MedicationsSupplements and Vitamins home > heart center > heart a-z list > activity improves implanted defibrillator survival article

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FRIDAY, May 15, 2015 (HealthDay News) -- A new study of nearly 100,000 people with implantable cardioverter-defibrillators found that more physical activity was tied to living longer.

Implantable cardioverter-defibrillators (ICDs) are battery-powered devices implanted in patients whose hearts cannot maintain a normal rhythm. The devices keep the heart beating normally and can provide a shock to return the heart to a normal rhythm when needed.

Researchers found that patients who were the most active during the first 30 to 60 days after getting their ICD were 40 percent less likely to die within four years compared to patients who were the least active.

"Patients with the highest level of activity had dramatically better long-term survival after four years -- about 90 percent -- than patients with the lowest activity level, whose four-year survival was only about 50 percent," said lead researcher Dr. Matthew Reynolds, a cardiologist at the Lahey Hospital and Medical Center in Burlington, Mass.

Although the researchers found a strong connection between activity and longer life in these patients, they wrote that this study can't prove cause-and-effect. It's possible that those who were more active were in better health, which could also lead to a longer life, they explained.

The report was published May 15 online in the Journal of the American Heart Association, to coincide with presentation of the study results at the annual meeting of the Heart Rhythm Society, in Boston.

For the study, Reynolds and colleagues collected data on more than 98,000 patients with implantable cardioverter-defibrillators from across the United States. ICDs are inserted under the skin and electric wires are attached to the heart. In addition to their lifesaving task, ICDs also record patients' activity levels.

This information can be monitored remotely or in a doctor's office, Reynolds said. For this study, researchers analyzed patient activity in the first 30 to 60 days after implantation. They followed up on the patients' overall health for four years.

People in the study who had the highest activity level were active for about three hours a day. Those with the lowest activity level were active for about 30 minutes a day, he said.

Activity recorded by the ICD includes general activity, such as walking. "We are not talking about exercise," Reynolds said. "The bar is quite low," he added.

Reynolds thinks doctors can use the data on activity to identify patients with ICDs who are at increased risk of premature death. For patients, his advice is: "Get up and move. Fundamentally, people who are more active have better health."

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said, "Physical fitness and engaging in regular physical activity have been associated with lower risk of dying in patients with heart disease."

Guidelines recommend regular physical activity in patients with heart disease and for some patients in cardiac rehabilitation, he said. This new study of men and women who have received an ICD shows that the level of physical activity as recorded by the device is predictive of patient survival, Fonarow said.

"These findings highlight how information that is collected by implanted devices and transmitted through remote monitoring may assist doctors in identifying individuals at higher risk," he said.

"The next step," he added, "is to determine whether a program that targets risk factors, such as physical inactivity, is effective in improving outcomes."

Copyright © 2015 HealthDay. All rights reserved.SOURCES: Matthew Reynolds, M.D., M.Sc., cardiologist, Lahey Hospital and Medical Center, Burlington, Mass.; Gregg Fonarow, M.D., professor, cardiology, University of California, Los Angeles; May 15, 2015, Journal of the American Heart Association, online; May 15, 2015, presentation, Heart Rhythm Society meeting, Boston

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MedicationsSupplements and Vitamins home > high blood pressure center > high blood pressure a-z list > sleep patterns and stroke risk with hypertension article

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FRIDAY, May 15, 2015 (HealthDay News) -- People with high blood pressure who sleep less than five hours or more than eight hours each night may have significantly higher odds of a stroke, new research suggests.

Analyzing data from more than 200,000 U.S. residents with high blood pressure, scientists determined that "insufficient" sleepers logging less than five hours of shuteye each night had an 83 percent increased risk of stroke compared to "healthy" sleepers who got seven to eight hours of sleep.

"Long" sleepers reporting more than eight hours of nightly sleep experienced a 74 percent higher stroke risk than healthy sleepers, according to the study.

"We were surprised, especially with the individuals reporting insufficient sleep, because most studies . . . have shown [only] a modest increase in the chances of suffering a stroke among those with short sleep duration," said study author Dr. Oluwaseun Akinseye, a resident in internal medicine at the Icahn School of Medicine of Mount Sinai Hospital in New York City.

"Our study showed much higher odds of a stroke, almost a twofold increase," Akinseye added.

Although this study found an association between sleep duration and stroke risk in people with high blood pressure, it wasn't designed to prove a cause-and-effect relationship.

Findings from the study are scheduled to be presented Friday at the American Society of Hypertension's annual scientific meeting in New York City. Research presented at scientific conferences typically hasn't been published or peer-reviewed, and results are considered preliminary.

About one-third of adults in the United States are affected by high blood pressure, the study authors said. High blood pressure, also known as hypertension, is a risk factor for stroke as well as other forms of heart disease.

