Device Improves Survival of Heart Failure Patients: Study

Cardiac-resynchronization therapy, or CRT-D, also reduces heart failure symptoms, such as edema (swelling) and shortness of breath, as well as hospitalizations for some patients with moderate to severe heart failure, the scientists added.
"The whole idea of the therapy is to try to resynchronize the heart," said lead researcher Dr. Anthony S.L. Tang, from the University of British Columbia in Vancouver.
It improves the heart's ability to contract and pump blood throughout the body, he explained.
This study demonstrates that, in addition to symptom relief, the CRT-D extends life and keeps heart failure patients out of the hospital, Tang noted.
Tang added that patients will continue to need medical therapy and an implantable cardioverter-defibrillator (ICD) in addition to a CRT-D.
"We are saying people who are receiving good medical therapy and are now going to get a defibrillator, please go ahead and also do resynchronization therapy as well," he said. "This is worthwhile, because they will live longer and be more likely to stay out of the hospital."
The report is published in the Nov. 14 online edition of the New England Journal of Medicine, to coincide with a scheduled presentation of the findings Sunday at the American Heart Association annual meeting in Chicago.
Tang's team randomly assigned 1,798 patients with mild or moderate heart failure to have a CRT-D plus an ICD implanted or only an ICD implanted.
Over 40 months of follow-up, the researchers found that those who received both devices experienced a 29 percent reduction in their symptoms, compared with patients who did not receive the resynchronization device.
In addition, there was a 27 percent reduction in deaths and heart failure hospitalizations among those who also had a CRT-D, they found.
More than 22 million people worldwide, including 6 million patients in the United States, suffer from heart failure. These patients' hearts cannot adequately pump blood through the body. And although deaths from heart disease have fallen over the last three decades, the death rate for heart failure is rising, the researchers said. Treating heart failure is also expensive, costing an estimated $40 billion each year in the United States alone, they noted.
In cardiac-resynchronization therapy, a stopwatch-sized device is implanted in the upper chest to resynchronize the contractions of the heart's upper chambers, called ventricles. This is done by sending electrical impulses to the heart muscle. Resynchronizing the contractions of the ventricles can help the heart pump blood throughout the body more efficiently.
A CRT-D can cost as much $35,000, or roughly $7,500 more than an ICD. About 650,000 Americans currently have either a CRT-D or an ICD, according to Medtronic spokeswoman Catherine Peloquin.
The study was partly funded by Medtronic of Canada, the maker of the device.
Dr. Arthur J. Moss, a professor of medicine at the University of Rochester School of Medicine and Dentistry, in Rochester, N.Y., and author of an accompanying journal editorial, said that "this is a major advance in the treatment and prevention of heart failure."
CRT-Ds will be used much more in the future, Moss said. "It's also going to be used for patients who are on the waiting list for heart transplants," he said. "It's also for patients who have impaired heart function and it will prevent them from developing heart failure."
Commenting on the study, Dr. Gregg Fonarow, American Heart Association spokesman and a professor of cardiology at the University of California, Los Angeles, said that "cardiac-resynchronization therapy alone or together with an implantable cardioverter-defibrillator has previously been shown to reduce mortality and hospitalizations in patients with moderate to severe heart failure."
Combined medical therapy and device therapy for patients with mild, moderate and severe heart failure can substantially improve survival and reduce the likelihood of hospitalization, he said. "The cumulative benefits offered to heart failure patients by evidence-based medication and device-based therapies are truly remarkable."
The meeting also produced another potentially positive development in heart failure treatment with the release on Sunday of a trial of the drug eplerenone (Inspra), conducted in Europe and led by Dr. Faiez Zannad of University of Nancy in Nancy, France. This trial was also reported in the New England Journal of Medicine.
In the study, more than 2,700 patients with chronic heart failure but mild symptoms were randomly chosen to receive up to 50 milligrams of eplerenone daily or a placebo, in addition to recommended therapy.
The results were so positive -- about 18 percent of patients on eplerenone dying from cardiovascular causes or being hospitalized for heart failure, versus almost 26 percent of those on a placebo -- that the trial was stopped prematurely at 21 months, the researchers reported.
Eplerenone is from a class of drugs called aldosterone antagonists, which also includes the cheaper medication spironolactone, according to a journal editorial written by Dr. Paul W. Armstrong of the University of Alberta, in Edmonton, Canada.
Zannad and his team "have added real value to the management of heart failure" with the release of the study results, Armstrong wrote. However, he questioned whether the results would have been as positive in patients who already had pacemakers or implanted defibrillators (as is recommended in current heart failure guidelines). Armstrong also wondered if the additional cost of eplerenone makes it a second choice for patients if they respond well to the less expensive spironolactone.

