Long-term outcomes in patients with advanced coronary artery disease are better than expected

Public release date: 15-May-2013
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Contact: Steve Goodyear
sgoodyear@mhif.org
612-863-1658
Minneapolis Heart Institute Foundation

MINNEAPOLIS (May 15, 2013) Death rates associated with patients with refractory angina, or chronic chest pain, are lower than previously considered; therefore, physicians should focus on relieving the chest pain symptoms and improving the quality of life in these patients according to an article published online this week in the European Heart Journal.

Refractory angina patients endure ongoing chest pain despite optimal medical management and for them, standard revascularization techniques, such as surgery or stenting, is no longer an option. Traditionally, these are the patients with the most advanced coronary artery disease, frequently referred to as "no-option patients."

"Importantly, this study describes the first long-term results from the largest and most contemporary follow-up of patients in a dedicated refractory angina clinic," says the study's first author Timothy D. Henry, MD, director of research at the Minneapolis Heart Institute Foundation. "Our results demonstrate that long-term mortality in patients with refractory angina is surprisingly low, below 4 percent per year."

The OPtions In Myocardial Ischemic Syndrome Therapy (OPTIMIST) program at the Minneapolis Heart Institute at Abbott Northwestern Hospital in Minneapolis was created for refractory angina patients in 1996 to develop new treatment options for this challenging patient population. This study reflects the long-term survival and predictors of mortality.

The study population consisted of 1,200 consecutive patients with either refractory myocardial ischemia and/or refractory angina, who were not candidates for traditional revascularization and referred for alternative treatment strategies from 1996 to present.

Overall, 241 patients of the 1,200 died during a median follow-up of 5.1 years. After an analysis, the researchers determined mortality was 3.9 percent at one year and 28.4 percent at nine years.

"Currently, data on the incidence and prevalence of refractory angina are scarce and mainly derived from registries," explains Henry.

In addition to the low overall mortality, the results indicated non-cardiac death in nearly 30 percent of patients and a low incidence of sudden cardiac death.

Improved secondary prevention strategies, evidence-based medical therapy and more advanced revascularization techniques all likely contributed to lower mortality, concluded Henry and his colleagues in the paper.

"Widespread and improved adherence to medical medications combined with aggressive lifestyle changes, such as diet, exercise and smoking cessation, has contributed to lower overall mortality in patients with coronary artery disease, and this includes the highest-risk patients with refractory angina," Henry notes.

Based on the findings, more than 70 percent of patients with refractory angina can expect to survive nine years from the time of diagnosis. Given these results, the researchers emphasized that therapeutic options for this growing population should therefore focus on chest pain relief and improved quality of life.

###

Jon Holden DeHaan Foundation supported the study.

Minneapolis Heart Institute Foundation

The Minneapolis Heart Institute Foundation is dedicated to creating a world without heart disease through groundbreaking clinical research and innovative education programs. MHIF's mission is to promote and improve cardiovascular health, quality of life and longevity for all.

Minneapolis Heart Institute

The Minneapolis Heart Institute is recognized internationally as one of the world's leading providers of heart and vascular care. This state-of-the-art facility combines the finest in personalized patient care with sophisticated technology in a unique, family-oriented environment. The Institute's programs, a number of which are conducted in conjunction with Abbott Northwestern Hospital, address the full range of heart and vascular health needs: prevention, diagnosis, treatment and rehabilitation.

Contact Information:

Steve Goodyear
Minneapolis Heart Institute Foundation
sgoodyear@mhif.org
612-863-1658
http://mplsheart.org

---

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AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Public release date: 15-May-2013
[ | E-mail | Share ]

Contact: Steve Goodyear
sgoodyear@mhif.org
612-863-1658
Minneapolis Heart Institute Foundation

MINNEAPOLIS (May 15, 2013) Death rates associated with patients with refractory angina, or chronic chest pain, are lower than previously considered; therefore, physicians should focus on relieving the chest pain symptoms and improving the quality of life in these patients according to an article published online this week in the European Heart Journal.

