Innovations in cardiac care - February 2, 2014

Courtesy of NWI Times

The year 2013 saw some promising advances in cardiovascular drugs and treatments — good news for doctors and their patients. According to northwest Indiana-area cardiologists, this year should offer patients more comfort and hope and doctors a bigger arsenal to combat the threats of heart disease and stroke.

New medicines to prevent dangerous blood clots are “A big deal,” said Dr. Sabrina Akrami, cardiologist and cardiovascular physician at Ingalls Health System in Harvey, Ill., said, “New anticoagulant medicines are very exciting. People with heart issues like atrial fibrillation have risk for a blood clot and stroke. Benefits include fewer blood tests than for Coumadin or warfarin and patients don’t need to avoid certain foods that have a negative effect with the older drugs,” Akrami said.

Dr. Michael Wheat, director of the Advanced Heart Failure Program at Porter Regional Hospital in Valparaiso, Ind., agreed. “Newer drugs are very promising for treating atrial fibrillation. They don’t require monthly blood tests because they’re working better and are more stable.”

Coumadin and warfarin are still good medicines for most people who have been on them a long time and do well, but for most of my newer patients I’ll use the newer drugs,” said Akrami. Another benefit is a shorter hospital stay. “The newer ones usually will kick in with 24 hours, so you can give one or two doses and usually send the patient home the same day.”

Wheat said one problem is “The newer drugs cost quite a bit and many patients can’t even afford the co-pays.”

Another drawback: “If patients develop a life-threatening bleeding issue, we can reverse that quickly with warfarin or Coumadin, but the newer ones don’t have an antidote,” said Akrami

New devices

Mechanical devices are helping cardiologists discover trouble spots.

“The infrared catheter we’re using identifies vulnerable plaque,” said Dr. Andre Artis, Methodist Hospital Director of cardiology for the Northlake campus, and co-director of Methodist Hospital Cardiology Service Live. “It allows us to look at the inside of the blood vessel wall, and that’s good for the patient who is likely to develop heart disease. It identifies the most vulnerable area” of fatty deposits, which eventually irritate and erode the inside of the vessel and fat is released into the bloodstream. The body tries to defend against it by sending a blood clot that can cause a heart attack.

“We are also able to perform better procedures to remove blood clots in patients,” said Dr. Sammi Dali, heart specialist and director of cardiovascular medicine at Franciscan Alliance St. Anthony Hospital in Michigan City, Ind. “A catheter is put in and medicine is infused and spread to the clot to dissolve it more.

“Other procedures include placing a stent for a clogged carotid artery. St. Anthony’s also does ablation for atrial fibrillation, which destroys where the arrhythmia may be coming from.”

What’s in, what’s out

For some patients it’s best to start all over with an LVAD — an artificial heart. “That’s one of the most exciting things,” said Wheat. Originally connected to a large external apparatus, “Artificial hearts are becoming quite small and battery operated.”

Rethinking outcomes

Sometimes what’s new is what’s not being used. “I have not been using a lot of niacin in the past year or so,” said Wheat. “Just a few years ago it was thought to be wonderful for reducing plaque, but we’re finding patients aren’t at less risk with it.”

“It’s the side effects, like flushing,” that patients don’t like, said Artis. “Statin (drugs) are better, good at raising the good cholesterol and lowering the bad cholesterol like triglycerides.”

Said Dali, “When you reach a point where the medicines are working well, adding new medicine (like niacin) isn’t helping and you might have more side effects.”

Understanding genetic heart disease can guide treatment. We perform genetic testing after coronary angioplasty,” said Community Hospital’s Dr. Samer Abbas. The interventional cardiologist explained the testing is “to make sure that patients will response in an appropriate way to anti-platelet therapy,” a regimen of powerful anticlotting drugs.

“Determining medications depends on genetic variations,” said Dali. “The genetics of heart disease is still a work in progress. It will help us understand treatment depending on those variations.”

Other points to ponder:

• “We’re learning that even a low-level inflammation can trigger the buildup of plaque leading to heart attacks,” said Wheat.

• “We know heart disease is an inflammatory process, so the presence of intestinal microbes (found in red meat) can contribute to developing heart disease.” — Dali

• “They’re coming out with newer and better stents; they last longer and have medicine in them.” — Akrami

• “The future holds hope for better blood pressure control. Current trials will likely lead to making a new device available in close to two years that will cause damage to the nerve that sends the message to constrict vessels, which raises blood pressure.” — Artis

“It’s exciting, because it’s better for patients to have more options,” said Akrami.