A new study by heart researchers at Intermountain Health finds that Utahns with heart disease, specifically those with heart failure, are especially vulnerable to the impacts of air pollution and poor air quality caused by seasonal winter inversions and wildfire smoke and should take steps to protect themselves.  

In the study, researchers found that two inflammatory markers — CCL27 (C-C motif chemokine ligand 27) and IL-18 (interleukin 18) — were elevated in heart failure patients who were exposed to poor air quality, but did not change in those without heart disease. This indicates that such air pollution events put more strain on the bodies of patients who already have heart problems.

While previous research has shown that people with some chronic health conditions, like heart failure, coronary disease, asthma, and COPD, struggle during spikes in air pollution, the new Intermountain Health study demonstrates that cardiac inflammation levels specifically rise in people with heart disease during periods of poor air quality.  

“These biomarkers rose in response to air pollution in people who already had heart disease, but not in patients who were heart disease free, showing that heart failure patients are not as able to adapt to changes in the environment,” said Benjamin Horne, PhD, principal investigator of the study and professor of research at Intermountain Health. 

 For the retrospective study, Intermountain Health researchers worked with scientists at Stanford University and the Harvard School of Public Health to examine the blood of patients enrolled in the Intermountain INSPIRE registry, which collects blood and other biological samples, medical information and laboratory data from healthy individuals and those who have been diagnosed with a variety of medical conditions. 

 Researchers specifically looked at blood tests for 115 different proteins that are signs of increased inflammation in the body.

They then examined blood draws of 44 patients with heart failure with preserved ejection fraction, and 35 people without heart disease. Some blood was drawn on days with low air pollution, where ambient PM_2.5levels were under 7 micrograms per cubic meter (μg/m³) of air; those test results were compared to draws done in other people on days when air pollution spiked to PM_2.5 levels of 20 μg/m³ or over. 

These spikes were caused by either wildfire smoke in the summer, or during a winter inversion, where air pollution is trapped when warm air holds pollution closer to the ground.

Researchers found that two inflammatory markers — CCL27 and IL-18 — were elevated in heart failure patients, but did not change in those without heart disease, indicating that such air pollution events put more strain on the bodies of patients who already have heart problems.

These findings “give us some information about mechanisms in people with heart failure who are having inflammation and suggest they’re not as capable in responding to acute inflammation as people who are healthy,” said Dr. Horne. 

He added that the results from the study suggest that heart failure patients need to take extra precautions during times when air pollution is high.

“It’s important that individuals with known heart disease, including those diagnosed with heart failure, need to be especially cautious during periods of poor air quality. This includes exercising indoors, making sure to take their prescribed medications, and avoiding areas like roadways and highways where there’s a lot more traffic and pollution,” he said. 

 Results of the study were presented at the American Heart Association’s national Scientific Session international conference in Chicago. 

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While coronary heart disease and diabetes are often seen in the same patients, a diagnosis of diabetes does not necessarily mean that patients also have coronary heart disease, according to a new study from researchers at Intermountain Health in Salt Lake City.

The Intermountain study found that proactively screening patients with diabetes 1 and 2 for coronary heart disease who have not shown symptoms of heart problems does not improve long-term mortality rates, nor does it lower the chance of them having a heart attack or stroke in the future.

“Our study found that doing these kinds of screenings on patients doesn’t make any marked difference in their long-term survival rates,” said J. Brent Muhlestein, principal investigator of the study and co-director of cardiovascular research at Intermountain Health.

“Instead, results of our study reinforce that we should be focusing on other proven interventions for people with diabetes, like medication management, diet and exercise, to help these patients lead long and healthy lives,” he added.

Findings from the Intermountain Health study were presented at the American Heart Association’s Scientific Sessions 2024 in Chicago on Monday, November 18.

For the study, Intermountain Health researchers examined data from FACTOR-64 study, a randomized clinical trial of 900 people with type 1 or type 2 diabetes for at least three to five years without coronary artery disease symptoms.

Of these patients, 452 were screened with a coronary computed tomography angiography (CCTA), which uses a powerful X-ray to make a 3D image of the heart. Researchers compared

these patients with a control group of 448 people who were treated with standard optimal diabetes care guidelines.

Enrollment occurred between July 2007 and May 2013, and followed up on in May 2024.