About 800,000 people each year in the United States have a stroke, according to the U.S. Centers for Disease Control and Prevention (CDC). Stroke is also a leading cause of disability in the United States, according to the CDC. The vast majority of strokes are triggered by a blood clot in the brain, while the remainder occur when a blood vessel bursts.

Akinseye and his colleagues used data collected over nine years from the U.S. National Health Interview Survey of nearly 204,000 Americans with high blood pressure. Overall, the stroke risk was nearly 14 percent among "long" sleepers; 11 percent among "insufficient" sleepers; 6 percent for "short sleepers" logging five to six hours per night; and about 5 percent among "healthy" sleepers.

Results were adjusted for the presence of other health conditions; demographic factors; and behavioral factors such as smoking and physical activity, Akinseye said.

It's not clear why sleep amount is associated with stroke risk, he said. But, he added that short amounts of shuteye are linked to higher levels of cortisol -- also known as the "stress hormone" -- in the body, while long amounts of sleep are linked to the release of inflammatory chemicals.

Dr. Amy Tai, a clinical assistant professor of neurology and neurological sciences at Stanford University School of Medicine in Palo Alto, Calif., said the study results were limited because participants self-reported their sleep amounts.

"With self-reporting, it's hard to measure the quality of the sleep the patient gets," said Tai, who wasn't involved in the new research. "It's hard to tease out if there's an independent common denominator patients share that's not being captured."

Future research should include "a more reliable form of sleep recording," Tai said.

"There are monitors that measure not only sleep duration but quality," she said. "I think studies using a more objective measurement of sleep, such as remote or recordable devices, would be helpful in truly capturing objective data because self-reporting has its limitations."

It's not clear from this study if getting the right amount of sleep will bring your stroke risk down, but if you need to get more sleep, the National Sleep Foundation has some suggestions:

Avoid alcohol, cigarettes and heavy meals two to three hours before bedtime.Have regular sleep and wake times, even on the weekends.Exercise every day -- any time of day or night is fine as long as the exercise doesn't interfere with your sleep. Keep your bedroom cool -- between 60 and 67 degrees. Avoid taking naps if you have trouble sleeping at night. Put away your electronic devices before bed.

Copyright © 2015 HealthDay. All rights reserved.SOURCES: Oluwaseun Akinseye, M.D., resident, internal medicine, Icahn School of Medicine, Mount Sinai Medical Center, New York City; Amy Tai, M.D., clinical assistant professor, neurology and neurological sciences, Stanford University School of Medicine, Palo Alto, Calif.; May 15, 2015, presentation, American Society of Hypertension annual meeting, New York City

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MedicationsSupplements and Vitamins home > cancer center > cancer a-z list > 'wiser' surgeries for those with terminal cancers article

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MONDAY, May 11, 2015 (HealthDay News) -- While surgery rates for patients with late-stage, terminal cancers have stayed about the same in recent years, complications and deaths for these patients have fallen because surgeons are more selective about who has surgery, a new study finds.

"Surgeons are becoming wiser," study author Dr. Sarah Bateni, a surgery resident at the University of California, Davis, said in a university news release.

"Our research suggests that surgeons may be operating on healthier patients who are more likely to recover well from an operation," she said. "These are patients who can perform activities of daily living without assistance, for example."

As Bateni explained, there are a number of reasons why surgeons might operate on late-stage cancer patients.

"Some of it has to do with the patients and families," she said. "If the patient is uncomfortable, the family wants a solution. In some cases, the surgeon also may be too optimistic about what the surgical outcome will be."

Still, the decision to undergo a surgery is a difficult one, because patients with late-stage cancer who have such procedures are at high risk for complications and death.

"It is common that patients end up dying in the intensive care unit instead of being managed with medication with hopes of returning home with their families, including with hospice care," Bateni noted.

In the study, her team tracked nearly 22,000 patients in the United States who had late-stage cancer between 2006 and 2010. The study found only a slight decline in the use of surgeries -- from 1.9 percent to 1.6 percent of all procedures performed on the patients.

The most common type of surgery was the removal of bowel obstructions in patients with cancers that had spread from their original location.

However, Bateni's team also found that, over the study period, doctors became more likely to restrict surgery to healthier patients, such as those who were more independent and did not experience dramatic weight loss or a serious blood infection called sepsis.

The researchers also found that rates of illness linked to the procedure among the patients fell from about 34 percent in 2006 to about 27 percent in 2010, and that the death rate fell from 10.4 percent to 9.3 percent during that time.

The study was published recently in the Journal of Surgical Research.

-- Robert Preidt
Copyright © 2015 HealthDay. All rights reserved.SOURCE: University of California, Davis, news release, May 1, 2015

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