Future of cardiology: personalized care through genetics?

Genetic arrhythmia programs are paving new roads for personalized cardiac care—from preventing unnecessary cautionary testing or treatment to improving screening.

Melvin Scheinman, MD—the first person to perform catheter ablation for arrhythmia in a human patient, now chief of the Comprehensive Genetic Arrhythmia Program at the University of California, San Francisco—believes genetic testing will lead to the "ultimate form of personalized medicine," writes Gregory A. Freeman of HealthLeaders Magazine.

"If you examine the genetic background of a patient, you may be able to identify sensitivity to specific drugs, propensity for developing some very serious heart disorders, and at the same time rule out those same things for other people," said Scheinman to HealthLeaders.

"That is really what personalized medicine is all about—delivering the right care to the patient because you truly understand the patient and don't have to treat him or her as just a member of a group with certain statistical risks."

A proliferation of genetic arrhythmia programs "across the country" have been introducing new, measured responses to a sudden cardiac death in the family—preventive healthcare for some, but not all family members.

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Mitral Valve Repair: “An Opportunity for Quality Improvement”

Even in low-volume VA centers, mitral valve repair outcomes best replacement.

A large multi-center study presented at the 96th American Association for Thoracic Surgery Annual Meeting followed trends in mitral valve (MV) surgeries in the Veterans Administration Health System from 2001-2013 and provided further evidence to support the use of mitral valve repair over mitral valve replacement in patients with degenerative MV disease.

"MVRepair has a greater short-term protective effect against mortality than MVReplace has in patients with primary degenerative MR," write the authors. "Despite this survival advantage, the rate of MVRepair is low at some centers; therefore, there is clearly an opportunity for quality improvement."

Beyond a survival advantage, mitral valve repair was also found to result in fewer complications and shorter hospital stays.

Is that success dependent on volume? Not necessarily.

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Is ExECG your default diagnostic?

"Exercise stress electrocardiography (ExECG) is underutilized as the initial test modality in patients with interpretable electrocardiograms who are able to exercise. Although stress myocardial imaging techniques provide valuable diagnostic and prognostic information, variables derived from ExECG can yield substantial data for risk stratification, either supplementary to imaging variables or without concurrent imaging. (abstract)

What's your diagnostic test workflow?

A recent paper in JACC: Cardiovascular Imaging reviewed literature on the latest advances in exercise stress electrocardiography (ExECG) and argued that despite the ACC's recommendations, the test is still "underutilized" as the initial diagnostic test modality for suspected coronary artery disease.

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