. 14 letter to the majority and minority leaders of the both the House and Senate, the American Medical Association, the American Academy of Family Physicians, the American Hospital Association, and the Federation of American Hospitals called on Congress to maintain the individual mandate. The four health provider groups were joined in the letter by America’s Health Insurance Plans and the Blue Cross Blue Shield Association.
“Eliminating the individual mandate by itself likely will result in a significant increase in premiums, which would in turn substantially increase the number of uninsured Americans,” the organizations warned.
The American College of Physicians also urged the Senate to not end the individual mandate, after the bill was passed out of the Senate Finance Committee along party lines.
“We are concerned that the bill approved by the Senate Budget Committee on a party-line vote would repeal the Affordable Care Act’s requirement that persons purchase qualified health insurance coverage. ... which will destabilize the individual insurance market and lead to 13 million Americans losing coverage, double-digit premium increases, and insurers dropping out of the individual insurance market, according to the Congressional Budget Office and other independent analyses,” the American College of Physicians wrote in a Nov. 30 letter to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Charles Schumer (D-N.Y.).
ACP leaders also voiced concern about the looming cuts to Medicare that could result from the bill, noting that the Congressional Budget Office estimated that $25 billion will be cut from Medicare as part of a larger sequestration – a 4% pay cut to the fee schedule – that would result if offsets are not found to keep the deficit from increasing.
The ACP noted that, along with other pay cuts on the books from other legislative action, physicians would be losing nearly 7% of their pay from the fee schedule, beginning in 2018.
The next step in the process is for a House and Senate conference committee to resolve differences between the two versions of the tax reform bills. Both chambers would then vote on a compromise bill. At some point, there would to be a vote to waive the pay-as-you-go rules to prevent the Medicare cuts from going into effect. However, such a vote requires 60 votes in the Senate and a simple majority in the House, neither of which are guaranteed.
“It’s hard to say right now whether or not that can be worked out,” Julius Hobson, a Washington-based health care lobbyist, said in an interview. “There is desire on the part of the Republican leadership in the two chambers, and I suspect it might pass the Senate. The problem may well be in the House with the conservatives, particularly the House Freedom Caucus, and whether they will go along with that.”
Mr. Hobson noted that GOP leadership has said they plan to move on to entitlement reform after tax reform is finished. So, even if the cuts are spared by a pay-as-you-go rules waiver, they could still come into effect in some way when GOP tackles Medicare, Medicaid, and Social Security reform.
“It looks interesting to be saving cuts in Medicare on the one hand, but on the other hand, reform really means cuts,” he said.
Phrenic-nerve stimulator maintains benefits for 18 months
TORONTO – The implanted phrenic-nerve stimulation device that received Food and Drug Administration marketing approval in October 2017 for treating central sleep apnea has now shown safety and efficacy out to 18 months of continuous use in 102 patients.
After 18 months of treatment with the Remede System, patients’ outcomes remained stable and patients continued to see the improvements they had experienced after 6 and 12 months of treatment. These improvements included significant average reductions from baseline in apnea-hypopnea index and central apnea index and significant increases in oxygenation and sleep quality, Andrew C. Kao, MD, said at the CHEST annual meeting.
“We were concerned that there would be a degradation of the benefit [over time]. We are very happy that the benefit was sustained,” said Dr. Kao, a heart failure cardiologist at Saint Luke’s Health System in Kansas City, Mo.
Dr. Kao did not report an 18-month follow-up for the study’s primary endpoint, the percentage of patients after 6 months on treatment who had at least a 50% reduction from baseline in their apnea-hypopnea index. His report focused on the 6-, 12-, and 18-month changes relative to baseline for five secondary outcomes: central sleep apnea index, apnea-hypopnea index, arousal index, oxygen desaturation index, and time spent in REM sleep. For all five of these outcomes, the 102 patients showed an average, statistically significant improvement compared with baseline after 6 months on treatment that persisted virtually unchanged at 12 and 18 months.
For example, average central sleep apnea index fell from 27 events/hour at baseline to 5 per hour at 6, 12, and 18 months. Average apnea-hypopnea index fell from 46 events/hour at baseline to about 25 per hour at 6, 12, and 18 months. The average percentage of sleep spent in REM sleep improved from 12% at baseline to about 15% at 6, 12, and 18 months.
During 18 months of treatment following device implantation, four of the 102 patients had a serious adverse event. One patient required lead repositioning to relieve discomfort and three had an interaction with an implanted cardiac device. The effects resolved in all four patients without long-term impact. An additional 16 patients had discomfort that required an unscheduled medical visit, but these were not classified as serious episodes, and in 14 of these patients the discomfort resolved.