Refractory angina patients endure ongoing chest pain despite optimal medical management and for them, standard revascularization techniques, such as surgery or stenting, is no longer an option. Traditionally, these are the patients with the most advanced coronary artery disease, frequently referred to as "no-option patients."

"Importantly, this study describes the first long-term results from the largest and most contemporary follow-up of patients in a dedicated refractory angina clinic," says the study's first author Timothy D. Henry, MD, director of research at the Minneapolis Heart Institute Foundation. "Our results demonstrate that long-term mortality in patients with refractory angina is surprisingly low, below 4 percent per year."

The OPtions In Myocardial Ischemic Syndrome Therapy (OPTIMIST) program at the Minneapolis Heart Institute at Abbott Northwestern Hospital in Minneapolis was created for refractory angina patients in 1996 to develop new treatment options for this challenging patient population. This study reflects the long-term survival and predictors of mortality.

The study population consisted of 1,200 consecutive patients with either refractory myocardial ischemia and/or refractory angina, who were not candidates for traditional revascularization and referred for alternative treatment strategies from 1996 to present.

Overall, 241 patients of the 1,200 died during a median follow-up of 5.1 years. After an analysis, the researchers determined mortality was 3.9 percent at one year and 28.4 percent at nine years.

"Currently, data on the incidence and prevalence of refractory angina are scarce and mainly derived from registries," explains Henry.

In addition to the low overall mortality, the results indicated non-cardiac death in nearly 30 percent of patients and a low incidence of sudden cardiac death.

Improved secondary prevention strategies, evidence-based medical therapy and more advanced revascularization techniques all likely contributed to lower mortality, concluded Henry and his colleagues in the paper.

"Widespread and improved adherence to medical medications combined with aggressive lifestyle changes, such as diet, exercise and smoking cessation, has contributed to lower overall mortality in patients with coronary artery disease, and this includes the highest-risk patients with refractory angina," Henry notes.

Based on the findings, more than 70 percent of patients with refractory angina can expect to survive nine years from the time of diagnosis. Given these results, the researchers emphasized that therapeutic options for this growing population should therefore focus on chest pain relief and improved quality of life.

###

Jon Holden DeHaan Foundation supported the study.

Minneapolis Heart Institute Foundation

The Minneapolis Heart Institute Foundation is dedicated to creating a world without heart disease through groundbreaking clinical research and innovative education programs. MHIF's mission is to promote and improve cardiovascular health, quality of life and longevity for all.

Minneapolis Heart Institute

The Minneapolis Heart Institute is recognized internationally as one of the world's leading providers of heart and vascular care. This state-of-the-art facility combines the finest in personalized patient care with sophisticated technology in a unique, family-oriented environment. The Institute's programs, a number of which are conducted in conjunction with Abbott Northwestern Hospital, address the full range of heart and vascular health needs: prevention, diagnosis, treatment and rehabilitation.

Contact Information:

Steve Goodyear
Minneapolis Heart Institute Foundation
sgoodyear@mhif.org
612-863-1658
http://mplsheart.org

---

[ | E-mail | Share ]

?

AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.

Source: http://www.eurekalert.org/pub_releases/2013-05/mhif-loi051513.php

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Keith Ellison: ?I don?t care what party you?re in. I?m in the Social Security party.? (Americablog)

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Is Sebelius shaking down health-care execs to finance Obamacare ...

U.S. Secretary of Health and Human Services Kathleen Sebelius speaks during the opening plenary of the National Health Policy Conference organized by The AcademyHealth February 4, 2013 in Washington, DC. Sebelius spoke on the Obama Administration?s health policy priorities. (Photo by Alex Wong/Getty Images)

Health care reform may be President Obama?s signature legislative achievement, but it?s still a work in progress. The Affordable Care Act?s most ambitious provisions?the expansion of Medicaid , the rollout of 50 state-based insurance exchanges, the enforcement of a law requiring everyone to find coverage?are all set to kick in on January 1. The deadlines would be daunting even in a friendly political environment, but the path is now littered with landmines.

