THURSDAY, Oct. 29 (HealthDay News) -- Stroke patients taken directly to a designated stroke center are much more likely to receive the clot-busting drug tPA than those taken to the nearest hospital, says a new study.

If given within the first few hours after a stroke, tPA (tissue plasminogen activator) can reduce stroke-related disability.

The study grew out of a citywide program in Toronto that trains paramedics to screen for stroke and to take stroke patients to one of three regional stroke centers. The researchers examined the impact of the protocol at one of the stroke centers -- Sunnybrook Health Sciences Centre -- in the first four months of the program and compared it with the same four-month period the previous year.

After implementation of the program, the percentage of stroke patients arriving at Sunnybrook less than two and a half hours after a stroke increased from 30 percent to 49 percent, with a four-fold increase in the number of people treated with tPA.

The study also found that the protocol led to significantly faster tPA treatment times and that the average hospital stay for stroke patients was reduced from five days to four.

The findings were published online Oct. 29 and will be in the December issue of Stroke.

"Protocols like this are necessary because not all hospitals offer thrombolytic therapy, and too many patients arrive at a hospital too late to receive treatment," lead author Dr. David Gladstone, an assistant professor of medicine at the University of Toronto and director of the Regional Stroke Prevention Clinic at Sunnybrook, said in a news release from the American Heart Association.

"Effective delivery of tPA for stroke requires an emergency response and a coordinated team approach involving paramedics, hospital stroke teams, emergency room and radiology personnel, and inpatient medical and intensive care staff," Gladstone said. "Time is brain. The faster the treatment is given, the greater the chance of a good outcome. Every minute counts during an acute stroke."

More information

The American Heart Association has more about tPA  .

MONDAY, Oct. 26 (HealthDay News) -- Hearts attacks have increased among middle-aged American women in the past two decades, but their chance of survival has improved, two new studies show.

"We found that men still have a higher prevalence than women, but what has happened is that the gap has narrowed," said Dr. Amytis Towfighi, assistant professor of clinical neurology at the University of Southern California, lead author of one of two reports in the Oct. 26 issue of Archives of Internal Medicine. "For women it has increased, for men it has decreased."

Her study used data from two national surveys conducted from 1988 to 1994 and 1999 to 2004. While 2.5 percent of the men and 0.7 percent of the women reported a history of heart attacks in the earlier survey, 2.2 percent of men and 1 percent of women reported heart attacks in the more recent survey.

The narrowing of the male-female difference is easily explained, Towfighi stated. "Very basically, the risk factors are being better controlled in men than in women."

In men, levels of "bad" LDL cholesterol remained the same between the two surveys, while levels of "good" HDL cholesterol improved. Blood pressure levels improved, and fewer men smoked.

The improvements for women were marginal, with LDL cholesterol levels about the same. The only risk factor that improved in women was HDL cholesterol. Diabetes and obesity increased in men and women, the study found.

"We don't know exactly what is going on in terms of risk factors being better controlled. Women aren't checked as often," Towfighi acknowledged.

Societal changes may play a role, she said.

With more women in the work force, she said, their rising rates of obesity and diabetes can be attributed to job demands that limit their ability to exercise and follow dietary rules.

It is no longer assumed that female hormones protect against heart disease, she said. Doctors are paying more attention to heart risk factors in women because "there is a red flag about women not being absolutely protected against heart disease in midlife, as we had thought, and we are aware that more effort must be made to reduce their risk," Towfighi said.

The second study used information from a different data bank listing death rate trends from 1994 to 2006. It found a marked reduction in hospital deaths from heart attacks in all patients, especially among women. For women under 55, the risk of dying dropped by 53 percent, which was the greatest improvement noted. The least reduction, 33 percent, was seen in men under 55.

A detailed examination of cardiac risk factors showed that "women experienced less worsening than men," said Dr. Viola Vaccarino, professor of medicine and director of the Emory Program in Cardiovascular Outcomes Research and Epidemiology, lead author of the report.

But changing attitudes about women and heart disease may also have had an effect, she said.

"Perhaps physicians are paying more attention to the detection and treatment of women with heart disease," Vaccarino said. "It could be the same thing happening in the general public, with women getting more knowledgeable about this."

"Basically, both studies show that there still is a gap between men and women," said Dr. Nieca Goldberg, clinical associate professor of medicine at NYU Langone Medical Center and a spokeswoman for the American Heart Association. "They both show the importance of continuing to pay attention to women's risk of cardiovascular disease and treatment of their heart attacks."

The studies offer some good news for women, Goldberg said. "I'd like to think that's because we have increased the awareness of women themselves. But these two important studies show the need to continue research about reducing women's risk of cardiovascular disease."

