CardioExchange Archive

Financial Worries Lead to Delays in Seeking Care for MI: Nearly 40% of patients in a registry of 3,721 U.S. acute MI patients were without insurance or were insured but had financial concerns. These patients were more likely to delay seeking care than patients who were insured without financial concerns, according to a report by Smolderen and colleagues in the Journal of the American Medical Association. The researchers also found that previously observed associations between delays and race, age, and sex  “were substantially attenuated after adjustment for insurance status and other social, psychological, and clinical variables in this study.” (The editor-in-chief of CardioExchange, Harlan Krumholz, is a co-author of the paper.)

Valve-in-Valve Approach to Fixing Failing Bioprosthetic Valves:
Webb and colleagues report in Circulation on their initial promising experience treating 24 patients with failing bioprosthetic valves employing a novel “valve-in-valve” percutaneous procedure. The group successfully restored valve function in all but one of the treated valves (aortic, mitral, pulmonary, and tricuspid). Thirty-day mortality was 4.2%. The authors conclude that “transcatheter valve-in-valve implantation is a reproducible option for the management of selected patients with bioprosthetic valve failure…. This finding may have important implications with regard to valve replacement in patients at prohibitive risk with conventional surgery.”
   
In an accompanying editorial, Blase Carabello writes that “percutaneous device therapy for VHD [valvular heart disease] is one of the most exciting events in cardiology in the last 50 years.” He discusses the “huge challenge” created by the rapid advances in the field and proposes a collaborative approach for choosing VHD therapy based on the “tumor board” model used in oncology.