The Remede System phrenic-nerve stimulator received FDA marketing approval for moderate to severe central sleep apnea based on 6-month efficacy and 12-month safety data (Lancet. 2016 Sept 3;388[10048]:974-82). The Pivotal Trial of the Remede System enrolled 151 patients with an apnea-hypopnea index of at least 20 events/hour, about half of whom had heart failure. All patients received a device implant: In the initial intervention group of 73 patients, researchers turned on the device 1 month after implantation, and in the 78 patients randomized to the initial control arm, the device remained off for the first 7 months and then went active. The researchers followed up with 46 patients drawn from both the original treatment arm and 56 patients from the original control arm, at which point the patients had been receiving 18 months of treatment.
The Remede System pivotal trial was sponsored by Respicardia, which markets the phrenic-verse stimulator. Dr. Kao’s institution, Saint Luke’s Health System, received grant support from Respicardia.
[email protected]
On Twitter @mitchelzoler
TORONTO – The implanted phrenic-nerve stimulation device that received Food and Drug Administration marketing approval in October 2017 for treating central sleep apnea has now shown safety and efficacy out to 18 months of continuous use in 102 patients.
After 18 months of treatment with the Remede System, patients’ outcomes remained stable and patients continued to see the improvements they had experienced after 6 and 12 months of treatment. These improvements included significant average reductions from baseline in apnea-hypopnea index and central apnea index and significant increases in oxygenation and sleep quality, Andrew C. Kao, MD, said at the CHEST annual meeting.
“We were concerned that there would be a degradation of the benefit [over time]. We are very happy that the benefit was sustained,” said Dr. Kao, a heart failure cardiologist at Saint Luke’s Health System in Kansas City, Mo.
Dr. Kao did not report an 18-month follow-up for the study’s primary endpoint, the percentage of patients after 6 months on treatment who had at least a 50% reduction from baseline in their apnea-hypopnea index. His report focused on the 6-, 12-, and 18-month changes relative to baseline for five secondary outcomes: central sleep apnea index, apnea-hypopnea index, arousal index, oxygen desaturation index, and time spent in REM sleep. For all five of these outcomes, the 102 patients showed an average, statistically significant improvement compared with baseline after 6 months on treatment that persisted virtually unchanged at 12 and 18 months.
For example, average central sleep apnea index fell from 27 events/hour at baseline to 5 per hour at 6, 12, and 18 months. Average apnea-hypopnea index fell from 46 events/hour at baseline to about 25 per hour at 6, 12, and 18 months. The average percentage of sleep spent in REM sleep improved from 12% at baseline to about 15% at 6, 12, and 18 months.
During 18 months of treatment following device implantation, four of the 102 patients had a serious adverse event. One patient required lead repositioning to relieve discomfort and three had an interaction with an implanted cardiac device. The effects resolved in all four patients without long-term impact. An additional 16 patients had discomfort that required an unscheduled medical visit, but these were not classified as serious episodes, and in 14 of these patients the discomfort resolved.
The Remede System phrenic-nerve stimulator received FDA marketing approval for moderate to severe central sleep apnea based on 6-month efficacy and 12-month safety data (Lancet. 2016 Sept 3;388[10048]:974-82). The Pivotal Trial of the Remede System enrolled 151 patients with an apnea-hypopnea index of at least 20 events/hour, about half of whom had heart failure. All patients received a device implant: In the initial intervention group of 73 patients, researchers turned on the device 1 month after implantation, and in the 78 patients randomized to the initial control arm, the device remained off for the first 7 months and then went active. The researchers followed up with 46 patients drawn from both the original treatment arm and 56 patients from the original control arm, at which point the patients had been receiving 18 months of treatment.
The Remede System pivotal trial was sponsored by Respicardia, which markets the phrenic-verse stimulator. Dr. Kao’s institution, Saint Luke’s Health System, received grant support from Respicardia.
[email protected]
On Twitter @mitchelzoler
TORONTO – The implanted phrenic-nerve stimulation device that received Food and Drug Administration marketing approval in October 2017 for treating central sleep apnea has now shown safety and efficacy out to 18 months of continuous use in 102 patients.
After 18 months of treatment with the Remede System, patients’ outcomes remained stable and patients continued to see the improvements they had experienced after 6 and 12 months of treatment. These improvements included significant average reductions from baseline in apnea-hypopnea index and central apnea index and significant increases in oxygenation and sleep quality, Andrew C. Kao, MD, said at the CHEST annual meeting.
“We were concerned that there would be a degradation of the benefit [over time]. We are very happy that the benefit was sustained,” said Dr. Kao, a heart failure cardiologist at Saint Luke’s Health System in Kansas City, Mo.