A small one exploded last weekend, after the Washington Post reported that Health and Human Services Secretary Kathleen Sebelius was soliciting private donations to help implement Obamacare. Congressional Republicans have forced the administration to go begging by rejecting its funding requests. But the same Republicans pounced when the HHS effort came to light?and the critics? predictable questions have left the administration on its heels.

At issue is whether Sebelius has requested donations from industries her agency regulates?a practice that would be ethically improper and possibly illegal. The Post story forcefully asserted that she has. Under the headline ?Sebelius turns to health executives to finance Obamacare,? the paper reported that she had spent the past three months hitting up insurance, hospital and pharmaceutical officials for ?large financial donations? to help the government shepherd consumers into the nation?s new health system. The claim was attributed to an anonymous HHS official and an unnamed ?industry person familiar with the secretary?s activities.?

The paper quoted agency spokesman Jason Young denying that Sebelius had ?solicited funds from industries that HHS regulates.? But the charge?set off a flurry of news coverage and righteous outrage.??To solicit funds from health-care executives to help pay for the implementation of the President?s $2.6 trillion health spending law is absurd,? Sen. Orrin Hatch said in a statement. ?I will be seeking more information from the administration about these actions to help better understand whether there are conflicts of interest and if it violated federal law.?

Lamar Alexander, the senior Republican on the Senate health committee, went further, likening the secretary?s fundraising effort to the Iran-Contra scandal, in which Reagan administration officials secretly sold arms to Iran and funneled the proceeds to right-wing insurgents in Nicaragua. ?Secretary Sebelius? fundraising . . . should be fully investigated by Congress,? he told reporters in Nashville on Saturday.

Will these charges stick? Is a cabinet secretary really shaking down the very industries she regulates??HHS acknowledges that she has asked them to help raise public awareness. The agency also confirms that she has asked business leaders from outside the health sector to help finance groups like?Enroll America, a nonprofit foundation set up to educate consumers about the new health care law. Those activities are all kosher under the Public Health Service Act.

But Young, the HHS spokesman, still disputes the central premise of the Washington Post story and all the criticism it has sparked. ?The secretary has made no fundraising request to entities regulated by HHS,? he says. ?We?ve worked with a wide range of stakeholders. But when it comes to fundraising, we ask only non-regulated entities??that is, no one from the health-care industry.

If that?s true, HHS could quickly clear the air by releasing a log of the calls Sebelius has made. Young says the agency is busy preparing one and will release it shortly.

This scandal-plagued administration should hope it vindicates her, but the congressional Republicans calling for her head should reflect on their own role in the affair. After failing repeatedly to repeal or overturn Obamacare, they?re now working to thwart its implementation: that?s why Sibelius is begging business leaders for the funds to secure the nation?s health. The richest country in the world should be able to do better.

Source: http://tv.msnbc.com/2013/05/14/is-sebelius-shaking-down-health-care-execs-to-finance-obamacare/

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Video provides suspect in Mother's Day parade shooting

NEW ORLEANS (AP) ? Video released early Monday by New Orleans police shows a possible suspect in the Mother's Day gunfire that wounded 19 people during a neighborhood parade.

The grainy surveillance video shows a crowd suddenly scattering in all directions, with some falling to the ground. They appear to be running from a man who turns and runs out of the picture. The person is wearing a white T-shirt and dark pants. The image isn't clear but police say they hope someone will recognize him and notify investigators.

Still pictures of the suspect have been posted on YouTube, police said.

Police believe more than one gun was fired in the burst of Sunday afternoon violence ? the latest to flare up around a celebration this year ? and they have vowed to swiftly track down those responsible. Detectives were conducting interviews, collecting any surveillance video they could find and gathering evidence from the scene. Cell phone video taken in the aftermath of the shooting shows victims lying on the ground, blood on the pavement and others bending over to comfort them.

Police also say the reward for information leading to arrests and indictments in the case is $10,000.

At least three of the victims were seriously wounded. Of the rest, many were grazed and authorities said that, overall, most wounds were not life threatening. No deaths were reported.

The victims included 10 men, seven women, a boy and a girl. The children, both 10 years old, were grazed and in good condition.

