AHA Scientific Statement Research Articles

“Are you beside the patient now?” Barriers to telephone assisted CPR in an Irish Ambulance Control setting

Purpose of study: Early CPR through the use of telephone CPR has been identified as an important factor in the strengthening chain of survival. 1 2012 AHA Scientific Statement, Emergency Medical Service Dispatch Cardiopulmonary ResuscitationPre-arrival Instructions to Improve Survival From Out-of-Hospital Cardiac Arrest. Circulation. 2012; 125: 648-655 Crossref PubMed Scopus (159) Google Scholar To initiate t-CPR the caller must first be beside the patient. This study examined if callers were with the patient at the time of making the call. The use of mobile phones has the advantage over fixed line phones, by allowing the caller to be close to the patient therefore increasing the reliability of the information about the patient's condition.

AHA Scientific Statement — Secondary Prevention After CABG

Sponsoring Organization: American Heart Association Target Audience: Cardiologists, cardiac surgeons, and cardiac anesthesiologists Background and Objective This scientific statement expands on 2011 guidelines from the American Heart Association and American College of Cardiology Foundation that focused on secondary prevention in general. This new guideline is specific to patients undergoing coronary artery bypass grafting (CABG). Key Points Antiplatelet Therapies

Abstract 19519: Closing the Cardiac Intensive Care Unit: Cost-Savings Associated with a “Closed” versus “Open” Model of Critical Care Delivery

Introduction: A recent AHA scientific statement highlighted the evolving complexity of critical care delivery for cardiac patients, and the emerging need for novel staffing models. In this document, a “closed” unit structure - in which a dedicated intensive care team treats all admitted patients - was specifically advocated. However, in light of escalating critical care costs within US hospitals, there is a pressing need to better understand the financial impact of different care platforms. Methods: In July 2013, our academic cardiac intensive care unit (CICU) was transitioned from an “open” to a “closed” model of care. In a before-and-after study design, consecutive admission records were reviewed from Aug 2012-Dec 2012 (“open” unit) and from Aug 2013-Dec 2013 (“closed” unit). Routinely collected financial and demographic data were examined, and the impact of case-mix index (CMI) on cost was evaluated. Results: In the “open” and “closed” models, there were 333 patient-visits accounting for 1,891 patient-days and 397 visits accounting for 2,558 patient-days, respectively. While demographics, payor mix, and fixed vs. variable cost distribution were unchanged (Table), the total cost-per-patient and cost-per-patient-day were lower within the “closed” CICU ($8,676 vs. $10,118 and $1,346 vs. $1,782, respectively) despite a greater average CMI (4.6 vs. 3.6). Total and 30d CICU readmission rates were also lower in the “closed” unit (Table). Readmissions in the "closed" unit resulted in greater cost-per-patient-day than new admits ($1,576 vs. $1,339). Conclusions: A “closed” CICU staffing model is associated with lower health care costs. This may be partly explained by lower CICU recidivism, but likely is multifactorial. Additional study will focus on the influence of resource use, critical care delivery to key sub-populations, and the development of effective strategies for further cost containment.

Beta-Blockers Lose Luster for Hypertension Therapy

Beta-Blockers Lose Luster for Hypertension Therapy

Should vascular closure devices be the method of choice for closing percutaneous coronary intervention patients?