Dr. Kao did not report an 18-month follow-up for the study’s primary endpoint, the percentage of patients after 6 months on treatment who had at least a 50% reduction from baseline in their apnea-hypopnea index. His report focused on the 6-, 12-, and 18-month changes relative to baseline for five secondary outcomes: central sleep apnea index, apnea-hypopnea index, arousal index, oxygen desaturation index, and time spent in REM sleep. For all five of these outcomes, the 102 patients showed an average, statistically significant improvement compared with baseline after 6 months on treatment that persisted virtually unchanged at 12 and 18 months.
For example, average central sleep apnea index fell from 27 events/hour at baseline to 5 per hour at 6, 12, and 18 months. Average apnea-hypopnea index fell from 46 events/hour at baseline to about 25 per hour at 6, 12, and 18 months. The average percentage of sleep spent in REM sleep improved from 12% at baseline to about 15% at 6, 12, and 18 months.
During 18 months of treatment following device implantation, four of the 102 patients had a serious adverse event. One patient required lead repositioning to relieve discomfort and three had an interaction with an implanted cardiac device. The effects resolved in all four patients without long-term impact. An additional 16 patients had discomfort that required an unscheduled medical visit, but these were not classified as serious episodes, and in 14 of these patients the discomfort resolved.
The Remede System phrenic-nerve stimulator received FDA marketing approval for moderate to severe central sleep apnea based on 6-month efficacy and 12-month safety data (Lancet. 2016 Sept 3;388[10048]:974-82). The Pivotal Trial of the Remede System enrolled 151 patients with an apnea-hypopnea index of at least 20 events/hour, about half of whom had heart failure. All patients received a device implant: In the initial intervention group of 73 patients, researchers turned on the device 1 month after implantation, and in the 78 patients randomized to the initial control arm, the device remained off for the first 7 months and then went active. The researchers followed up with 46 patients drawn from both the original treatment arm and 56 patients from the original control arm, at which point the patients had been receiving 18 months of treatment.
The Remede System pivotal trial was sponsored by Respicardia, which markets the phrenic-verse stimulator. Dr. Kao’s institution, Saint Luke’s Health System, received grant support from Respicardia.
[email protected]
On Twitter @mitchelzoler
AT CHEST 2017
Key clinical point:
Major finding: Average central apnea index improved from 27 events/hour at baseline to 5 events/hour after 6, 12, and 18 months of treatment.
Data source: 102 patients enrolled in the Pivotal Trial of the remede System were followed for 18 months of treatment.
Disclosures: The remede System pivotal trial was sponsored by Respicardia, which markets the phrenic-verse stimulator. Dr. Kao’s institution, Saint Luke’s Health System, received grant support from Respicardia.
EXCEL: Quality of life better after PCI than CABG
DENVER – Several key validated measures of health status were significantly more favorable a full year after percutaneous coronary intervention using an everolimus-eluting stent than with coronary artery bypass surgery in patients with unprotected left main CAD in the prespecified quality-of-life analysis of the landmark EXCEL trial.
By 3 years of follow-up, there was no longer a difference between the PCI and CABG groups in terms of the various quality-of-life measures, Suzanne J. Baron, MD, reported at the Transcatheter Cardiovascular Therapeutics annual educational meeting. Nor as previously reported was there any significant difference in the primary composite endpoint comprised of all-cause mortality, stroke, or MI.
“My take away from this is that these results provide an ideal opportunity to give patients a choice about which choice they would want: An earlier recovery with angioplasty versus really similar outcomes long-term with either procedure. For me, these EXCEL results make me feel that angioplasty for less complex coronary disease is really probably the preferred option,” said John A. Spertus, MD, director of health outcomes research at Saint Luke’s Mid America Heart Institute and professor of medicine at the University of Missouri-Kansas City.
“The faster recovery with PCI, the similar angina relief after 3 years, and also the less depression with PCI, which is an important finding, I think – all this goes in favor of PCI for left main disease,” commented Evald H. Christiansen, MD, a cardiologist at Aarhus (Denmark) University and senior investigator in the NOBLE trial (Lancet. 2016 Dec 3;388[10061]:2743-52), which randomized patients to CABG or a stent that’s no longer marketed.
The previously published clinical outcomes of EXCEL (N Engl J Med. 2016 Dec 8;375[23]:2223-35) were based upon a median 3 years of follow-up. Dr. Baron presented updated outcomes in which all study participants had completed the full 3 years of follow-up. The results were little changed: The primary composite endpoint of all-cause mortality, stroke, or MI occurred in 15.2% of the group treated with the everolimus-eluting Xience stent and was closely similar at 14.7% of the CABG patients, while the 12.5% repeat revascularization rate in the PCI arm was significantly greater than the 7.4% rate with CABG.
