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Cardiology > Prevention


WEIGHT LOSS PILL WARNING; VERY LOW LDL-C STAYS COURSE; FUNGAL GROWTH ON TAVR
VALVE


— RECENT DEVELOPMENTS OF INTEREST IN CARDIOVASCULAR MEDICINE

by Nicole Lou, Senior Staff Writer, MedPage Today February 14, 2023


MedpageToday

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FDA warns consumers that Alfia Weight Loss Capsulesopens in a new tab or window
contain sibutramine, a controlled substance known to pose cardiac risks to
certain people.

Taking LDL cholesterol all the way down to <20 mg/dLopens in a new tab or window
was associated with reduced cardiovascular events and no safety signals around 5
years into FOURIER-OLE. (Circulation)

Modeling predicts risk of long-term atherosclerotic cardiovascular disease for a
given young adult over a horizon of 30 yearsopens in a new tab or window.
(Journal of the American College of Cardiology)



Contemporary snapshot across health systems in Canada, Europe, and Israel
suggests a heart failure prevalence of 1-2%opens in a new tab or window for
adults around the world. (Heart)

Researchers describe a new way to preserve donor heartsopens in a new tab or
window that increases both the amount of time they can be stored and
transported, as well as improves their function after they are transplanted.
(Science Translational Medicine)

For people with coronary artery disease in cardiac rehabilitation,
high-intensity interval exercise trainingopens in a new tab or window improved
cardiorespiratory fitness to a larger degree than moderate intensity
steady-state workouts. (European Journal of Preventive Cardiology)

Personal counseling did not get people with peripheral artery disease to walk
moreopens in a new tab or window, a randomized trial found. (JAMA Cardiology)

Consumption of free sugarsopens in a new tab or window, not total carbohydrates,
was associated with higher risk of cardiovascular disease in an analysis of the
U.K. Biobank. (BMC Medicine)

A jury ruled that Medtronic infringed on Colibri's patentsopens in a new tab or
window in transcatheter aortic valve replacement (TAVR) and that the company now
owes over $106 million in damages. (FierceBiotech)



A case of fungal endocarditis of an Evolut TAVR valveopens in a new tab or
window that had to be surgically explanted and followed by re-do aortic valve
replacement. (European Heart Journal)

Outpatients with isolated left bundle branch blockopens in a new tab or window
demonstrated deficits in maximal functional capacity even with a highly active
lifestyle. (Clinical Cardiology)

LivaNova says its Essenz Perfusion Systemopens in a new tab or window, featuring
a heart-lung machine and a patient monitor, is now under limited commercial
release to support patients during cardiopulmonary bypass procedures in Europe.

FDA cleared the LVivo IQS software systemopens in a new tab or window for
cardiac ultrasound acquisition aided by artificial intelligence, DiA Imaging
Analysis announced.

Artificial intelligence modelsopens in a new tab or window have shown good
results for individualized prediction of malignant ventricular arrhythmia or
sudden cardiac arrest -- in practice, however, they may have issues with
generalizability. (eBioMedicine)

The selective thrombin inhibitor argatroban (Acova)opens in a new tab or window
did not improve outcomes when given on top of alteplase (Activase) for acute
ischemic stroke. (JAMA)

Study finds infants in certain socioeconomic groups more likely to be diagnosed
with congenital heart diseaseopens in a new tab or window later in life. (USA
Today)

 * Nicole Lou is a reporter for MedPage Today, where she covers cardiology news
   and other developments in medicine. Follow

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This content was created by Everyday Health Media on behalf of an advertiser.
More Information.
Content on this page was created by the Everyday Health Media team and is funded
by an advertiser. The content conforms to Everyday Health Media’s editorial
standards for accuracy, objectivity, and balance. The advertiser may select the
specialty area but does not edit or approve the content.
Agitation in Alzheimer's > Clinical Essentials
The Power of Music in Caring for Dementia Patients


—CAN MUSIC HAVE A POSITIVE EFFECT ON LEVELS OF AGITATION AMONG LONG-TERM CARE
RESIDENTS WITH ALZHEIMER’S DISEASE OR RELATED DEMENTIA? THAT WAS THE QUESTION A
TEAM OF U.S.-BASED RESEARCHERS SOUGHT TO ANSWER.


By Sarah Nicholson, PhD
Reviewed by Sejal Makvana Bhavsar, MD

In 2020, an estimated 5.8 million Americans age 65 and older were living with
Alzheimer’s disease or related dementia (ADRD).1 More than half of nursing home
residents have been diagnosed with ADRD, 80% of whom exhibit behavioral and
psychological symptoms of dementia (BPSD),2 requiring treatment through
redirection, pleasurable stimuli, or a modified environment.3

One example of a pleasurable stimulus, implemented by the Texas Health and Human
Services Commission (HHSC), is a proprietary method of delivering music and/or
audiobooks to patients with ADRD, called Music and Memory (M&M).3 Similar
music-based interventions have reduced BPSD, and agitation specifically, as
measured by the Cohen-Mansfield Agitation Inventory (CMAI).3

The effect of music on cognition, however, is not yet well understood, and
several music intervention studies have reported no significant change in
cognitive status using the Mini-Mental State Examination (MMSE). To date, music
intervention studies have lacked randomization and other controls, calling into
question the practicality of the interventions.3




Designing a pragmatic study



In order to evaluate the application of M&M for BPSD, Tracie Harrison, PhD, RN,
of The University of Texas at Austin, and colleagues designed a nonblinded,
randomized, pragmatic trial involving 13 long-term care facilities solicited by
the Texas HHSC.3 Up to 15 residents were identified from each facility as
potential participants, and demographic variables (age, race, marital status,
etc.) were collected for each. Participants were divided into an intervention
group (n=103) who received music therapy and a control group (n=55) who listened
to audiobooks; randomization was done by a coin flip.