Clin. Pract. (2014) 11(3), 269–271 ISSN 2044-9038 part of Vascular access site complications are an infrequent but persistent complication following cardiac catheterization and percutaneous coronary intervention (PCI). These complications can lead to significant morbidity and mortality with an associated increase in healthcare costs. The use of radial artery access is effective in decreasing vascular site complications. However, a transfemoral approach is still utilized in the majority of patients undergoing cardiac catheterization and coronary intervention. Rates of vascular access site complications and bleeding rates have improved temporally, with the current rate of access site-related bleeding complications following PCI at approximately 2% [1–3]. While more contemporary anticoagulation strategies may account for some of this improvement, the increased use of vascular closure devices (VCDs) likely also plays a role. Since introduction in the early 1990s VCDs have become an increasingly common alternative to manual compression as a means of achieving access site hemostasis. While digital compression remains the ‘gold standard’, other manual compression strategies include devices with both clamp-based and pneumatic compression systems. Distinct from these compression-based strategies, multiple different VCDs have been developed with significant heterogeneity among devices with rapid technological evolution and advancement. These devices typically employ sutures, clips or plugs to achieve arterial hemostasis. Currently available and frequently used devices include the PercloseProGlide (Abbott Vascular, CA, USA) suture-mediated closure system, the StarClose (Abbott Vascular) extravascular nitinol-clip closure system, the Angio-Seal (St Jude Medical, MN, USA) bioabsorbable collagen-plug closure system and the Mynx (AccessClosure) polyethylene glycol-based sealant system. The exact details and specifications of these individual platforms are discussed elsewhere [4,5]. VCDs are typically utilized to provide the benefit of reduced duration of bed rest and arterial compression. Other benefits include improved patient comfort, satisfaction and convenience while affording increased staff availability. VCD use is also expanding as larger caliber arterial access for structural interventions becomes more common, with suture-based preclosure playing an integral role in access management for transcatheter aortic valve replacement [6]. Current guidelines, however, continue to emphasize the use of VCDs primarily for patient comfort and convenience. A 2010 AHA Scientific Statement on the use of arteriotomy closure devices, as well as a 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, both recommend the use of VCDs to achieve more rapid hemostasis and ambulation following transfemoral arterial access after accounting for patient body habitus, arteriotomy location, sheath size and presence of systemic disease (Class IIa, level of evidence [LOE]: B), but not for the purposes of decreasing vascular complications, including bleeding (Class III, LOE: B) [7,8]. Should vascular closure devices be the method of choice for closing percutaneous coronary intervention patients?

G366 Service improvement in paediatric renal biopsies

AimsThe current national drive to build robust paediatric nephrology networks recommends services cater for the needs of the family and minimise time away from the home1. Families often have to...

Response to Evidence for Upgrading the Ratings for Transcendental Meditation: Response to AHA Scientific Statement on Alternative Methods and BP

We thank Dr Schneider1 for his positive comments and for raising important issues on our recent scientific statement. We highlight that when our conclusions differ it is a result of variances in perspective and not from any bias against transcendental meditation (TM). The writing group had spirited discussions on the level of evidence (LOE) and class of recommendation for each modality. Reaching consensus is often not as simple as following the exact wording of the writing-group guidance table.2 We did indeed review 11 randomized controlled trials and 3 meta-analyses, while acknowledging some limitations of the AHRQ (Agency for Healthcare Research & Quality) report,3 before conferring on …

Evidence for Upgrading the Ratings for Transcendental Meditation: Response to AHA Scientific Statement on Alternative Methods and BP