But the prespecified EXCEL quality-of-life substudy with assessments at baseline, 1 month, 1 year, and 3 years in 1,788 participants is all new information. Among the highlights: The proportion of patients with clinically significant depression as defined by a Patient Health Questionnaire 8 (PHQ-8) score of 10 or more was 21% at baseline in both groups; 8% in the PCI group, compared with 19% in the CABG arm at 1 month; and 8% in the PCI arm versus 12% with CABG at 12 months of follow-up, with the differences at both time points being significant. By 3 years, the rate was 8%-9% in both groups, reported Dr. Baron of Saint Luke’s Mid America Health Institute and the University of Missouri-Kansas City.
“We now have a new treatment for depression: PCI,” quipped session moderator Gregg W. Stone, MD, professor of medicine at Columbia University in New York, who was lead investigator in EXCEL.
Also, scores on the SF-12 physical summary scale improved sharply from a baseline of 39 points in the PCI group during the first month of follow-up while worsening in the CABG group, such that at 1 month the between-group difference averaged 8.2 points. The gap narrowed over the next 11 months, and by 1 year the CABG patients had caught up.
Scores on the Seattle Angina Questionnaire and the Rose Dyspnea Scale were significantly better in the PCI group than the CABG arm at 1 month, but at 12 and 36 months the two groups were indistinguishable in these domains.
Dr. Spertus, who is credited with inventing both the Seattle Angina Questionnaire and the Kansas City Cardiomyopathy Questionnaire, said that in the context of EXCEL he puts more stock in the SF-12 and PHQ-8 results than the angina and dyspnea measures.
Jonathan Hill, MD, an interventional cardiologist at King’s College London, said the EXCEL quality-of-life substudy provides a valuable picture of the real-life impact of sternotomy.
“We mustn’t underplay that, the months and even up to a year of your life for recovery from the revascularization procedure, compared with days of recovery time with PCI. Patients want the option of PCI if it’s available. This data really vindicates that decision making,” he said.
“I think we minimize the recovery period from CABG. People talk a lot about outcomes at 3 years and 5 years, but look at this prolonged recovery. I think that’s very, very important,” said Dr. Grines, chair of cardiology at Hofstra University, Hempstead, N.Y.
The updated full 3-year data show a trend, albeit not statistically significant, for higher all-cause mortality in the PCI group, by a margin of 8% versus 5.8% with CABG. When asked about it, Dr. Baron said she and her coinvestigators took a closer look and determined that the cardiovascular death rate was virtually identical in the two groups.
“You have to wonder if this was just a random signal regarding the non-cardiovascular-associated deaths,” she added.
The EXCEL trial was supported by Abbott Vascular. Dr. Baron reported serving as a consultant to Edwards Lifesciences and St. Jude Medical.
DENVER – Several key validated measures of health status were significantly more favorable a full year after percutaneous coronary intervention using an everolimus-eluting stent than with coronary artery bypass surgery in patients with unprotected left main CAD in the prespecified quality-of-life analysis of the landmark EXCEL trial.
By 3 years of follow-up, there was no longer a difference between the PCI and CABG groups in terms of the various quality-of-life measures, Suzanne J. Baron, MD, reported at the Transcatheter Cardiovascular Therapeutics annual educational meeting. Nor as previously reported was there any significant difference in the primary composite endpoint comprised of all-cause mortality, stroke, or MI.
“My take away from this is that these results provide an ideal opportunity to give patients a choice about which choice they would want: An earlier recovery with angioplasty versus really similar outcomes long-term with either procedure. For me, these EXCEL results make me feel that angioplasty for less complex coronary disease is really probably the preferred option,” said John A. Spertus, MD, director of health outcomes research at Saint Luke’s Mid America Heart Institute and professor of medicine at the University of Missouri-Kansas City.
“The faster recovery with PCI, the similar angina relief after 3 years, and also the less depression with PCI, which is an important finding, I think – all this goes in favor of PCI for left main disease,” commented Evald H. Christiansen, MD, a cardiologist at Aarhus (Denmark) University and senior investigator in the NOBLE trial (Lancet. 2016 Dec 3;388[10061]:2743-52), which randomized patients to CABG or a stent that’s no longer marketed.
The previously published clinical outcomes of EXCEL (N Engl J Med. 2016 Dec 8;375[23]:2223-35) were based upon a median 3 years of follow-up. Dr. Baron presented updated outcomes in which all study participants had completed the full 3 years of follow-up. The results were little changed: The primary composite endpoint of all-cause mortality, stroke, or MI occurred in 15.2% of the group treated with the everolimus-eluting Xience stent and was closely similar at 14.7% of the CABG patients, while the 12.5% repeat revascularization rate in the PCI arm was significantly greater than the 7.4% rate with CABG.
