Famed Cardiologist, father of modern heart medicine, Dr. Michael DeBakey Dead At 99

Often referred to as the father of modern heart medicine, Dr. Michael DeBakey died in Houston at the age of 99. Tony Guida recounts the life of a man who helped save the lives of millions.

Heart Failure Raises Risks After Non-Cardiac Surgeries

(HealthDay News) -- Older people with heart failure face heightened odds of complications and death after non-cardiac surgeries, according to the largest study ever conducted on the issue.

"We're trying to draw attention to this major problem," said lead researcher Dr. Adrian F. Hernandez, an assistant professor of medicine at Duke University in Durham, N.C.

Heart failure, the progressive loss of the heart's ability to pump blood, is widespread among older Americans, but it sometimes is overlooked as a risk factor when surgery is needed, he said.

"Most physicians focus on whether [older patients] have coronary artery disease or have a risk of heart attack," Hernandez said. "Heart failure is by far a more important risk factor, but it doesn't usually have greater weight when they want to identify patients at risk of complications or consider how they want to treat them after surgery."

Symptoms of heart failure include shortness of breath, fatigue and swelling of the legs.

Hernandez' group published the study in the April issue of Anesthesiology. They used Medicare data on more than 159,000 people undergoing major surgery not involving the heart, such as hip replacement operations. Past estimates have put the incidence of heart failure in the older population between 5 percent and 12 percent, but the new study found the condition in almost 20 percent of those having surgery.

The study divided the participants into three groups: those with heart failure, with or without coronary artery disease; those with only coronary artery disease; and those with neither condition.

Nearly 98 percent of all those who had surgery were discharged soon afterward from the hospital. But 17.1 percent of those with heart failure had to be re-hospitalized within 30 days, compared to 10.8 percent of those with coronary artery disease and just 8.1 percent of those with neither ailment.

In the month after a surgery, 1.6 percent of those with heart failure died, compared to 0.5 percent for those with coronary artery disease and 0.3 percent of those with neither condition, the study found.

Steps can be taken to reduce the toll, Hernandez said.

"The first thing is to check on what the conditions are that might influence the patients outcomes," he said. "We have to identify therapies that lower the risk of a poor outcome and assure that all patients, when they have surgery, are carefully monitored."

Close attention should be paid to be sure that symptoms of heart failure are kept to a minimum, Hernandez said. Medications such as beta blockers and diuretics can be used to keep heart failure under control, he added.

But he noted that it's not certain how effective such measures might be in reducing risks -- only a rigorous, controlled study could answer that question definitively.

"We are planning to do such studies, but our planning is still in the early stages," he said. "We still need to identify sponsors of such a study."

One expert applauded the new research.

The increase in surgery risk due to heart failure has been noted before, but "this is a big study that involves a lot of people. It solidifies that the risk is real, and the risk is substantial," said Dr. Robert Hobbs, a staff cardiologist at the Cleveland Clinic whose work covers heart failure and transplant medicine.

Measures that can be taken to reduce the risk include simply not performing surgery, if possible, on someone whose life might be endangered, Hobbs said. "If surgery is necessary for someone with heart failure, there should be targeted use of heart failure medications before the operation and an effort to avoid overloading the body with intravenous fluid during the procedure," he said.

"And we would certainly watch them more carefully in the postoperative period," Hobbs added.

More information
Learn about heart failure, its symptoms and treatment, from the U.S. Library of Medicine.

Hormone Therapy Only Helps Some Older Men With Prostate Cancer

(HealthDay News) -- Adding hormone therapy to radiation treatment for fast-moving prostate cancer can save lives, but the benefit often doesn't apply to men who have other serious medical problems, a new study shows.

"The new message from this study is that there definitely is a difference in outcome, depending on the gentleman's health," said Dr. Anthony V. D'Amico, chief of genitourinary oncology at Brigham and Women's Hospital in Boston. His report is published in the Jan. 23 issue of the Journal of the American Medical Association.

The old message, reported in 2004 on the five-year point of the study, was that treatment to suppress the activity of male hormones known as androgens improved survival of older men with aggressive prostate cancer, D'Amico said.

But the new report showed the benefit was limited to men without other serious medical problems. Adding hormone therapy to radiation treatment in the 206-man study decreased the rate of death significantly, but the benefit was confined to men without other health issues.

"This report is important, because it is part of a story that is emerging about hormone therapy in men with prostate cancer who are elderly," D'Amico said. "If a man is 75 and otherwise healthy, adding hormone therapy is likely to help. If the same man has had a heart attack or stroke, or if he is a smoker or diabetic, adding hormone therapy makes it worse."

In terms of clinical practice, the finding means that "before I treat him, I get him to a specialist and try to get his health cleared up as much as possible before giving the hormone therapy," D'Amico said. "If he has heart disease, I would consult a cardiologist; if a stroke, I would consult a neurologist; if diabetes, a diabetologist."

The idea is not anything new in medicine, he added. "It is the same as with a surgical procedure," D'Amico said. "You do not give the therapy until it is cleared by the appropriate specialist."

The study is relatively small and requires further confirmation, said Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society.

"But for men trying to make a decision about prostate cancer treatment, it provides useful information for the men and their physicians," Brooks said. "A man who has had radiation treatment, if he and his doctor talk about the results of this study, it can help them make a decision about hormone treatment in a more informed way."

The results apply to "a significant percentage of older prostate cancer patients," Brooks said, noting that the average age of men in the study was over 70.