Researchers found that using CCTA to screen for cardiovascular disease did not significantly affect the rates of all-cause mortality or of non-fatal heart incidents, like heart attack and stroke. This was true when researchers initially followed up four or five years after the CCTA screening, and again at 12 years.

“These findings should discourage the use of CCTA for screenings in diabetes patients who do not show any symptoms of heart disease,” said Dr. Muhlestein.

“While our study showed that screening for coronary heart disease with CCTA won’t make any difference, it did show that if patients carefully medically manage their diabetes, they may live almost as long as somebody who does not have diabetes, which wasn’t the case before,” said Dr. Muhlestein. “This study shows that, even over an extended period of time, a screening like this can’t replace those kinds of critical behaviors.”

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Coronary artery calcium (CAC) scores have become a non-invasive way for physicians to easily determine how much plaque has built up inside a patient’s coronary arteries, but the question has been how accurate the score is in identifying women, as well as men, who are at high risk for a heart attack or death.

Now, a major new study by researchers at Intermountain Health in Salt Lake City finds coronary artery calcium scores are not only highly effective in identifying those at risk for future heart attacks, but also for death, and risk prediction was found to be as good in women as in men.

Results from the Intermountain Health study found that in addition to predicting risk of coronary death and non-fatal heart attacks, coronary artery calcium scores also correlated to all-cause mortality. Researchers found that people with a score of zero were three times less likely to die from any cause.

“The coronary artery calcium score appears to be an excellent and accurate indicator of health and overall prognosis, even beyond heart disease,” said Jeffrey L. Anderson, principal investigator of the study and distinguished research physician at Intermountain Health.

Findings from the Intermountain Health study were presented at the American Heart Association National Scientific Sessions 2024 in Chicago on Monday, Nov. 18, 2024.

Coronary artery calcium testing is becoming more common in heart healthcare. These tests are non-invasive, use as little radiation as a mammogram, and are relatively cheap, especially compared to PET stress tests, coronary CT angiograms, or coronary angiography.

For the Intermountain Health study, researchers reviewed the electronic health records of 19,495 women and 20,523 men who had undergone PET/CT scans because their physicians

suspected they had a risk of heart disease, but who hadn’t yet had a heart event, such as a heart attack.

Of these patients, 7,967 had a CAC score of zero, meaning they had no calcified plaque in their coronary arteries. Of this group, women on average were older than men (60.5 years for women, 53.8 for men), which correlates to how women often develop heart disease later in life than men, Dr. Anderson said.

Researchers then followed up on patients about two years later. They found that a zero CAC score predicted a low risk for coronary death or nonfatal heart attacks in both men and women. CAC scores of zero were more frequently observed in women despite having an older average age.

Intermountain researchers also found that those with a zero CAC had three times lower risk of all-cause death or heart attack in both sexes.

While it’s obvious why a CAC score of zero would be a good indicator of heart health, its ability to predict all-cause mortality is novel and deserves additional study.

“We will be exploring this further to understand better why a zero-calcium score is such a good signal to overall health,” said Dr. Anderson.

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Using an innovative risk score assessment score, heart researchers at Intermountain Health in Salt Lake City say they can accurately predict whether patients being assessed for kidney transplant will likely have a future major cardiac event, like a heart attack or stroke, according to a new study.

Intermountain Health clinicians regularly review patient data through their electronic health system to determine who may have heart disease without knowing it. Now, in a major new study, Intermountain heart researchers found that using their Intermountain Risk Score (IMRS) they could also accurately predict whether patients being assessed for kidney transplant would have a major cardiac event, like a heart attack or stroke.  

“This study demonstrates that we could adapt our already existing risk score guide to help identify which of these patients might also be at risk for having a heart event, which could lead to better and more personalized treatment,” said Benjamin Horne, PhD, director of cardiovascular and genetic epidemiology at the Intermountain Health.  

Findings from the new study will be presented at the American Heart Association Scientific Sessions in Chicago on Sunday, November 17, 2024.

The Intermountain Risk Score is a well-validated, sex-specific risk prediction tool that includes factors like age and results from complete blood count and basic metabolic profile testing to predict the risk of major cardiovascular events and death.

These scores are assessed automatically based on information input into electronic health records. If a patient has a high score, their care team is alerted. 

In the Intermountain study, researchers looked specifically at the accuracy of the IMRS for patients being considered for kidney transplant.