But the prespecified EXCEL quality-of-life substudy with assessments at baseline, 1 month, 1 year, and 3 years in 1,788 participants is all new information. Among the highlights: The proportion of patients with clinically significant depression as defined by a Patient Health Questionnaire 8 (PHQ-8) score of 10 or more was 21% at baseline in both groups; 8% in the PCI group, compared with 19% in the CABG arm at 1 month; and 8% in the PCI arm versus 12% with CABG at 12 months of follow-up, with the differences at both time points being significant. By 3 years, the rate was 8%-9% in both groups, reported Dr. Baron of Saint Luke’s Mid America Health Institute and the University of Missouri-Kansas City.
“We now have a new treatment for depression: PCI,” quipped session moderator Gregg W. Stone, MD, professor of medicine at Columbia University in New York, who was lead investigator in EXCEL.
Also, scores on the SF-12 physical summary scale improved sharply from a baseline of 39 points in the PCI group during the first month of follow-up while worsening in the CABG group, such that at 1 month the between-group difference averaged 8.2 points. The gap narrowed over the next 11 months, and by 1 year the CABG patients had caught up.
Scores on the Seattle Angina Questionnaire and the Rose Dyspnea Scale were significantly better in the PCI group than the CABG arm at 1 month, but at 12 and 36 months the two groups were indistinguishable in these domains.
Dr. Spertus, who is credited with inventing both the Seattle Angina Questionnaire and the Kansas City Cardiomyopathy Questionnaire, said that in the context of EXCEL he puts more stock in the SF-12 and PHQ-8 results than the angina and dyspnea measures.
Jonathan Hill, MD, an interventional cardiologist at King’s College London, said the EXCEL quality-of-life substudy provides a valuable picture of the real-life impact of sternotomy.
“We mustn’t underplay that, the months and even up to a year of your life for recovery from the revascularization procedure, compared with days of recovery time with PCI. Patients want the option of PCI if it’s available. This data really vindicates that decision making,” he said.
“I think we minimize the recovery period from CABG. People talk a lot about outcomes at 3 years and 5 years, but look at this prolonged recovery. I think that’s very, very important,” said Dr. Grines, chair of cardiology at Hofstra University, Hempstead, N.Y.
The updated full 3-year data show a trend, albeit not statistically significant, for higher all-cause mortality in the PCI group, by a margin of 8% versus 5.8% with CABG. When asked about it, Dr. Baron said she and her coinvestigators took a closer look and determined that the cardiovascular death rate was virtually identical in the two groups.
“You have to wonder if this was just a random signal regarding the non-cardiovascular-associated deaths,” she added.
The EXCEL trial was supported by Abbott Vascular. Dr. Baron reported serving as a consultant to Edwards Lifesciences and St. Jude Medical.
DENVER – Several key validated measures of health status were significantly more favorable a full year after percutaneous coronary intervention using an everolimus-eluting stent than with coronary artery bypass surgery in patients with unprotected left main CAD in the prespecified quality-of-life analysis of the landmark EXCEL trial.
By 3 years of follow-up, there was no longer a difference between the PCI and CABG groups in terms of the various quality-of-life measures, Suzanne J. Baron, MD, reported at the Transcatheter Cardiovascular Therapeutics annual educational meeting. Nor as previously reported was there any significant difference in the primary composite endpoint comprised of all-cause mortality, stroke, or MI.
“My take away from this is that these results provide an ideal opportunity to give patients a choice about which choice they would want: An earlier recovery with angioplasty versus really similar outcomes long-term with either procedure. For me, these EXCEL results make me feel that angioplasty for less complex coronary disease is really probably the preferred option,” said John A. Spertus, MD, director of health outcomes research at Saint Luke’s Mid America Heart Institute and professor of medicine at the University of Missouri-Kansas City.
“The faster recovery with PCI, the similar angina relief after 3 years, and also the less depression with PCI, which is an important finding, I think – all this goes in favor of PCI for left main disease,” commented Evald H. Christiansen, MD, a cardiologist at Aarhus (Denmark) University and senior investigator in the NOBLE trial (Lancet. 2016 Dec 3;388[10061]:2743-52), which randomized patients to CABG or a stent that’s no longer marketed.