HomeHypertensionVol. 62, No. 6Evidence for Upgrading the Ratings for Transcendental Meditation: Response to AHA Scientific Statement on Alternative Methods and BP Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBEvidence for Upgrading the Ratings for Transcendental Meditation: Response to AHA Scientific Statement on Alternative Methods and BP Robert H. Schneider Robert H. SchneiderRobert H. Schneider Institute for Natural Medicine and Prevention, Maharishi University of Management, Fairfield, IA Search for more papers by this author Originally published14 Oct 2013https://doi.org/10.1161/HYPERTENSIONAHA.113.02115Hypertension. 2013;62:e42Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2013: Previous Version 1 To the Editor:The AHA Statement on alternative approaches to lowering blood pressure (BP) is a groundbreaking effort to inform physicians and public of their options.1 As principal investigator on several randomized controlled trials (RCTs) on the Transcendental Meditation (TM) technique and other alternative interventions for BP and cardiovascular disease, I suggest 5 points for consideration.First, an alert reader notices a discrepancy between the level of evidence (LOE) of B for research on TM and the published evidence. The Statement defines LOE B as “Data derived from a single randomized controlled trial or nonrandomized studies.” However, the Statement surveys 11 RCTs with >1200 subjects and 2 well-conducted meta-analyses on TM and BP.2–5 Moreover, there are multiple hard event outcome trials on TM that are not available for other nonpharmacologic approaches.5,6Most of the RCTs published in the past 20 years have been competitively reviewed and externally funded, rigorously conducted in collaboration with leading academic medical centers, blinded, independently monitored, published in peer-reviewed journals, and replicated.4 The 2012 cardiovascular disease event trial was analyzed independently.5 BP effects of TM have been confirmed by numerous investigators, in multiple populations and with ambulatory monitoring.2,3,6Second, on page 18, it was suggested that TM is less practical, and on page 19, TM was omitted from the conclusion although it received a IIb recommendation (classification of recommendation [COR]), the same or higher than other methods in the list. Practicality has not been an issue in RCTs on TM conducted at 10 clinical sites with diverse sex, race/ethnicity, socioeconomic status, age, and geographic populations.2,3,6 Subjects generally report the practice is easy, relaxing, enjoyable, and convenient. Certified TM instructors are available widely. In the trials, the standard TM course of 1.5 hours/d over 5 or 6 days was implemented.2–6My impression is that both the LOE B and the COR IIb ratings were based only partially on objective evidence and that additional, nonprespecified judgments were applied. Ideally, the Statement would be transparent about subjective input and systematically apply prespecified criteria.Third, page 6 reads: “As a result of the paucity of data, we are unable to recommend a specific method of practice when TM is used for the treatment of high BP.” This implies there is >1 method of TM, but there is only 1. As with other behavioral therapies, there is consideration of individual patient characteristics. However, instruction is protocolized and standardized.2–6Fourth, the summary states that TM "modestly lowers BP"; however, the effect is the same order of magnitude as aerobic exercise and other nonpharmacologic methods recommended by the Statement.1Fifth, Table I indicates that COR is based on size of treatment effect, whereas the text suggests that LOE and clinical practicality are also considered. Given that the magnitude of treatment effect is similar to other recommended methods, that LOE meets criteria for level A, and the TM techniques demonstrated practicality and generalizability, it seems that COR of IIa should be considered as a more appropriate clinical rating.Overall, the AHA Statement is to be commended. We think that these clarifications will further enhance its veracity and clinical use.Robert H. SchneiderInstitute for Natural Medicine and PreventionMaharishi University of ManagementFairfield, IADisclosuresDr Schneider is a consultant to Maharishi Foundation USA, a nonprofit educational organization.

血管奇形 脳動静脈奇形の至適治療方針

The treatment goal for cerebral AVMs is mainly to prevent hemorrhage. Bleeding risks of cerebral AVMs depend on several factors such as size/location of the nidus, types of presentation, and angiographical cure does not necessarily mean no risk of hemorrhage. The treatment strategy based on Spetzler-Martin grading is proposed in several guidelines: Grade I, II, and III are a therapeutic target; Grade IV and V should be treated conservatively. According to AHA Scientific Statement, surgical extirpation should be conceded for Spetzler-Martin Grade I and II, and surgical extirpation with preoperative feeder embolization is often effective for Spetzler-Martin Grade III, but single surgical extirpation is not recommended for Spetzler-Martin Grade IV and V. Although low grade AVMs are reported to be amenable to extirpation with low morbidity, patient selection bias seems to reduce estimates of risk. It is difficult to decide the treatment only by the Spetzler-Martin grading system because of degraded ability of AVM patients to communicate, and wide ranges of risk of hemorrhage and risk of extirpation in each patient. Treatments should be individualized using adequate pre-, and intra-operative assessment of risk.

