Clinical Updates

June 17, 2008

SOUTH SAN FRANCISCO, Calif., diaDexus, Inc. today announced the release of a supplement to The American Journal of Cardiology, Vol. 101, No 12A June 16, 2008 that includes an expert consensus panel recommendation to include testing for lipoprotein-associated phospholipase A2 (Lp-PLA2), a vascular-specific inflammatory marker, as an adjunct to traditional cardiovascular disease (CVD) risk assessment. These recommendations are consistent with and build on the Adult Treatment Panel III guidelines (ATP III) for the use of inflammatory markers in patients at moderate to high CVD risk to improve identification of those at even higher risk for heart attack and stroke who would benefit from proven therapeutic and lifestyle treatments to prevent these cardiovascular events.

Both a PDF of the supplement and a searchable text version can be found on The American Journal of Cardiology

February is Cardiovascular Professionals Month. To mark the occasion, American Nurse Today asked Joanna D. Sikkema, MSN, ANP, Immediate Past President of the Preventive Cardiovascular Nurses Association (PCNA), to describe the cardiovascular (CV) nursing specialty, the important role her organization fulfills, and the benefits PCNA can bring to both nurses and patients. Read more

Julie Louise Gerberding, MD, MPH, Director of the Centers for Disease Control and Prevention (CDC) encourages everyone to get an influenza (flu) vaccination this 2007-2008 season. Read full letter.

2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina

A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to Develop the Focused Update of the 2002 Guidelines for the Management of Patients With Chronic Stable Angina. More information can be found in the full report.

Cardiac Societies Release First Cardiac Rehabilitation Performance Measures to Help Bridge Gaps in the
Delivery of Secondary Prevention Services

CHICAGO, Sept. 25, 2007 - The first performance measures to increase cardiac rehabilitation (CR) referrals and establish standards of excellence for this highly effective but vastly underutilized service are being jointly released by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the American College of Cardiology (ACC) and the American Heart Association (AHA).

More than one-and-a-half years in the making, the AACVPR/ACC/AHA Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services will be published in the September/October issue of the Journal of Cardiopulmonary Rehabilitation and Prevention, and the Oct. 2 editions of Circulation and the Journal of the American College of Cardiology. The measures have been endorsed by nine other medical societies.

"The status quo is not acceptable," said Randal Thomas, M.D., director of the Cardiovascular Health Clinic at Mayo Clinic and chair of the writing committee for the new CR performance measures. "The benefits of CR have been demonstrated in the medical literature but healthcare professionals continue to underutilize CR services. The new CR performance measures are a stimulus - a systematic solution - to apply these services more appropriately."

CR Benefits High, Utilization Alarmingly Low

CR has been shown in multiple studies to reduce the risk of death after a cardiac illness by 20 percent to 25 percent - a benefit level similar to that of statin drugs, beta blockers and aspirin - and to improve physical strength and endurance by 20 percent to 50 percent.

Still, fewer than 3 in 10 eligible patients participate in CR after a cardiovascular disease (CVD) event. Patient, provider and health system barriers exist; however, the most common reason for non-referral of eligible patients is resolvable, according to Marjorie King, M.D., a member of the CR performance measures writing committee.

"Most CVD patients simply don't receive a CR referral because it hasn't been a mandated performance measure and no one is specifically responsible for making sure that it gets done," said Dr. King, who directs cardiac services for the Helen Hayes Hospital, West Haverstraw, NY. "Every aspect of the new CR clinical guidelines is evidence-based, and our goal is to make CR for CVD patients as automatic as aspirin after myocardial infarction."

Two Sets of Performance Measures: CR Referral and Delivery

Two sets of CR performance measures have been developed - the first seeks to improve referral of eligible CVD patients, and the second is aimed at stimulating CR programs to deliver CR services appropriately to all eligible patients.

The first set of CR measures stipulates referral to outpatient CR prior to discharge for all eligible hospitalized patients with a qualifying CVD event, and referral of outpatients who received a qualifying diagnosis in the past year but have not participated in CR.
This set is designed for easy integration with other, existing performance measures, to make referral of eligible patients to CR standard practice after myocardial infarction/ acute coronary syndrome, coronary artery bypass graft surgery, percutaneous coronary artery intervention and diagnosis of stable angina. CR also is considered appropriate and beneficial for persons after heart valve surgical repair or replacement and heart or heart/lung transplantation, and increasing evidence supports the benefits of CR for persons with chronic heart failure or peripheral arterial disease.