The previously published clinical outcomes of EXCEL (N Engl J Med. 2016 Dec 8;375[23]:2223-35) were based upon a median 3 years of follow-up. Dr. Baron presented updated outcomes in which all study participants had completed the full 3 years of follow-up. The results were little changed: The primary composite endpoint of all-cause mortality, stroke, or MI occurred in 15.2% of the group treated with the everolimus-eluting Xience stent and was closely similar at 14.7% of the CABG patients, while the 12.5% repeat revascularization rate in the PCI arm was significantly greater than the 7.4% rate with CABG.
But the prespecified EXCEL quality-of-life substudy with assessments at baseline, 1 month, 1 year, and 3 years in 1,788 participants is all new information. Among the highlights: The proportion of patients with clinically significant depression as defined by a Patient Health Questionnaire 8 (PHQ-8) score of 10 or more was 21% at baseline in both groups; 8% in the PCI group, compared with 19% in the CABG arm at 1 month; and 8% in the PCI arm versus 12% with CABG at 12 months of follow-up, with the differences at both time points being significant. By 3 years, the rate was 8%-9% in both groups, reported Dr. Baron of Saint Luke’s Mid America Health Institute and the University of Missouri-Kansas City.
“We now have a new treatment for depression: PCI,” quipped session moderator Gregg W. Stone, MD, professor of medicine at Columbia University in New York, who was lead investigator in EXCEL.
Also, scores on the SF-12 physical summary scale improved sharply from a baseline of 39 points in the PCI group during the first month of follow-up while worsening in the CABG group, such that at 1 month the between-group difference averaged 8.2 points. The gap narrowed over the next 11 months, and by 1 year the CABG patients had caught up.
Scores on the Seattle Angina Questionnaire and the Rose Dyspnea Scale were significantly better in the PCI group than the CABG arm at 1 month, but at 12 and 36 months the two groups were indistinguishable in these domains.
Dr. Spertus, who is credited with inventing both the Seattle Angina Questionnaire and the Kansas City Cardiomyopathy Questionnaire, said that in the context of EXCEL he puts more stock in the SF-12 and PHQ-8 results than the angina and dyspnea measures.
Jonathan Hill, MD, an interventional cardiologist at King’s College London, said the EXCEL quality-of-life substudy provides a valuable picture of the real-life impact of sternotomy.
“We mustn’t underplay that, the months and even up to a year of your life for recovery from the revascularization procedure, compared with days of recovery time with PCI. Patients want the option of PCI if it’s available. This data really vindicates that decision making,” he said.
“I think we minimize the recovery period from CABG. People talk a lot about outcomes at 3 years and 5 years, but look at this prolonged recovery. I think that’s very, very important,” said Dr. Grines, chair of cardiology at Hofstra University, Hempstead, N.Y.
The updated full 3-year data show a trend, albeit not statistically significant, for higher all-cause mortality in the PCI group, by a margin of 8% versus 5.8% with CABG. When asked about it, Dr. Baron said she and her coinvestigators took a closer look and determined that the cardiovascular death rate was virtually identical in the two groups.
“You have to wonder if this was just a random signal regarding the non-cardiovascular-associated deaths,” she added.
The EXCEL trial was supported by Abbott Vascular. Dr. Baron reported serving as a consultant to Edwards Lifesciences and St. Jude Medical.
AT TCT 2017
Key clinical point:
Major finding: The rate of clinically significant depression 1 year after revascularization of unprotected left main CAD via PCI using an everolimus-eluting stent was 8%, significantly lower than the 12% rate in CABG patients.
Data source: This was a prespecified prospective quality-of-life substudy featuring 3 years of follow-up in 1,788 patients randomized to PCI or CABG.
Disclosures: The EXCEL trial was supported by Abbott Vascular. The presenter reported serving as a consultant to Edwards Lifesciences and St. Jude Medical.
Sleep apnea treatment may reduce risk of epileptic seizures
WASHINGTON – In patients with epilepsy, treatment of obstructive sleep apnea with continuous positive airway pressure may lead to substantial and sustained reductions in seizure activity, according to data presented at the annual meeting of the American Epilepsy Society.
The reduction in seizure activity with continuous positive airway pressure (cPAP) in patients with epilepsy contributes to other evidence that poor sleep quality is an important but preventable risk factor for seizures, according to Thapanee Somboon, MD, a research fellow at the Sleep Disorders Center at the Cleveland Clinic in Ohio.
In this study, which was characterized as the largest yet to evaluate the effect of cPAP on seizure activity, all 197 patients had epilepsy but only 122 had obstructive sleep apnea (OSA). Of those with OSA, 73 were treated with cPAP and 49 were not. An additional 75 patients with epilepsy but no OSA were also treated with cPAP. Seizure activity in all groups was evaluated over a period of 1 year.