脳動静脈奇形の治療方針

The treatment of cerebral AVMs aims to prevent hemorrhage, control seizures and ameliorate neurological deficits. Of these, prevention of hemorrhage is the most important. There is no established treatment strategy for the lesion. The treatment strategy based on Spetzler-Martin grading is that Grades I, II, and III are a therapeutic target but Grades IV and V should be treated conservatively. According to an AHA Scientific Statement, surgical extirpation should be conceded for Spetzler-Martin Grades I and II, and surgical extirpation with preoperative feeder embolization is often effective for Spetzler-Martin Grade III, but single surgical extirpation is not recommended for Spetzler-Martin Grades IV and V. However, it is difficult to decide the treatment based only on Spetzler-Martin grading system, and applied treatments should be individualized even for patients with cerebral AVMs of the same size and location because each patient has a unique clinical condition and medical background. In this paper, we analyze clinical date of patients with cerebral AVMs to estimate annual bleeding rate and re-bleeding rate, morbidity and mortality rates of surgical extirpation, and also discuss decision making of any treatment for patients without a history of hemorrhage.

Correction

HomeCirculationVol. 118, No. 12Correction Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection Originally published16 Sep 2008https://doi.org/10.1161/CIRCULATIONAHA.108.190868Circulation. 2008;118:e497This article corrects the followingInfective EndocarditisIn the AHA Scientific Statement, “Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association,” by Baddour et al (Circulation. 2005;111:e394–e434), the following correction is needed:In Table 14 on page e417 under the heading for “Suspected Bartonella, culture negative,” the entry for doxycycline currently reads: “200 mg/kg per 24 h IV/PO in 2 equally divided doses.” It should read “200 mg/24 h IV or PO in 2 equally divided doses.”This correction has been made to the current online version of the article, which is available at http://circ.ahajournals.org/cgi/content/full/111/23/e394. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesInfective EndocarditisLarry M. Baddour, et al. Circulation. 2005;111:e394-e434 September 16, 2008Vol 118, Issue 12 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.108.190868 Originally publishedSeptember 16, 2008 PDF download Advertisement

The AHA Scientific Statement of MRI in Patients with Devices: Neat, but Incomplete. Unwise and Unsupported

The AHA Scientific Statement of MRI in Patients with Devices: Neat, but Incomplete. Unwise and Unsupported

Recommendations for Blood Pressure Measurement in Humans: An AHA Scientific Statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee

Recommendations for Blood Pressure Measurement in Humans: An AHA Scientific Statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee

Response

Response

February 10, 2004

HomeCirculationVol. 109, No. 5February 10, 2004 Free AccessAnnouncementPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAnnouncementPDF/EPUBFebruary 10, 2004 James T. Willerson, MD James T. WillersonJames T. Willerson Search for more papers by this author Originally published10 Feb 2004https://doi.org/10.1161/circ.109.5.557Circulation. 2004;109:557Editor’s Comments for the Current Issue of CirculationCirculation. 2004;109:557–693We have devoted much of the current issue of Circulation to the problems of cardiovascular disease in women. The cover figure, three Focused Perspectives, the Clinician Update, eight of the Clinical Investigation and Reports papers, and the AHA Scientific Statement address problems of clinicial relevance to women’s cardiovascular health. We hope the issue will be useful to our readers.CIRCULATION’S NEWEST FEATURE!!!ONLINE SUBMISSION AND PEER REVIEW IS NOW AVAILABLEhttp://circ.ahajournals.orgORhttp://submit-circ.ahajournals.orgWill take you there.…Cardiovascular NewsImages in Cardiovascular MedicineAvoiding Papillary Muscle Infarction With Myocardial Contrast Echocardiographic Guidance of Nonsurgical Septal Reduction Therapy for Hypertrophic Obstructive CardiomyopathySherif F. Nagueh, MD; Nasser M. Lakkis, MD; Katherine J. Middleton, RCT; Jennifer Franklin, RN; William H. Spencer III, MD (Circulation. 2004; 109:e27–e28Google Scholar.) Correspondence (Circulation. 2004; 109:e29–e37Google Scholar.) Previous Back to top Next FiguresReferencesRelatedDetails February 10, 2004Vol 109, Issue 5 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.109.5.557 Originally publishedFebruary 10, 2004 PDF download Advertisement