It's not the first time gunfire has shattered a festive mood in the city this year. Five people were wounded in January after a Martin Luther King Jr. Day parade, and four were wounded in a shooting in the French Quarter in the days leading up to Mardi Gras.

"The specialness of the day doesn't appear to interrupt the relentless drumbeat of violence," Mayor Mitch Landrieu said at a news conference outside a hospital where victims were being treated Sunday night.

Mary Beth Romig, a spokeswoman for the FBI in New Orleans, said federal investigators have no indication the shooting was an act of terrorism.

"It's strictly an act of street violence in New Orleans," she said.

As many as 400 people came out for the second-line procession ? a boisterous New Orleans tradition ? though only half that many were in the immediate vicinity of the shooting, Police Superintendent Ronal Serpas said. Officers were interspersed with the marchers, which is routine for such events.

Police saw three suspects running from the scene. No arrests had been made as of late Sunday.

Outside the hospital Sunday night, Leonard Temple became teary as he talked about a friend who was in surgery after being shot three times during the parade. Temple was told the man was hit while trying to push his own daughter out of the way.

"People were just hanging out. We were just chilling. And this happened. Bad things always happen to good people," said Temple, who was at the parade but didn't see the shootings.

Second-line parades are loose processions in which people dance down the street, often following behind a brass band. They can be planned events or impromptu offshoots of other celebrations. They trace their origins to the city's famous jazz funerals.

A social club called The Original Big 7 organized Sunday's event. The group was founded in 1996 at the Saint Bernard housing projects, according to its MySpace page.

The neighborhood where the shooting happened is a mix of low-income and middle-class row houses, some boarded up. As of last year, the 7th Ward's population was about 60 percent of its pre-Hurricane Katrina level.

The crime scene was about 1.5 miles from the heart of the French Quarter and near the Treme neighborhood, which has been the centerpiece for the HBO TV series "Treme."

Sunday's violence comes at a time when the city is struggling to pay for tens of millions of dollars required under federal consent decrees to reform the police department and the city jail.

Shootings at parades and neighborhood celebrations have become more common in recent years as the city has struggled with street crime, sometimes gang-related.

In January, police said a feud resulted in the drive-by shooting that wounded five people about 30 minutes after a parade had passed by on Martin Luther King Jr. Day. The next month, four people were shot following an argument in the French Quarter during the last weekend of partying before Mardi Gras. Arrests were made in both cases.

Police vowed to solve Sunday's shooting, too. Serpas said it wasn't clear if particular people in the second line were targeted, or if the shots were fired at random.

"We'll get them. We have good resources in this neighborhood," Serpas said.

___

Contributing to this report were Associated Press writers Michael Kunzelman and Kevin McGill in New Orleans and AP Radio reporter Jackie Quinn in Washington.

Source: http://news.yahoo.com/police-vow-solve-shootings-19-orleans-083911390.html

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Justice investigating IRS targeting of tea party

Attorney General Eric Holder pauses during a news conference at the Justice Department in Washington, Tuesday, May 14, 2013. Holder said he's ordered a Justice Department investigation into the Internal Revenue Service's targeting of conservative groups for extra tax scrutiny. (AP Photo/J. Scott Applewhite)

Attorney General Eric Holder pauses during a news conference at the Justice Department in Washington, Tuesday, May 14, 2013. Holder said he's ordered a Justice Department investigation into the Internal Revenue Service's targeting of conservative groups for extra tax scrutiny. (AP Photo/J. Scott Applewhite)

Gov. Scott Walker says the IRS's targeting of conservative groups for extra scrutiny is a real threat to our freedoms, on Tuesday, May 14, 2013, in Madison, Wis. (AP Photo/Scott Bauer)

The John Weld Peck Federal Building, shown Tuesday, May 14, 2013, in Cincinnati, houses the main offices for the Internal Revenue Service in the city. The IRS apologized Friday for what it acknowledged was "inappropriate" targeting of conservative political groups during the 2012 election to see whether they were violating their tax-exempt status. In some cases, the IRS acknowledged, agents inappropriately asked for lists of donors. The agency blamed low-level employees in a Cincinnati office, saying no high-level officials were aware.(AP Photo/Al Behrman)

WASHINGTON (AP) ? The Justice Department is investigating the Internal Revenue Service for targeting tea party groups for extra scrutiny when they applied for tax exempt status, Attorney General Eric Holder said Tuesday, widening a probe that includes investigations by three committees in Congress.

