An implanted pump may allow for longer and better lives.
* THE QUESTION People with advanced heart failure often are confined to a bed or chair because they have severe difficulty breathing. The vast majority have no hope of getting a heart transplant. Might implanting a mechanical heart pump improve their life?
* THIS STUDY randomly assigned 129 people with advanced heart failure to have a pump, called a left ventricular assist device, implanted or to receive cardiologist-supervised treatment designed to reduce suffering. Nearly three-fourths of the participants were so sick that they were already taking intravenous medications to improve their heart's pumping ability. Of those getting intravenous drugs, 49 percent who received a pump were alive after one year, compared with 24 percent of the others. Among those who did not need intravenous medication, one-year survival was 57 percent with the pump and 40 percent without it. People who received a pump also reported an improved quality of life.
* WHO MAY BE AFFECTED BY THESE FINDINGS? People with heart failure, a condition in which the heart does not pump blood adequately through the body. The more advanced the disease, the more it restricts daily life. About 5 million Americans have been diagnosed with heart failure.
* CAVEATS A new generation of mechanical pumps has replaced the type used in this study, which was funded in part by Thoratec Corp., a pump maker.
* BOTTOM LINE People with advanced heart failure may want to ask their cardiologist about an implantable heart pump.
* FIND THIS STUDY Aug. 17 issue of Circulation; abstract available online at http://circ.ahajournals.org.
* LEARN MORE ABOUT heart failure at www.nhlbi.nih.gov and www.americanheart.org.
DEEP VEIN THROMBOSIS
Elastic stockings may prevent complications of leg clots.
* THE QUESTION People with deep vein thrombosis who have a blood clot in a leg vein often later develop post-thrombotic syndrome, which is marked by pain, swelling, cramping, numbness, skin discoloration, ulcers and other symptoms. Doctors generally suggest compression stockings when this occurs. Could this syndrome be prevented by wearing the stockings before any symptoms develop?
* THIS STUDY randomly assigned 90 adults who had been diagnosed with their first case of deep vein thrombosis to wear below-the-knee compression stockings daily. A similar group of 90 people did not wear the stockings. All participants also were given blood-thinning medication for up to six months. After about two years, 26 percent of those who wore the stockings had developed signs of the syndrome, compared with 49 percent of the others.
* WHO MAY BE AFFECTED BY THESE FINDINGS? People with deep vein thrombosis. In the United States, an estimated 600,000 new cases are diagnosed each year.
* CAVEATS The study suggests initiating stocking use soon after a clot occurs because syndrome symptoms generally develop within one to two years; whether wearing the stockings after the first two years would be helpful remains unknown.
* BOTTOM LINE People who have a blood clot in a leg vein may want to ask their doctor about compression stockings. (The stockings used in this study are available over-the-counter for about $42 each.)
* FIND THIS STUDY Aug. 17 issue of Annals of Internal Medicine; abstract available online at www.annals.org.
* LEARN MORE ABOUT deep vein thrombosis at www.sirweb.org (under "Patients and Public") and www.nhlbi.nih.gov/health.
Radiation and hormones may help treat localized disease.
* THE QUESTION A combination of radiation and three years of hormone therapy has been shown to improve the survival rates of men whose prostate cancer has spread. Might this combination, given for a shorter time period, offer a similar benefit to men with prostate cancer that has not spread?
* THIS STUDY randomly assigned 206 men with localized prostate cancer to receive either two months of radiation or two months of radiation plus six months of hormone therapy as an alternative to having their prostates removed. After about five years, 12 percent of the men who received the combination treatment had died, compared with 22 percent of those who received only radiation.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Men diagnosed with localized prostate cancer. About one in six American men are expected to have this disease at some point.
* CAVEATS Different doses of radiation or hormones might produce different results. The study did not clarify whether changing the order or timing of the combination treatment would affect the outcome. Whether people with advanced prostate cancer might benefit from shorter-term hormone therapy also was not evaluated. Participants and doctors knew which treatment participants received.
* BOTTOM LINE Men with localized prostate cancer may want to talk with their oncologist about combining hormone therapy and radiation.
* FIND THIS STUDY Aug. 18 issue of the Journal of the American Medical Association; abstract available online at www.jama.com.
* LEARN MORE ABOUT prostate cancer at www.afud.org and www.cancer.org.
-- Linda Searing