Correction

HomeCirculationVol. 107, No. 3Correction Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection Originally published28 Jan 2003https://doi.org/10.1161/01.CIR.0000054601.17182.B0Circulation. 2003;107:512This article corrects the followingFish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular DiseaseAfter the publication of the AHA Scientific Statement “Fish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular Disease” by Kris-Etherton et al, which appeared in a previous issue of the journal (Circulation. 2002;106:2747–2757), the following errors were noted in Table 3. First, two other sources for the fatty acid composition of fish should have been included.1,2 Secondly, the footnote to “cod liver oil” should have read, “This intake of cod liver oil would provide approximately the Recommended Daily Allowance (RDA) of vitamin A and twice the RDA for vitamin D.” Finally, the EPA+DHA content for four fish was given incorrectly, and should have been as follows:TABLE 3. Amounts of EPA+DHA in Fish and Fish Oils and the Amount of Fish Consumption Required to Provide ≈1 g of EPA+DHA per DayFishEPA+DHA Content, g/3-oz Serving Fish (Edible Portion) or g/g OilAmount Required to Provide ≈1 g of EPA+DHA per Day, oz (Fish) or g (Oil)Sockeye salmon1.052.5 ozEastern oysters0.953 ozAtlantic cod0.1323 ozPacific cod0.2412.5 ozReferences1 Hepburn FN, Exler J, Weihrauch JL. Provisional tables on the content of omega-3 fatty acids and other fat components of selected foods. J Am Diet Assoc. 1986; 86: 788–793.Google Scholar2 Ackman RG. Nutritional composition of fats in seafoods. Prog Food Nutr Sci. 1989; 13: 161–289.Google ScholarIn the “ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina—Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina)” by Gibbons et al that appeared in the January 7/14, 2003, issue of Circulation (Circulation. 2003;107:149–158), page numbers were not included in the Guideline’s internal Table of Contents. The complete corrected Guideline follows this page. The page numbers shown are consistent with the pagination of the January 7/14 issue. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Ramprasath V, Thandapilly S, Yang S, Abraham A, Jones P and Ames N (2015) Effect of consuming novel foods consisting high oleic canola oil, barley β-glucan, and DHA on cardiovascular disease risk in humans: the CONFIDENCE (Canola Oil and Fibre with DHA Enhanced) study – protocol for a randomized controlled trial, Trials, 10.1186/s13063-015-1014-5, 16:1, Online publication date: 1-Dec-2015. Related articlesFish Consumption, Fish Oil, Omega-3 Fatty Acids, and Cardiovascular DiseasePenny M. Kris-Etherton, et al. Circulation. 2002;106:2747-2757 January 28, 2003Vol 107, Issue 3 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000054601.17182.B0 Originally publishedJanuary 28, 2003 PDF download Advertisement

