8:30 a.m. - Abstract #1502 (poster) - Clot-busting drug shows promise in unresponsive cardiac arrest. A trial of the clot-busting drug tenecteplase (TNK) suggests that it may improve outcomes in some of the most difficult cases of cardiac arrest. Fast-acting TNK was given to 30 cardiac arrest patients (66 percent male, average age 59) who did not respond initially to advanced cardiac life support. A return of spontaneous circulation (ROSC) occurred in 30 percent, 17 percent survived to be admitted to intensive care and 7 percent (1 of 22) survived to hospital discharge. Time to getting the drug averaged 31 minutes, and time from drug administration to ROSC averaged 7.8 minutes. The researchers concluded that TNK use in cardiac arrest is associated with ROSC and with survival to hospital discharge with good neurologic function, even in patients who initially fail to respond to resuscitation efforts. "Prospective controlled trials are indicated to evaluate this promising new therapy," said the researchers.
4 p.m. Abstract #3266 - Pharmacist-managed cardiovascular risk reduction program works. Published data indicate that despite the short-term success of programs that make sure all patients with cardiovascular disease are treated according to clinical guidelines, recidivism can still be as high as 50 percent one year after treatment begins. Recidivism occurs when patients receive orders for therapy in accordance with guidelines, but then are "lost" to follow-up and may not reach treatment goals. Kaiser Permanente Colorado reports that its clinical pharmacist-managed cardiovascular risk reduction service (CPCRS) reduces recidivism among CVD patients. The service uses pharmacy specialists to manage patients as well as a patient-tracking system to ensure patients reach treatment goals. The Kaiser program tracked cholesterol-lowering treatment among 8,000 CVD patients (70 percent male) for about 2.5 years. Kaiser reports that 72.8 percent achieved low-density lipoprotein (LDL) levels below 100 mg/dl. The majority of these patients (76.4 percent) were receiving therapy with statins (a class of cholesterol-lowering drugs) alone, 7.8 percent were receiving combination therapy, and 12.7 percent received no therapy. However, researchers noted women did not achieve target cholesterol levels as well as men. The findings were unique in that they were sustainable over time and reduced recidivism. The researchers said their results indicate that a pharmacist-managed service, in conjunction with a patient-tracking system, can achieve results as outlined by programs such as the American Heart Association's Get With The GuidelinesSM. Another study, Abstract #3334, finds that in one Minnesota county, only 55 percent of recovering heart attack patients took part in rehabilitation, despite evidence that participation enhances survival. Females and older patients were less likely to join the programs.