The second set of CR measures involves structure- and process-based measures to be implemented by CR programs. These measures are designed to ensure patient safety, optimize patient care and document CR program effectiveness.

The structure measures promote a safe exercise environment by requiring a physician medical director, patient assessment prior to exercise, and an emergency response team. Process measures include assessment of all CR patients for modifiable cardiovascular risk factors, interventions such as education about lifestyle modification to reduce risk, and communication with other healthcare providers about progress and goals. Data collection and ongoing analysis also are required of all CR programs, and sample instruments are included in the measures.

Making it Work

The authors emphasize that, to work effectively, the new CR performance measures must be put into use and supported by health systems, providers, insurance carriers, chronic disease organizations and other healthcare groups providing care to persons with CVD.

"Built into the CR performance measures is the expectation that there will be significant communication and coordination of care between healthcare providers," Dr. Thomas said. "These measures are not only important for cardiology, but for general medicine, endocrinology, physical medicine and rehabilitation, psychiatry, and others who play an important role in the management of people with coronary artery disease."

Insurance companies also play an important role.

"If we're able to provide CR to all eligible patients, we'll need to have new models of care to do so," Dr. Thomas said. "Even a 30 percent to 50 percent increase in the number of CR patients would be so great that most traditional CR programs wouldn't be able to meet demand in the short-term. Furthermore, many CR programs are located a distance away from patients who aren't able to travel to receive services, so it's not feasible to think that the traditional model of CR will fit all patients."

Part of the solution, he said, is for insurance carriers to support newer ways to provide CR services in a cost-effective and feasible manner, such as home-based and community-based cardiac rehabilitation/secondary prevention models.

Nine Societies Endorse New CR Performance Measures

The AACVPR/ACC/AHA Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services have been endorsed by the following societies: The American College of Chest Physicians; American College of Sports Medicine; American Physical Therapy Association; Canadian Association of Cardiac Rehabilitation; European Association for Cardiac Rehabilitation and Prevention; Inter-American Heart Foundation; National Association of Clinical Nurse Specialists; Preventive Cardiovascular Nurses Association; and the Society of Thoracic Surgeons.

Do you know what's pretty in pink and "light and luscious" -- but kills?

This year, R.J. Reynolds (RJR), the second largest tobacco company in the U.S., introduced a new product - Camel No. 9. With its sleek packaging, flowery ads, a pink camel on every cigarette and the slogan, "light and luscious," Camel No. 9 openly targets women, but is also very appealing to girls.

Camel No. 9 has been launched with a huge marketing effort that is estimated to cost between $25 and $50 million. Full-page ads are running in some of the most popular women's magazines, including Vogue, which is also read by 1.4 million young girls.

We need your help to protect our kids from a lifetime of tobacco addiction and disease.

Please click here to send Vogue an email and let the editors know how offensive you find both the targeted marketing and their decision to run the ads.

Camel No. 9 is another clear example of why we need to actively support passage of legislation in Congress that gives the U.S. Food and Drug Administration (FDA) the authority to regulate tobacco products. At a minimum, this would eliminate colorful and eye-catching ads in magazines with high youth readership and the use of the term "light", reduce the colorful point-of-sale marketing, and cover at least 30 percent of the pack with a large warning label, marring the sleek look designed to lure young women.

Fun, exciting, and luscious are hardly words that describe a product that lures young women into a deadly addiction that kills. More than 150,000 women in the U.S. die every year from smoking-caused disease and those diseases result in $34.7 billion in annual health care costs.

Lung cancer is the only form of cancer among women that is on the rise and it is the leading cancer killer of women. Smoking causes heart disease - the #1 killer of women, many forms of cancer, respiratory illnesses such as emphysema, low birth weight, reduced fertility, early menopause, osteoporosis and the list goes on.

Please click here to send Vogue an email and let the editors know how offensive you find both the targeted marketing and their decision to run the ads.

Thank you for taking the time to write your own message to Vogue and helping to protect our kids, especially young women, from tobacco addiction.

Sincerely,

Carter Headrick
Director, Grassroots
Campaign for Tobacco-Free Kids

P.S. Click here to see one of the many Camel No. 9 ads.