Critical Issues in the Use of Psychotropic Medication and Prolonged QTc

Free AccessCritical Issues in the Use of Psychotropic Medication and Prolonged QTcDorothy E. Stubbe and Lawrence ScahillDorothy E. Stubbe1. Child and adolescent psychiatry residency training, Yale University School of Medicine Child Study Center.Search for more papers by this author and Lawrence Scahill2. Yale University School of Nursing and Yale Child Study Center.Search for more papers by this authorPublished Online:June 2005https://doi.org/10.1521/capn.7.5.6.22724PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutSuggested ReadingsDubin , D. (2000). Rapid Interpretation of EKG's (6th Edition), Cover Publishing Company, Tampa FL. Google ScholarGlassman , A. H., & Bigger, J. T. (2001). Antipsychotic drugs: Prolonged interval, torsade de pointes, and sudden death. American Journal of Psychiatry, 158, 1774–1782. Crossref, Google ScholarGralinski , M. R. (2000). The assessment of potential for QT interval prolongation with new pharmaceuticals: Impact on drug development. Journal of Pharmacological and Toxicological Methods, 43, 91–99. Crossref, Google ScholarGutgesell , H., Atkins, D., Barst, R., Muck, M., Franklin, W., Humes, R., Ringel, R., Shaddy, R., & Taubert, K. (1999). AHA scientific statement: Cardiovascular monitoring of children and adolescents receiving psychotropic drugs. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1047–1050. Crossref, Google ScholarKeating , M. T., & Sanguinetti, M. D. (1996). Molecular genetic insights into cardiovascular disease. Science, 272, 681–685. Review. Crossref, Google ScholarOesterheld , J. R., & Shader, R. I. (1998). Cytochromes: A primer for child and adolescent psychiatrists. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 447–450. Crossref, Google ScholarPopper , C. W, & Zimnitzky, B. (1995). Sudden death putatively related to desipramine treatment in youth: A fifth case and a review of speculative mechanisms. Journal of Child and Adolescent Psychopharmacology, 5, 283–300. Crossref, Google ScholarReilly , J. G., Ayis, S. A., Ferrier, I. N., & Jones, S. J., & Thomas, S. H. L. (2000). QT-interval abnormalities and psychotropic drug therapy in psychiatric patients. Lancet, 355, 1048–1052. Crossref, Google ScholarUnited States Food and Drug Administration. Available at: http://www.verity.fda.gov/search97cgi/s97cgi.exe. Accessed September 4th, 2001. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 7Issue 5Oct 2002 Information© Guilford Publications Inc.PDF download

AHA Scientific Statement: Summary of the Scientific Conference on Dietary Fatty Acids and Cardiovascular Health: Conference Summary From the Nutrition Committee of the American Heart Association

Conference Planning and Writing Committee:Penny Kris-Etherton, PhD, Stephen R. Daniels, MD, PhD, Robert H. Eckel, MD, Marguerite Engler, PhD, RN, Barbara V. Howard, PhD, Ronald M. Krauss, MD, Alice H. Lichtenstein, DSc, Frank Sacks, MD, Sachiko St. Jeor, PhD, Meir Stampfer, MD, DrPH, For the American Heart Association Nutrition Committee Speakers and Discussants:, Robert H. Eckel, MD, Scott M. Grundy, MD, PhD, Lawrence J. Appel, MD, MPH, Tim Byers, MD, Hannia Campos, PhD, Greg Cooney, PhD, Margo A. Denke, MD, Barbara V. Howard, PhD, Eileen Kennedy, DSc, Ronald M. Krauss, MD, Penny Kris-Etherton, PhD, Alice H. Lichtenstein, DSc, Peter Marckmann, MD, DSc, Thomas A. Pearson, MD, PhD, Gabriele Riccardi, MD, Lawrence L. Rudel, PhD, Mike Rudrum, PhD, Frank Sacks, MD, Daniel T. Stein, MD, Russell P. Tracy, PhD, Virginia Ursin, PhD, Robert A. Vogel, MD, Peter L. Zock, PhD, AHA Members:, Terry L. Bazzarre, PhD and Julie Clark, AHA Staff

AHA Scientific Statement: AHA Dietary Guidelines: Revision 2000: A Statement for Healthcare Professionals From the Nutrition Committee of the American Heart Association

AHA Scientific Statement: AHA Dietary Guidelines: Revision 2000: A Statement for Healthcare Professionals From the Nutrition Committee of the American Heart Association

Supplement to the AHA Guidelines for the Management of Transient Ischemic Attacks

To the Editor: I must respectfully disagree with the recent AHA Scientific Statement on the management of transient ischemic attacks.1 First, the inclusion of the combination antiplatelet agent extended release dipyridamole and aspirin (ERDP/ASA) as a “recommended therapy” is premature. The current data are insufficient to definitively establish that ERDP/ASA offers anything in addition to aspirin alone. Although the results of the ESPS-2 trial2 of ERDP/ASA are encouraging and generate great optimism for this and other combination strategies, serious questions remain. The ESPS-2 results are highly inconsistent with previous data on 5317 patients treated with the combination.3 Although a heterogeneous set of trials, these data were sufficient to all but abandon use of dipyridamole in the 1980s. Further, the high rate of subject dropout,2 the lack of …