They identified patients who were assessed for transplant surgery at Intermountain Health between June 2015 and April 2024 and found 891 patients. 200 patients did not have all of the laboratory tests needed to calculate an IMRS, so they were excluded from the next step in the study.

That left 691 patients with enough information to retroactively calculate IMRS.

Intermountain researchers found that these patients were on average 55.9 years old, and 34.3% were women.

Of those 691 patients, 171 experienced a major cardiac event over a five-year follow-up period. Researchers found that IMRS was effective in predicting these outcomes, showing the potential use of calculating such a score in people being evaluated for kidney transplant.

The score can be “a really valuable piece of information, but some of these patients were missing lab tests that would have enabled us to calculate it,” said Dr. Horne, referring to the 200 people in this retrospective study who did not have enough laboratory tests to be included. 

“This is the first step in assessing if we can make a risk score specifically keyed to the risk of people who are going to have a rental transplant, and make sure we collected all the appropriate data so we can do so,” he said.

Next steps include validating the risk score in another patient population, determining whether modifying the risk score by adding data routinely collected in kidney patients improves its ability to assess risk for kidney transplant patients, and then conducting a prospective clinical trial of using the risk score in modifying clinical care processes to determine whether personalized care improves patient outcomes.

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Stroke is the fifth-leading cause of death and a leading cause of disability in the United States. According to the Utah Department of Health and Human Services, strokes were the sixth leading cause of death in 2020.

A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood and oxygen it needs, so brain cells die. Early stroke detection and treatment are key to improving survival, minimizing disability, and accelerating recovery times.

The Get With the Guidelines puts the expertise of the American Heart Association and American Stroke Association to work for hospitals nationwide, helping ensure patient care is aligned with the latest research- and evidence-based guidelines. This program helps improve stroke care by promoting consistent adherence to these guidelines, which can minimize the long-term effects of a stroke and even prevent death.

The Intermountain Health team of specialists has developed protocols that shorten the amount of time it takes to diagnose and treat a stroke. This is important because a quick diagnosis and treatment can mean less long-term damage, less disability, and better overall outcomes.

Intermountain Health offers a full spectrum of specialized care that ranges from neuro critical care through acute care and into rehabilitation and outpatient therapy. 

“This recognition reflects the unwavering dedication of our team of physicians, APPs, nurses, and technicians to the community we are so honored to serve. We have a saying in neurology that ‘Time is Brain’, because the sooner we treat stroke patients, the better their outcomes will be,” said Katherine Thomas, MD, chief medical officer for Intermountain Medical Center.

“We are committed to continually assessing and refining our stroke processes while leveraging our incredible caregivers to ensure that every patient receives the highest quality stroke care.” 

“We are incredibly pleased to recognize Intermountain Medical Center for its commitment to caring for patients with stroke,” said Steven Messe, MD, volunteer chairperson of the American Heart Association Stroke System of Care Advisory Group and professor of neurology and director of fellowships of neurology at the Hospital of the University of Pennsylvania. “Participation in Get With the Guidelines is associated with improved patient outcomes, fewer readmissions and lower mortality rates – a win for health care systems, families and communities.”

Intermountain Medical Center also received the American Heart Association’s Target: Stroke Honor Roll Elite Plus award, the AHA’s Honor Roll Advanced Therapy award, and the AHA’s Target: Type 2 Diabetes Honor Roll award.

To qualify for this recognition, hospitals must meet specific criteria that reduce the time between an eligible patient’s arrival at the hospital and treatment with thrombolytic therapy. Additionally, hospitals must meet specific criteria that reduce the time between an eligible patient’s arrival at the hospital and treatment to remove the clot causing the stroke.

“Intermountain Medical Center is committed to improving patient care by adhering to the latest treatment guidelines,” said Dr. Thomas. “The Get With the Guidelines program makes it easier for our teams to put proven knowledge and guidelines to work on a daily basis, which studies show can help patients recover better. The end goal is to ensure more people in our community experience longer, healthier lives.”

The Target: Type 2 Diabetes program aims to ensure patients with Type 2 diabetes, who might be at higher risk for complications, receive the most up-to-date, evidence-based care when hospitalized due to stroke.

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El accidente cerebrovascular es la quinta causa principal de muerte y una de las principales causas de discapacidad en los Estados Unidos. Según el Departamento de Salud y Servicios Humanos de Utah, los accidentes cerebrovasculares fueron la sexta causa principal de muerte en 2020.