Treatment success, defined as no seizure activity or at least a 50% reduction from baseline in seizure activity, was achieved in 85% of those with OSA treated with cPAP, 55% of those with OSA that did not receive cPAP, and 65% of those who were treated with cPAP but did not have OSA.
The difference was even greater among those with seizure activity in the 6 months prior to cPAP use. In these, a 50% or greater reduction in seizure activity was achieved in 63% of those with OSA treated with cPAP but in only 14% of those with OSA that did not receive cPAP. In the group without OSA, 44% achieved a 50% or greater reduction in seizure activity from baseline on cPAP.
“Epilepsy patients without OSA also appeared to benefit from cPAP, although prospective data are needed to further explore this observation,” Dr. Somboon said.
All patients remained on antiepileptic drugs over the course of study, and the drug levels were not different between groups, according to Dr. Somboon. About half of all three groups were seizure free in the 6 months prior to cPAP. Those with OSA who received cPAP had a higher body mass index than did those who were not treated (34.6 vs. 31.1; P less than .001), but they were of similar age (47.6 vs. 47.9 years). Those without OSA who were treated with cPAP had a lower BMI (27.5; P less than .001) and were 10 years younger than were those with OSA (37.7 years; P less than .001). About two-thirds of all three groups had a history of focal seizures.
When expressed as odds ratios (OR), those treated for OSA had almost 10 times the likelihood of treatment success at 1 year (OR, 9.58; P less than .001), although being seizure free in the 6 months prior to cPAP had a 20-fold increased likelihood of treatment success (OR, 20.88; P less than .001).
Sleep disturbances and OSA are more common in patients with epilepsy than age-matched controls, according to Dr. Somboon, who cited published studies substantiating these statements. She noted that there are also previously published studies associating improved sleep hygiene, including improved sleep hygiene achieved with cPAP, with a reduced risk of seizure activity in epilepsy patients. However, at present there are no guideline recommendations for screening patients with epilepsy for OSA or other causes of impaired sleep, according to Dr. Somboon.
Although Dr. Somboon acknowledged that the data collected in this study cannot provide a definitive link between cPAP treatment, improved sleep, and reduced risk of seizure activity, this study does support these associations in the context of other evidence.
“We think clinicians should routinely screen patients with epilepsy for OSA and consider cPAP as a strategy to reduce seizure risk,” she said.
Dr. Somboon reported no financial relationships relevant to the study.
WASHINGTON – In patients with epilepsy, treatment of obstructive sleep apnea with continuous positive airway pressure may lead to substantial and sustained reductions in seizure activity, according to data presented at the annual meeting of the American Epilepsy Society.
The reduction in seizure activity with continuous positive airway pressure (cPAP) in patients with epilepsy contributes to other evidence that poor sleep quality is an important but preventable risk factor for seizures, according to Thapanee Somboon, MD, a research fellow at the Sleep Disorders Center at the Cleveland Clinic in Ohio.
In this study, which was characterized as the largest yet to evaluate the effect of cPAP on seizure activity, all 197 patients had epilepsy but only 122 had obstructive sleep apnea (OSA). Of those with OSA, 73 were treated with cPAP and 49 were not. An additional 75 patients with epilepsy but no OSA were also treated with cPAP. Seizure activity in all groups was evaluated over a period of 1 year.
Treatment success, defined as no seizure activity or at least a 50% reduction from baseline in seizure activity, was achieved in 85% of those with OSA treated with cPAP, 55% of those with OSA that did not receive cPAP, and 65% of those who were treated with cPAP but did not have OSA.
The difference was even greater among those with seizure activity in the 6 months prior to cPAP use. In these, a 50% or greater reduction in seizure activity was achieved in 63% of those with OSA treated with cPAP but in only 14% of those with OSA that did not receive cPAP. In the group without OSA, 44% achieved a 50% or greater reduction in seizure activity from baseline on cPAP.
“Epilepsy patients without OSA also appeared to benefit from cPAP, although prospective data are needed to further explore this observation,” Dr. Somboon said.
All patients remained on antiepileptic drugs over the course of study, and the drug levels were not different between groups, according to Dr. Somboon. About half of all three groups were seizure free in the 6 months prior to cPAP. Those with OSA who received cPAP had a higher body mass index than did those who were not treated (34.6 vs. 31.1; P less than .001), but they were of similar age (47.6 vs. 47.9 years). Those without OSA who were treated with cPAP had a lower BMI (27.5; P less than .001) and were 10 years younger than were those with OSA (37.7 years; P less than .001). About two-thirds of all three groups had a history of focal seizures.
