David C. Lange

Pacemaker Reuse An Initiative to Alleviate the Burden of Symptomatic Bradyarrhythmia in Impoverished Nations Around the World

> Health of body and mind is so fundamental to the good life that if we believe men have any personal rights at all as human beings, they have an absolute right to such a measure of good health as society and society alone is able to give them. > > —Aristotle, 330 bc For most of the industrialized world, the morbidity and mortality attributed to cardiovascular disease have declined in recent decades as a result of improvements in technology and a greater emphasis on primary and secondary preventative strategies.1 Unfortunately, this dramatic improvement in disease burden has not been witnessed in low- and middle-income countries (LMICs), defined by the World Bank as generating a gross national income per capita lower than US

Safety and efficacy of pacemaker reuse in underdeveloped nations: a case series.

9200.2 Currently, cardiovascular disease is the primary cause of mortality worldwide, accounting for 30% of all global deaths,3 and it has twice the mortality rate of HIV/AIDS, malaria, and tuberculosis combined.4 Secondary treatments are often limited because of a paucity of skilled healthcare providers and, more important, the inability of the patient to afford costly medical procedures.5 This great disparity in medical health care is clearly evident in the field of cardiac electrophysiology, specifically pacemaker implantation; this specialty is either severely underdeveloped or entirely nonexistent in many LMICs.6 As a result, many individuals with symptomatic bradycardia experience a decreased quality of life and/or decreased life expectancy because of a lack of resources (personal correspondence, University of Philippines–Philippine General Hospital [UP-PGH], November 15, 2008). As the epidemic of cardiovascular disease continues to alter the demographics of disease in LMICs, healthcare providers with access to medical technology must investigate novel methods of easing the burden of those less fortunate. The purpose of this article is to address the concept of postmortem pacemaker use for those in LMICs who otherwise …

Systolic blood pressure influences the interpretation of cardiopulmonary exercise tests and helps identify a very high-risk cohort of heart failure patients.

To the Editor: The morbidity and mortality associated with cardiovascular disease (CVD) has been steadily declining in industrialized nations over recent decades due to innovations in technology and widespread access to health care; however, the prevalence of CVD is expected to increase 137%

Response to Letter Regarding Article, “Pacemaker Reuse: An Initiative to Alleviate the Burden of Symptomatic Bradyarrhythmia in Impoverished Nations Around the World”

BACKGROUND Ventilatory inefficiency (high volume of expired air/volume of carbon dioxide eliminated [Ve/Vco2] slope), and impaired exercise tolerance (low peak volume of oxygen consumption) obtained from cardiopulmonary exercise testing (CPX) strongly predict mortality in heart failure (HF) patients; however, other CPX variables may also contain prognostic information. Therefore, the purpose of this study was to determine the prognostic power of the aggregate of CPX data. METHODS The study prospectively monitored 390 patients referred for cardiac transplantation evaluation for 10 years for events (death, urgent transplant, left ventricular assist devices). Cox regression was used to analyze 18 CPX variables to identify the best survival model. RESULTS Ve/Vco2 slope was the most powerful mortality predictor, and only resting systolic blood pressure (SBP) added additional independent prognostic power when expressed at its threshold effect value as SBP ≤ 100 mm Hg. Patients with low SBP had a greater risk than those who were within the next higher quartile of Ve/Vco2 slope with SBP > 100 mm Hg. A very high-risk cohort included 9% of the population that had a Ve/Vco2 slope > 41 and SBP ≤ 100 mm Hg and an associated 2-year event rate of 67%; conversely, a low-risk cohort had a Ve/Vco2 slope ≤ 30 and SBP >100 mm Hg and associated 2-, 5-, and 10-year event rates of 5%, 12%, and 30%, respectively. CONCLUSIONS Ve/Vco2 slope was the best individual predictive CPX variable and its interpretation was significantly altered by the presence of hypotension. An algorithm combining these CPX variables identifies a HF population at very high risk of early death and warranting advanced therapies.

Structural and material changes in the aging thorax and their role in crash protection for older occupants

We would like to thank Dr Syed Wamique Yusuf for his comments regarding “Pacemaker Reuse: an Initiative to Alleviate the Burden of Symptomatic Bradyarrhythmia in Impoverished Nations Around the World.”1 In addition, we applaud the great humanitarian efforts of Dr Yusuf, the Association of Pakistani-descent Cardiologists of North America, …