Ineffective management at the IRS allowed agents to improperly target tea party groups for more than 18 months, concluded one investigation, by the Treasury inspector general for tax administration. The inspector general's report, released Tuesday, lays much of the blame on IRS supervisors in Washington who oversaw a group of specialists in Cincinnati who screened applications for tax exempt status.

The report does not indicate that Washington initiated the targeting of conservative groups. But it does say a top supervisor in Washington did not adequately supervise agents in the field even after she learned the agents were acting improperly.

"The report's findings are intolerable and inexcusable," President Barack Obama said in a statement. "The federal government must conduct itself in a way that's worthy of the public's trust, and that's especially true for the IRS. The IRS must apply the law in a fair and impartial way, and its employees must act with utmost integrity. This report shows that some of its employees failed that test."

Holder said he ordered the FBI to investigate Friday ? the day the IRS publicly acknowledged that it had singled out conservative groups.

"Those (actions) were, I think, as everyone can agree, if not criminal, they were certainly outrageous and unacceptable," Holder said. "But we are examining the facts to see if there were criminal violations."

Three congressional committees already are investigating the IRS for singling out tea party and other conservative groups during the 2010 congressional elections and the 2012 presidential election. But Holder's announcement takes the matter to another level, if investigators are able to prove that laws were broken.

Holder said he wasn't sure which laws may have been broken.

The agency started targeting groups with "Tea Party," ''Patriots" or "9/12 Project" in their applications for tax exempt status in March 2010, the inspector general's report said. By August 2010, it was part of the written criteria used to flag groups for additional scrutiny.

Lois Lerner, who heads the IRS division that oversees tax exempt organizations, had been briefed on the matter in June 2011. She ordered the initial tea party criteria to be scrapped but it later evolved to include groups that promoted the Constitution and the Bill of Rights.

IRS agents were trying to determine whether the political activities of such groups disqualified them for tax-exempt status. These groups were claiming tax-exempt status as organizations promoting social welfare. Unlike other charitable groups, they can engage in political activity. But politics cannot be their primary mission.

It is up to the IRS to make the determination.

But by using improper criteria, the IRS targeted some groups, even though there were no indications that they engaged in significant political activities, the report said. Other non-tea party groups that had significant political activities were not screened, the report said.

"The criteria developed by the Determinations Unit gives the appearance that the IRS is not impartial in conducting its mission," the report said.

In all, IRS agents identified 296 applications for additional, sometimes burdensome scrutiny. Ninety-one of them should not have been targeted because they did not indicate they were engaged in significant political activities, investigators concluded.

Of the groups that were not engaged in significant political activities, 17 were tea party, patriot or 9/12 groups, the report said.

The additional screening resulted in long delays as IRS agents asked intrusive, sometimes inappropriate questions, or merely let applications languish, the report said. Inappropriate questions included requests for lists of donors and the political affiliation of officers.

As of December, the delays averaged 574 days, which probably made donors reluctant to contribute, the report said. No group has had their application denied, though about half are still waiting, the IRS said.

"Unfortunately, the report raises more questions than it answers," said House Oversight Committee chairman Darrell Issa, R-Calif. "What we do know for sure is that the IRS personnel responsible for granting tax exemptions systematically targeted conservative groups for extra scrutiny, and thatofficials in Washington, D.C. were aware of this practice, even while publically claiming that it never happened."

Obama said he is ordering Treasury Secretary Jacob Lew to implement all of the inspector general's recommendations to improve oversight at the IRS.

"But regardless of how this conduct was allowed to take place, the bottom line is, it was wrong," Obama said.

The practice of targeting conservative groups ended in May 2012, the report said.