Participants in both groups were predominantly female, including 63 women in the
intervention group and 31 in the control group. When considering marital status,
the most common category was “widowed,” which described 42 women in the
intervention group and 23 in the control group. The mean age was 79.7 years in
the intervention group (range 50 to 99, standard deviation [SD] 11.2 years) and
80.6 years in the control group (range 27 to 100, SD 12.6 years).

The MMSE and the CMAI, used to measure cognitive status and agitation,
respectively, were implemented at baseline, and data were collected every 2
weeks for up to 8 weeks. The CMAI measured 4 agitation subscales:

 * physical, non-aggressive (CMAI-PNA)
 * physical, aggressive (CMAI-PA)
 * verbal, non-aggressive (CMAI-VNA)
 * verbal, aggressive (CMAI-VA)




Change in agitation was evaluated by mixed-effects models while addressing
dependencies of scores within both participants and facilities.



Music and audiobooks reduce agitation in ADRD

In the first subscale, CMAI-PNA, although physical, non-aggressive agitation
tended to increase over time for both groups, music had the benefit of
decreasing these behaviors early in the study period. In terms of physical
aggression, after adjusting for attrition and the effects of being married,
having visitors, or MMSE scores, there was evidence of a decrease in CMAI-PA
scores (ꞵ11 = -0.04, 95% confidence interval [CI] -0.09 to -0.0003); there was
no evidence of a difference between treatment groups.

Turning next to verbal, non-aggressive agitation, CMAI-VNA scores tended to
decrease over time when adjusting for attrition (ꞵ11 = -0.11, 95% CI -0.19 to
-0.031), an effect which remained statistically significant regardless of which
covariate, including MMSE, was incorporated in the model; the difference in
change between groups was not statistically significant.




Finally, higher MMSE scores were related to higher CMAI-VA scores over time (ꞵ06
= 0.02, 95% CI 0.010 to 0.031), although none of the other covariates were
related to CMAI-VA scores; moreover, there was no difference between groups in
average response levels.



Implications for the future

When comparing music intervention and audiobooks, Dr. Harrison and her
colleagues found that both were effective for long-term treatment of ADRD.

“These low-cost interventions can reduce negative behaviors that might interfere
with necessary care,” Dr. Harrison told MedPage Today. “Although music had a
greater effect initially, both were effective tools in long-term care” and could
be immediately useful in treating patients.




“Having readily available headsets with self- or family-selected books or music
for folks when they come in for long-term care, to reduce aggression and anxiety
during routine activities,” could be an ideal low-cost, easily implemented
protocol, Dr. Harrison says. This type of treatment represents “a very low risk
and a potentially high benefit,” she added.



The promising results of this study raise many questions, and present
opportunities for future research. “I’d like to study how narratives and music,
culturally applied to people’s values and experiences, help them to cope with
negative events within their long-term care settings,” Dr. Harrison concluded.
Furthermore, she elucidated many more promising avenues for future work,
including how the reduction of traumatic healthcare events could help build
trust within cultural communities; how audio therapy can contribute to healing
from trauma among people of all ages; and how to measure the cost effectiveness
of audio interventions when compared with medications.

Published: September 9, 2022

Sarah Nicholson is a medical writer with training in the fields of oncology and
immunology. She works out of Greenville, S.C.

References

 * 1. 2020 Alzheimer’s disease facts and figures. Alzheimers Dement. 2020 Mar
   10. doi:10.1002/alz.12068. [Epub ahead of print]
 * 2. Thomas KS, Baier R, Kosar C, Ogarek J, Trepman A, Mor V. Individualized
   music program is associated with improved outcomes for U.S. nursing home
   residents with dementia. Am J Geriatr Psychiatry. 2017;25(9):931-938.
   doi:10.1016/j.jagp.2017.04.008
 * 3. Harrison TC, Blozis SA, Schmidt B, et al. Music compared with auditory
   books: a randomized controlled study among long-term care residents with
   Alzheimer’s disease or related dementia. J Am Med Dir Assoc.
   2021;22(7):1415-1420. doi:10.1016/j.jamda.2021.01.086




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2
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4
Tdap vaccine during pregnancy protects 9 out of 10 newborns against whooping
cough: CDC
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Circulation
5
Anesthetic Care of the Pregnant Patient With Cardiovascular Disease: A
Scientific Statement From the American Heart Association.
opens in a new tab or window
The American Journal of Psychiatry
6
Adjunctive Cariprazine for the Treatment of Patients With Major Depressive
Disorder: A Randomized, Double-Blind, Placebo-Controlled Phase 3 Study.
opens in a new tab or window


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