Clinical Implications of the New York Heart Association Classification.

Background The New York Heart Association (NYHA) classification has served as a fundamental tool for risk stratification of heart failure (HF) and determines clinical trial eligibility and candidacy for drugs and devices. However, its ability to adequately stratify risk is unclear. Methods and Results To compare NYHA class with objective assessments and survival in patients with HF, we performed secondary analyses of 4 multicenter National Institutes of Health-funded HF clinical trials that included patients classified as NYHA class II or III: TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist), DIG (The Effect of Digoxin on Mortality and Morbidity in Patients With Heart Failure), HF-ACTION (Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure), and GUIDE-IT (Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart Failure). Twenty-month cumulative survival was compared between classes using Kaplan-Meier curves and the log rank test. NT-proBNP (N-terminal pro-B-type natriuretic peptide), Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, 6-minute walk distances, left ventricular ejection fraction, and cardiopulmonary test parameters were compared using Wilcoxon rank sum tests and percentage overlap using kernel density estimations. Cumulative mortality varied significantly across NYHA classes and HF clinical trials (likelihood ratio, P<0.001). Mortality at 20 months for NYHA class II ranged from 7% for patients in HF-ACTION to 15% in GUIDE-IT, whereas mortality for NYHA class III ranged from 12% in TOPCAT to 26% in GUIDE-IT. There was substantial percentage overlap in values for NT-proBNP levels (79% and 69%), KCCQ scores (63% and 54%), 6-minute walk distances (63% and 54%), and left ventricular ejection fraction (88% and 83%). Similarly, there was substantial overall in values for minute ventilation-carbon dioxide production relationship (71%), maximal oxygen uptake (54%), and exercise duration (53%). Conclusions The NYHA system poorly discriminates HF patients across the spectrum of functional impairment. These findings raise important questions about the need for improved phenotyping of these patients to facilitate risk stratification and response to interventions.

Increasing women's leadership in academic medicine: report of the AAMC Project Implementation Committee.

The AAMC's Increasing Women's Leadership Project Implementation Committee examined four years of data on the advancement of women in academic medicine. With women comprising only 14% of tenured faculty and 12% of full professors, the committee concludes that the progress achieved is inadequate. Because academic medicine needs all the leaders it can develop to address accelerating institutional and societal needs, the waste of most women's potential is of growing importance. Only institutions able to recruit and retain women will be likely to maintain the best housestaff and faculty. The long-term success of academic health centers is thus inextricably linked to the development of women leaders. The committee therefore recommends that medical schools, teaching hospitals, and academic societies (1) emphasize faculty diversity in departmental reviews, evaluating department chairs on their development of women faculty; (2) target women's professional development needs within the context of helping all faculty maximize their faculty appointments, including helping men become more effective mentors of women; (3) assess which institutional practices tend to favor men's over women's professional development, such as defining "academic success" as largely an independent act and rewarding unrestricted availability to work (i.e., neglect of personal life); (4) enhance the effectiveness of search committees to attract women candidates, including assessment of group process and of how candidates' qualifications are defined and evaluated; and (5) financially support institutional Women in Medicine programs and the AAMC Women Liaison Officer and regularly monitor the representation of women at senior ranks.

Takotsubo syndrome.

The Takotsubo Syndrome was first described by Japanese investigators approximately 20 years ago and has been increasingly recognized in all countries. It occurs almost exclusively in postmenopausal women and is triggered by a severe emotional stress. Severe chest pain is common and the electrocardiogram often mimics that seen with an acute myocardial infarction. An echocardiogram or a left ventriculogram resembles a Takotsubo, a Japanese octopus fishing pot. In Japanese 'Takotsubo' means a 'fishing pot for trapping octopus.' These traps have a round bottom with a narrow neck. When the octopus enters the Takotsubo it is most often trapped while the fisherman pulls the device to the surface. The syndrome is reversible and over the next several weeks to months all electrocardiographic and echocardiographic changes revert to normal. It is likely that the emotionally induced catecholamine surge in an estrogen-deficient woman causes a combination of epicardial coronary artery constriction, constriction of the myocardial microvasculature, and direct cardiomyocyte toxicity producing a temporary stunning effect on the left ventricular myocardium.

La aspirina: reduccion del riesgo de ataque cardiaco

Resultados a los que arribó el estudio de salud de médicos realizado en los EEUU sobre la aplicación de dosis bajas de aspirina para la prevención primaria del infarto

La aspirina: reduccion del riesgo de ataque cardiaco

Resultados a los que arribó el estudio de salud de médicos realizado en los EEUU sobre la aplicación de dosis bajas de aspirina para la prevención primaria del infarto