When expressed as odds ratios (OR), those treated for OSA had almost 10 times the likelihood of treatment success at 1 year (OR, 9.58; P less than .001), although being seizure free in the 6 months prior to cPAP had a 20-fold increased likelihood of treatment success (OR, 20.88; P less than .001).
Sleep disturbances and OSA are more common in patients with epilepsy than age-matched controls, according to Dr. Somboon, who cited published studies substantiating these statements. She noted that there are also previously published studies associating improved sleep hygiene, including improved sleep hygiene achieved with cPAP, with a reduced risk of seizure activity in epilepsy patients. However, at present there are no guideline recommendations for screening patients with epilepsy for OSA or other causes of impaired sleep, according to Dr. Somboon.
Although Dr. Somboon acknowledged that the data collected in this study cannot provide a definitive link between cPAP treatment, improved sleep, and reduced risk of seizure activity, this study does support these associations in the context of other evidence.
“We think clinicians should routinely screen patients with epilepsy for OSA and consider cPAP as a strategy to reduce seizure risk,” she said.
Dr. Somboon reported no financial relationships relevant to the study.
WASHINGTON – In patients with epilepsy, treatment of obstructive sleep apnea with continuous positive airway pressure may lead to substantial and sustained reductions in seizure activity, according to data presented at the annual meeting of the American Epilepsy Society.
The reduction in seizure activity with continuous positive airway pressure (cPAP) in patients with epilepsy contributes to other evidence that poor sleep quality is an important but preventable risk factor for seizures, according to Thapanee Somboon, MD, a research fellow at the Sleep Disorders Center at the Cleveland Clinic in Ohio.
In this study, which was characterized as the largest yet to evaluate the effect of cPAP on seizure activity, all 197 patients had epilepsy but only 122 had obstructive sleep apnea (OSA). Of those with OSA, 73 were treated with cPAP and 49 were not. An additional 75 patients with epilepsy but no OSA were also treated with cPAP. Seizure activity in all groups was evaluated over a period of 1 year.
Treatment success, defined as no seizure activity or at least a 50% reduction from baseline in seizure activity, was achieved in 85% of those with OSA treated with cPAP, 55% of those with OSA that did not receive cPAP, and 65% of those who were treated with cPAP but did not have OSA.
The difference was even greater among those with seizure activity in the 6 months prior to cPAP use. In these, a 50% or greater reduction in seizure activity was achieved in 63% of those with OSA treated with cPAP but in only 14% of those with OSA that did not receive cPAP. In the group without OSA, 44% achieved a 50% or greater reduction in seizure activity from baseline on cPAP.
“Epilepsy patients without OSA also appeared to benefit from cPAP, although prospective data are needed to further explore this observation,” Dr. Somboon said.
All patients remained on antiepileptic drugs over the course of study, and the drug levels were not different between groups, according to Dr. Somboon. About half of all three groups were seizure free in the 6 months prior to cPAP. Those with OSA who received cPAP had a higher body mass index than did those who were not treated (34.6 vs. 31.1; P less than .001), but they were of similar age (47.6 vs. 47.9 years). Those without OSA who were treated with cPAP had a lower BMI (27.5; P less than .001) and were 10 years younger than were those with OSA (37.7 years; P less than .001). About two-thirds of all three groups had a history of focal seizures.
When expressed as odds ratios (OR), those treated for OSA had almost 10 times the likelihood of treatment success at 1 year (OR, 9.58; P less than .001), although being seizure free in the 6 months prior to cPAP had a 20-fold increased likelihood of treatment success (OR, 20.88; P less than .001).
Sleep disturbances and OSA are more common in patients with epilepsy than age-matched controls, according to Dr. Somboon, who cited published studies substantiating these statements. She noted that there are also previously published studies associating improved sleep hygiene, including improved sleep hygiene achieved with cPAP, with a reduced risk of seizure activity in epilepsy patients. However, at present there are no guideline recommendations for screening patients with epilepsy for OSA or other causes of impaired sleep, according to Dr. Somboon.
Although Dr. Somboon acknowledged that the data collected in this study cannot provide a definitive link between cPAP treatment, improved sleep, and reduced risk of seizure activity, this study does support these associations in the context of other evidence.
“We think clinicians should routinely screen patients with epilepsy for OSA and consider cPAP as a strategy to reduce seizure risk,” she said.
Dr. Somboon reported no financial relationships relevant to the study.
AT AES 2017
Key clinical point:
Major finding: In epilepsy patients and OSA, seizure activity was reduced by at least half in 63% of those treated with cPAP versus 14% of those who were not (P less than .001).
Data source: A retrospective study of 197 patients with epilepsy.
Disclosures: The presenter reported no financial relationships relevant to the study.