Cocoa genome 'will save chocolate industry'

The public release of the genome of the cacao tree - from which chocolate is made - will save the chocolate industry from collapse, a scientist has said.

Howard Yana-Shapiro, a researcher for Mars, said that without engineering higher-yielding cacao trees, demand would outstrip supply within 50 years.

Dr Yana-Shapiro said such strains will also help biodiversity and farmers' welfare in cacao-growing regions.

The genome's availability will likely lead to healthier, tastier chocolate.

The sequencing of the genome was an international, multidisciplinary effort between firms including Mars and IBM, the US department of agriculture and a number of universities, and was announced in September.

Dr Shapiro, once described as a "biodiversifarian", was speaking at an event at IBM's research labs in Zurich when he called the date the genome was released "the greatest day of my life".

"In late 2007, it became very apparent to me that we would not have a continuous supply of cocoa going into the future if we did not intervene on a massive scale to secure our supply chain."

"Cote d'Ivoire is the largest producer of cocoa in the world," Dr Shapiro continued. "Mars has bought cocoa from there for sixty years - but when we started to understand the environmental and ecological conditions, the productivity, sociocultural and economic conditions, I realised this was a moment of crisis for this region."

Dr Shapiro says the date the cocoa genome was released was the "greatest day" of his life

What is at issue is both the inherent yield of varying strains of the Theobroma cacao tree, which on average currently produce 400 kilograms per hectare of land. What is needed is to make more cocoa from fewer trees and less land.

"In 10 years, under a 2% increase in consumption we will need (an area corresponding to) another Cote d'Ivoire. There is no more place to grow it, productivity with less land must be our driver."

The genetic codes of major global staple crops such as rice and wheat have been decoded, with a view to improving yields or nutritive properties. However, those crops are grown principally on large, industrial farms.

Cocoa, by comparison, is grown for the most part on small farms by individual farmers and sold on in a less centralised market.

Greediness gene dooms dieting

Your dieting resolve can be doomed if you are carrying a 'greediness' gene, a study shows. Researchers have shown that a rogue gene linked to obesity makes us fat by boosting appetite. This deep-seated drive to eat could also explain why so many of us succumb to temptation, no matter how strong our

initial resolve to lose weight, according to the journal Nature Genetics.

Fat womanThe breakthrough opens the door for drugs that take the edge off appetite, melting away 'muffin tops' and pruning pot bellies, reports the Daily Mail. Oxford University and the Medical Research Council researchers studied a gene called FTO, which when discovered in 2007, was the first gene to be linked with obesity.

Up to 14 percent of Britons carry two rogue copies of FTO, increasing their risk of obesity by 70 percent and diabetes by 50 percent. These people are, on average, almost half a stone heavier. The 49 percent who have inherited just one flawed FTO gene are 30 percent more likely to be obese than those with two normal copies of the gene and 25 percent more likely to develop diabetes.

Scientists found that mice bred to have extra copies of the rogue gene were healthy, but ate more and became heavier than normal rodents. Researcher Chris Church said: "For the first time, we have provided convincing proof that the FTO gene causes obesity."

Prof Frances Ashcroft, one of the research leaders, said: "Too much activity of this gene can lead to putting on weight by overeating."

Malaysia to approach India, Pakistan for doctors

Kuala Lumpur, Nov 15 (IANS) Malaysia will soon approach the governments of India, Pakistan and Egypt for medical specialists to work in the country, as previously recruited doctors were found 'not very good', the health minister has said.
Malaysia is facing a lack of medical specialists and many patients are forced to go to India. Indian doctors also come to perform surgeries in Malaysia.
The health ministry had advertised in the foreign media for specialists, but those who applied were 'not very good', The Star newspaper quoted Health Minister Seri Liow Tiong Lai as saying.
Many of those who came directly after interviews had to leave because of 'attitude problems', Lai said Sunday in Johor Baru, around 300 km from Kuala Lumpur.
'The doctors who replied to our advertisements were qualified, but many of them were sent back because of attitude problems.'
'Of course, these doctors also had to go through an interview locally. But sometimes, they could not perform according to our expectations,' he said.
'By working directly with the governments, we would be able to hire better doctors, as they would be vetted by both the foreign and local governments,' he said.
Lai said the Egyptian health ministry has submitted a list of 58 specialists who would be recruited to work in local hospitals or medical facilities.
'Many of them are more than willing to leave their country and serve here,' he said.
There would be an agreement for these doctors to serve only for two years. The same would be applicable for specialists from India and Pakistan.