Study briefs, 2-07: heart surgery, hernia surgery, Alzheimer's

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BY The Washington Post

Heart surgery seems to enhance odds of survival more than drugs do

THE QUESTION Faced with a heart that cannot effectively pump blood throughout the body, doctors generally recommend either surgery or medication to manage the problem. Do the chances of dying from this problem, known as heart failure, vary by the type of treatment?

THIS STUDY analyzed data on 765 people treated for advanced heart failure; 230 (30 percent) had surgery — most often a bypass or balloon angioplasty — within six months of their diagnosis, and 535 (70 percent) were treated only with drugs. After three years, 34 percent of the people given only drugs had died, compared with 20 percent of those who had had surgery. Taking into consideration factors related to the condition of their hearts at the start of the study, people in the surgery group were calculated to have about half the risk of dying within three years as those whose condition was managed only with medication.

WHO MAY BE AFFECTED BY THESE FINDINGS? People with advanced heart failure. About 5 million people in the United States have this condition, which is responsible for some 300,000 deaths a year. Among people over 65, heart failure is one of the most frequent causes of hospitalization.

CAVEATS Some people who had surgery also took medication. The study did not determine whether the results varied by the type of surgical procedure.

FIND THIS STUDY Jan. 17 issue of Circulation; abstract available online at www.circulationaha.org.

LEARN MORE ABOUT heart failure at www.nhlbi.nih.gov/health and www.americanheart.org.

Deferring hernia surgery appears to be a safe and reasonable option

THE QUESTION Even though a hernia is a protrusion of the intestine through a weak spot in the abdominal muscles, it often does not cause much pain. And because surgery to repair the bulge increases the risk of a recurrence and added pain, people sometimes choose to do nothing unless symptoms worsen. Is this safe?

THIS STUDY randomly assigned 720 men with inguinal hernias (in the groin area) to have surgery or to watch for symptoms and contact a doctor if problems develop. After two years, both groups reported less pain than at the start of the study, with about an equal decline. About 2 percent of the men who had surgery said pain still limited their daily activities, compared with 5 percent of the others. About 23 percent of the watch-and-wait group decided to have surgery during the two years, and 17 percent of the men originally slated for surgery declined the procedure. Those who deferred surgery did not have more frequent or serious complications than those who had surgery immediately. Overall, about 97 percent of both groups said they were satisfied with their treatment at the end of the study.

WHO MAY BE AFFECTED BY THESE FINDINGS? Men with inguinal hernias, the most common type of hernia. About 2 percent of men in the United States have inguinal hernias, which women also can develop. Overall, about 5 million Americans of all ages have some type of abdominal hernia.

CAVEATS The findings may not apply to women or young people or those with other types of hernias.

FIND THIS STUDY Jan. 18 issue of the Journal of the American Medical Association; abstract available online at www.jama.com.

LEARN MORE ABOUT hernias at www.medem.com and www.mayoclinic.com.

A late-stage Alzheimer’s drug may also have value for the long term

THE QUESTION Sometimes drugs that work for a few weeks or months continue to be effective long-term. Sometimes they don’t, or side effects occur. When tested for six months, memantine proved able to slow the progression of symptoms in people with advanced Alzheimer’s. Might it continue to help if taken longer?

THIS STUDY involved 175 people with moderate to severe Alzheimer’s disease who had been randomly assigned in an earlier study to take memantine (Namenda) or a placebo daily for 24 weeks. For the next 28 weeks, everyone was given the drug. During this time, the 80 people who had switched from taking a placebo to taking memantine showed a slower rate of decline in their ability to perform daily functions and in their scores on cognitive tests than they had shown while taking the placebo. Also, their caregivers rated their behavior as improved. In those who had taken the drug for a year, the slowing of symptoms achieved during the first study was maintained and the medication was well tolerated.

WHO MAY BE AFFECTED BY THESE FINDINGS? People with moderate to severe Alzheimer’s. In later stages of the disease, people become increasingly confused and can quickly lose the ability to care for themselves. Nearly 5 million Americans have this disease, a number that is projected to grow to 16 million by 2050.

CAVEATS The study was funded by Merz Pharmaceuticals GmbH, which markets the drug outside the United States; two of the six authors were its employees.

FIND THIS STUDY January issue of the Archives of Neurology; abstract available online at www.archneurol.com.

LEARN MORE ABOUT Alzheimer’s disease at www.alz.org and www.alzinfo.org.