Un accidente cerebrovascular ocurre cuando un vaso sanguíneo que transporta oxígeno y nutrientes al cerebro está bloqueado por un coágulo o se rompe. Cuando eso sucede, una parte del cerebro no puede obtener la sangre y el oxígeno que necesita, por lo que las células cerebrales mueren. La detección y el tratamiento tempranos del accidente cerebrovascular son clave para mejorar la supervivencia, minimizar la discapacidad y acelerar los tiempos de recuperación.

Get With the Guidelines pone la experiencia de la Asociación Americana del Corazón y la Asociación Americana de Accidentes Cerebrovasculares al servicio de los hospitales de todo el país, ayudando a garantizar que la atención al paciente esté alineada con las últimas directrices basadas en la investigación y la evidencia. Este programa ayuda a mejorar la atención de los accidentes cerebrovasculares al promover el cumplimiento constante de estas pautas, lo que puede minimizar los efectos a largo plazo de un accidente cerebrovascular e incluso prevenir la muerte.

El equipo de especialistas de Intermountain Health ha desarrollado protocolos que acortan la cantidad de tiempo que se tarda en diagnosticar y tratar un accidente cerebrovascular. Esto es importante porque un diagnóstico y tratamiento rápidos pueden significar menos daño a largo plazo, menos discapacidad y mejores resultados generales.

Intermountain Health ofrece un espectro completo de atención especializada que abarca desde la atención neurocrítica hasta la atención aguda y la rehabilitación y la terapia ambulatoria.

"Este reconocimiento refleja la dedicación inquebrantable de nuestro equipo de médicos, APP, enfermeras y técnicos a la comunidad a la que nos sentimos tan honrados de servir. Tenemos un dicho en neurología que dice que 'el tiempo es cerebro', porque cuanto antes tratemos a los pacientes con accidente cerebrovascular, mejores serán sus resultados", dijo Katherine Thomas, MD, directora médica de Intermountain Medical Center.

"Estamos comprometidos a evaluar y refinar continuamente nuestros procesos de accidente cerebrovascular mientras aprovechamos a nuestros increíbles cuidadores para garantizar que cada paciente reciba atención de la más alta calidad para el accidente cerebrovascular".

"Estamos increíblemente complacidos de reconocer a Intermountain Medical Center por su compromiso con el cuidado de los pacientes con accidentes cerebrovasculares", dijo Steven Messe, MD, presidente voluntario del Grupo Asesor del Sistema de Atención de Accidentes Cerebrovasculares de la Asociación Estadounidense del Corazón y profesor de neurología y director de becas de neurología en el Hospital de la Universidad de Pensilvania. "La participación en Get With the Guidelines se asocia con mejores resultados para los pacientes, menos readmisiones y menores tasas de mortalidad, una victoria para los sistemas de atención médica, las familias y las comunidades".

Intermountain Medical Center también recibió el premio Target: Stroke Honor Roll Elite Plus de la American Heart Association, el premio Honor Roll Advanced Therapy de la AHA y el premio Target: Type 2 Diabetes Honor Roll de la AHA.

Para calificar para este reconocimiento, los hospitales deben cumplir con criterios específicos que reduzcan el tiempo entre la llegada de un paciente elegible al hospital y el tratamiento con terapia trombolítica. Además, los hospitales deben cumplir con criterios específicos que reduzcan el tiempo entre la llegada de un paciente elegible al hospital y el tratamiento para eliminar el coágulo que causa el accidente cerebrovascular.

"Intermountain Medical Center está comprometido a mejorar la atención al paciente al adherirse a las últimas pautas de tratamiento", dijo el Dr. Thomas. "El programa Get With the Guidelines hace que sea más fácil para nuestros equipos poner en práctica el conocimiento y las pautas comprobados a diario, lo que los estudios muestran que puede ayudar a los pacientes a recuperarse mejor. El objetivo final es garantizar que más personas de nuestra comunidad experimenten vidas más largas y saludables".

El objetivo: El programa de diabetes tipo 2 tiene como objetivo garantizar que los pacientes con diabetes tipo 2, que podrían tener un mayor riesgo de complicaciones, reciban la atención más actualizada y basada en evidencia cuando sean hospitalizados debido a un accidente cerebrovascular.

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