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The recommended pain medication for patients with myocardial infarction may interfere with clopidogrel, and a new effort targets readmissions.
Morphine Gets in the Way of Clopidogrel
When morphine and clopidogrel were administered at the same time, the antiplatelet didn't work as well, potentially explaining the previously observed association between morphine and increased mortality in patients with non-ST-segment elevation acute coronary syndrome.
In a randomized, crossover trial, , of the Medical University of Vienna, and colleagues gave 24 healthy individuals a 600-mg loading dose of clopidogrel followed by either placebo or 5 mg of morphine. The presence of morphine delayed resorption of clopidogrel, reduced plasma levels of its active metabolite to levels typically seen in intermediate or poor metabolizers, and impaired platelet inhibition.
"Co-administration of morphine and clopidogrel should likely be avoided, if possible," the researchers wrote in the . "More potent P2Y12 inhibitors may provide greater efficacy when morphine is injected, but their interaction with morphine should be evaluated in further trials."
Program Aims to Keep Patients Out of the Hospital
The American College of Cardiology has recruited the first hospitals to participate in its , for which AstraZeneca is the founding sponsor. The purpose of the program is to ease the transition from the hospital to home for patients admitted with MI or heart failure and to prevent readmissions.
At participating centers, a team consisting of nurses, pharmacists, social workers, and others will help patients manage the issues that arise shortly after a major cardiovascular event.
Eleven hospitals -- "chosen because of their commitment to quality demonstrated by participation in the National Cardiovascular Data Registry and Hospital to Home program," according to an -- have been brought on board so far, and the plan is to have a total of 35 participating centers by the end of 2015.
The effort comes in response to increased penalties levied by the Centers for Medicare & Medicaid Services for excessive readmission rates.
Trouble Buying Food Might Hike Heart Risk
Difficulty affording food might be a sign of poor cardiovascular outcomes to come, according to a study in .
Food security -- a measure of the ability to afford food -- has been associated with some cardiovascular risk factors in prior studies, although there is little information about its relationship with overall cardiovascular risk. , of the CDC's Division of Population Health in Atlanta, explored the issue using data from 10,455 adults, 20 and older, who participated in the National Health and Nutrition Examination Survey from 2003 to 2008.
Most of the participants (83.9%) had full food security, and 6.7%, 5.4%, and 3.6% had marginal, low, and very low food security, respectively. Among individuals ages 30 to 59 -- but not older individuals -- having very low food security was associated with more than double the likelihood of having a predicted 10-year cardiovascular risk exceeding 20% (prevalence ratio 2.38, 95% CI 1.31-4.31).
"Because little information is available about the cardiovascular health of food-insecure adults, additional research is needed in this area," Ford wrote.
Post-traumatic Stress Linked to Ischemia
Patients with post-traumatic stress disorder (PTSD) were more likely to have evidence of myocardial ischemia detected during exercise treadmill testing, according to a study in .
Although previous studies have identified associations between PTSD and increased cardiovascular risk, few studies have had objective measures of heart disease. , of the University of California San Francisco, and colleagues addressed that limitation in a study of 663 outpatients from two VA medical centers; 35% had PTSD.
Myocardial ischemia was identified in 17% of the patients with PTSD and 10% of those without PTSD. The difference remained after multivariate adjustment for several factors, including traditional cardiac and psychosocial risk factors (OR 2.24, 95% CI 1.20-4.18), which suggests that "additional mechanisms linking PTSD and ischemia should be explored," the authors wrote. The findings were similar when patients with prior cardiovascular disease were excluded.
"The association of PTSD and ischemia among patients without known cardiovascular disease highlights an opportunity for early interventions to prevent progression of cardiovascular disease," Cohen and colleagues wrote.
New Classification for Cardiomyopathy
A new classification system and to assist physicians in the diagnosis and management of patients with cardiomyopathy has been developed.
The system is called MOGE(S), which stands for the five characteristics included in the scheme:
- Morpho-functional
- Organ/system involvement
- Genetic
- Etiological annotation
- Stage (optional)
MOGE(S) was developed by a committee chaired by , of the Icahn School of Medicine at Mount Sinai in New York City, who reported the finished product in the and Global Heart, the journal of the World Heart Federation, which endorsed the new scheme.
MOGE(S) "will allow better understanding of the disease, allow easier communication among physicians, and help develop multicenter/multinational registries to promote research in diagnosis and management of cardiomyopathies," the authors wrote.