Until now, only general advice about hormone treatment could be given to such men, he said. "Now we can be a little more specific and say, 'If you don't have underlying cardiac disease or other major co-morbid conditions, the chance of having a good response to the treatment is better.' But many men with heart disease or other problems may decide they do not want to deal with the side effects of hormone treatment."

More information
Learn more about prostate cancer and its treatment from the American Cancer Society.

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'Easy Does It' Eases Holiday Stress

(HealthDay News) -- It's supposed to be the happiest time of the year, but don't tell that to the patients who mob the offices of San Diego cardiologist Dr. Mimi Guarneri between Thanksgiving and New Year's.

Some complain of what doctors call "holiday heart" -- skipped beats, high blood pressure and angina due to stress or overindulgence. Others feel physically and emotionally overwhelmed, distracted by thoughts of difficult relatives or missing loved ones.

Guarneri, medical director of the Scripps Center for Integrative Medicine, has different advice for her patients, depending on their situations. But she's always sure to emphasize one theme: relaxation.

"The one thing is do is to take time out, take a deep breath, connect your mind with your body by simple breathing," she said. "And remember to not sweat the small stuff."

Easier said than done, of course. But when it comes to crippling holiday stress, specialists say the simplest pieces of advice are also the best.

Dr. Redford Williams, director of the Behavioral Medicine Research Center at Duke University in Durham, N.C., advises people to be reasonable with their expectations from the season, and to anticipate trouble -- ranging from long lines at stores and airports, to bouts of sadness when images of absent loved ones come to mind.

By readying yourself for these moments, "they won't come as a shock when you realize, 'I'm getting ready to honk my horn or get steamed over this person who just pulled in front of me.' If you can do that, you can probably head off some of it," Williams explained.

He said it's not clear how many people get the blues around the holidays, but it's probably not uncommon. "It's perfectly normal to get a little bit depressed or a little sad during the holidays at one point or another," Williams said.

However, it may not be as bad as some might assume. In recent years, American researchers have looked at local statistics and debunked the long-held assumption that suicide rates shoot up around the holidays.

Not every episode of Christmastime depression is minor, however. If you find yourself early in the new year having trouble with sleeping or eating -- doing either one too much or too little -- it's possible that you've fallen into a clinical depression.

If that might be the case, "You should seek some professional evaluation and possibly treatment," Williams said.

In other cases, a little self-help can be key. "In the grand scheme of life, we say, 'Don't sweat the small stuff,'" Guarneri said. "We have to realize that a lot of stress is what we put on ourselves, not what other people are putting on us."

If you're alone and feeling isolated, she said, "get out and do service work, which brings joy to people." And, if you have the opposite problem -- too much to do and too many people to worry about pleasing -- learn to do less. "None of this is worth dying for," she said.

More information
Learn more about holiday stress from the American Psychological Association.

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New Drug Fails to Improve Odds for Heart Failure Patients

(HealthDay News) -- A new drug is no more effective at improving the survival rates of people with decompensated heart failure than a widely used medication is, a new international study has found.

Decompensated heart failure is one form of the general condition in which the heart progressively loses the ability to pump blood. It is characterized by a set of symptoms including shortness of breath and intolerance to exercise.

There were hopes that the new drug, levosimendan, would improve survival, because it uses a unique mechanism that makes heart muscle cells more sensitive to the calcium that causes them to contract. However, the study of 1,347 persons with acute decompensated heart failure, done at 75 centers in nine countries between March 2003 and December 2004, found essentially the same death rate for participants who got levosimendan as those who received an established medication, dobutamine, said a report in the May 2 issue of the Journal of the American Medical Association.

The trial leaves cardiologists without a totally satisfactory treatment for decompensated heart failure, said Dr. Robert Hobbs, a Cleveland cardiologist specializing in treatment of the condition. Some 5 million Americans have one form or another of heart failure, and about 1 million of them are hospitalized for it each year.

"The original therapy, which is still basic, is diuretics," Hobbs explained. "They make the body lose water, so people feel better. In the 1980s, ACE inhibitors came along to make people feel better and live longer, and they were added for long-term benefit. The third group of drugs to be used were beta blockers."

Dobutamine is a positive inotropic agent that has been found to improve symptoms, but it has also been associated with an increased risk of death and cardiovascular problems. In the latest trial, participants with decompensated heart failure received levosimendan or dobutamine intravenously.

"The common practice has been to give dobutamine in the belief that the heart is like a battery that has lost its charge," Hobbs said. "By giving dobutamine, you would recharge it. That didn't actually happen [in previous studies]. It appeared to be associated with complications, longer hospital stays and more mortality."

In another previous study, careful analysis indicated that levosimendan was associated with a lower risk of death than dobutamine. "It did have the different mechanism of action, and it was felt that might translate into improved safety," Hobbs said. But it proved to be no better in the new trial.

In the 180 days after drug infusion, the death rate was 26 percent among patients who got levosimendan and 28 percent in those getting dobutamine. There was no statistical difference between other endpoints, such as incidence of breathing difficulties and days spent out of the hospital.

Participants who got levosimendan were less likely to experience cardiac failure but more likely to experience the abnormal heartbeat called atrial fibrillation, low blood levels of potassium, and headache.

"The bottom line on all of this is that it is hard to show benefit for what we do for acute decompensated heart failure," Hobbs said.

More information
All aspects of heart failure are explored by the American Heart Association .