More information

To find out who is at risk for coronary artery disease, visit the U.S. National Heart, Lung, and Blood Institute.

MONDAY, Oct. 26 (HealthDay News) -- New research provides the first hard evidence that the characteristic snorting and gasping of sleep apnea can spur potentially fatal heartbeat abnormalities.

Previous studies have suggested an association between sleep apnea and cardiac arrhythmias but they had not established a cause-and-effect relationship, said study senior author Dr. Susan Redline, a professor of medicine at Case Western Reserve University in Cleveland.

But in this research, "we studied the specific risk of cardiac arrhythmias and sleep apnea -- do these events act as a trigger for cardiac abnormalities?" she said. "And we established that there is a close temporal relationship."

The study will be published in the Nov. 3 issue of the Journal of the American College of Cardiology.

Redline and colleagues at sleep research centers across the country studied nearly 2,900 polysomnograms -- detailed sleep-time recordings of biophysical activities of the brain, muscles and heart of more than 2,500 people participating in the nationwide Sleep Heart Health Study. Specifically, the researchers compared heartbeat patterns seen during normal breathing against those occurring within 90 seconds of a sleep apnea episode.

They detected 62 arrhythmias occurring in 57 people with a wide range of sleep apnea disorders. Overall, the study found that the odds of experiencing a heartbeat abnormality were 18 times higher immediately after an episode of sleep apnea than during periods of normal breathing of sleep.

The researchers focused on two dangerous heartbeat abnormalities: atrial fibrillation, a disordered fluttering of the two upper chambers of the heart (a major risk factor for stroke); and ventricular tachycardia, a too-fast beating of the lower blood-pumping chambers that can cause sudden death.

One important finding of the study was that these abnormal heart rhythms were not linked to the severity of a person's sleep apnea, Redline said. "The study did look to see whether more intense sleep apnea increased the risk of arrhythmias," she said. "In fact, most of the arrhythmias occurred in people with mild-to-moderate sleep apnea."

The researchers stressed that abnormal heartbeats were relatively rare, with sleep apnea increasing their incidence by one for every 40,000 breathing disturbances. But the potentially serious effect of those heartbeat errors requires alertness in detecting sleep apnea, Redline said.

Conversely, the study suggests that doctors should be alert for the possibility of sleep apnea in people who have heart rhythm abnormalities, Redline said. "Those who present with arrhythmias should be screened for apnea," she advised.

For now, the study is more of scientific interest than immediate medical application, added study author Dr. Ken Monahan, an assistant professor of medicine. "It adds additional evidence to what was already suggested in the literature," he said.

It is important to note that the relationship established in the new study, "was built on the work of others," he said. "It raises a lot of very interesting questions about what the ultimate clinical applications of other findings may be."

More information

Find out more about sleep apnea at the U.S. National Library of Medicine.

TUESDAY, Oct. 20 (HealthDay News) -- A recommended treatment for heart failure is underused in U.S. hospitals, a new study finds.

The use of aldosterone antagonist therapy in patients with heart failure is designated as "useful and recommended" in chronic heart failure guidelines established by the American College of Cardiology/American Heart Association (ACC/AHA), but this study found that less than one-third of patients hospitalized for heart failure receive the treatment.

Researchers analyzed data on 43,625 patients admitted with heart failure and discharged home from 241 hospitals participating in a hospital recognition program called Get With The Guidelines -- HF between 2005 and 2007.

The study found that 12,565 patients (28.8 percent) from 201 hospitals met ACC/AHA heart failure management guidelines criteria, and 4,087 eligible patients received an aldosterone antagonist when they were discharged from hospital. Overall, treatment increased from 28 percent to 34 percent during the study period, but there was wide variation in aldosterone antagonist use among hospitals -- ranging from 0 percent to 90.6 percent.

"Aldosterone antagonist use in eligible patients was associated with younger age, African-American race/ethnicity, lower systolic blood pressure, history of implantable cardioverter-defibrillator use, depression, alcohol use and pacemaker implantation, and with having no history of renal insufficiency," wrote Nancy M. Albert of the Cleveland Clinic and colleagues.

"These data confirm that in the context of a hospital-based performance improvement program, aldosterone antagonist therapy can be used according to guidelines with little inappropriate use. Given the substantial morbidity and mortality risk faced by patients hospitalized with HF and the established efficacy of aldosterone antagonist prescription in HF, a stronger uptake of aldosterone antagonist therapy indicated by evidence-based guidelines may be warranted," the researchers concluded.

The study was published in the Oct. 21 issue of the Journal of the American Medical Association.

More information

The American Heart Association has more about heart failure  .