"After seeing issues with particular cases, inappropriate shortcuts were used to determine which cases may be engaging in political activities," the IRS said in a statement Tuesday evening. "It is important to note that the vast majority of these cases would still have been centralized based on the general criteria used for other cases."

"It is also important to understand that the group of centralized cases included organizations of all political views," the statement said.

The IRS has said the improper reviews were limited to a Cincinnati office where a special team was assembled to screen them. The inspector general's report does not contradict the agency on this assertion.

However, documents obtained by The Associated Press suggest the targeting of conservative groups could be more widespread. Documents sent from the IRS to tea party groups show that IRS offices in California and Washington, D.C., also sought extensive information from tea party groups who requested tax-exempt status.

In letters provided by the American Center for Law and Justice, which represents 27 tea party groups that have sought tax exempt status, IRS officials from two cities in California ? El Monte and Laguna Nigel ? as well as officials in Washington, D.C., and Cincinnati contacted groups seeking extensive information.

The law center's chief counsel, Jay Sekulow, said he was astonished the IRS said activity was limited to Cincinnati.

"To me, that was what was mind-boggling, they tried to create a narrative," he said.

On Monday, the IRS said acting IRS Commissioner Steven Miller was first informed on May, 3, 2012, that applications for tax-exempt status by tea party groups were inappropriately singled out for extra scrutiny.

At least twice after the briefing, Miller wrote letters to members of Congress to explain the process of reviewing applications for tax-exempt status without disclosing that tea party groups had been targeted. On July 25, 2012, Miller testified before the House Ways and Means oversight subcommittee but again did not mention the additional scrutiny ? despite being asked about it.

On Tuesday, the IRS said, "While flaws in our process were corrected last year based on our own review, we only recently discussed this publicly as there had been a concurrent ongoing (inspector general) audit of the situation. There was no intent to hide this issue, but rather we waited until (the inspector general) completed their fact finding, made recommendations, and we reviewed their findings.

Miller was a deputy commissioner at the time. He became acting commissioner in November, after Commissioner Douglas Shulman completed his five-year term. Shulman had been appointed by President George W. Bush.

Miller is scheduled to testify before the House Ways and Means Committee at a hearing Friday.

___

Associated Press writer Pete Yost contributed to this report.

___

Follow Stephen Ohlemacher on Twitter: http://twitter.com/stephenatap

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/89ae8247abe8493fae24405546e9a1aa/Article_2013-05-14-IRS-Political%20Groups/id-fb30f38c6cb64d5882a251c30c44d5bb

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Was Commander Hadfield?s Performance of Space Oddity the Most Expensive Music Video Ever?

Commander Chris Hadfield's cover version of Space Oddity took the internet by storm yesterday, but it got a lot of people thinking: does it amount to the most expensive music video ever made?

Read more...

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Study questions if bed rest prevents prematurity

In this undated family photo, Sandy Lutton of McLean, Va., sits with her three children, twins Lilly and Luke and their older brother Jack, right. Lilly and Luke were born after Lutton spent 18 weeks of her pregnancy on strict bed rest. Research is raising new concern about the value of bed rest in preventing premature birth, and some specialists are urging strict clinical trials to settle the questions. (AP Photo)

In this undated family photo, Sandy Lutton of McLean, Va., sits with her three children, twins Lilly and Luke and their older brother Jack, right. Lilly and Luke were born after Lutton spent 18 weeks of her pregnancy on strict bed rest. Research is raising new concern about the value of bed rest in preventing premature birth, and some specialists are urging strict clinical trials to settle the questions. (AP Photo)

WASHINGTON (AP) ? New research is raising fresh concern that an age-old treatment for troubled pregnancies ? bed rest ? doesn't seem to prevent premature birth, and might even worsen that risk.

Doctors have known for years that there's no good evidence that bed rest offers any benefit for certain pregnancy complications, and it can cause side effects in the mother, not to mention emotional and financial strain. Yet estimates suggest nearly 1 in 5 moms-to-be is told to cut her activity ? ranging from quitting work to actually staying in bed all day ? at some point during pregnancy.

Now, spurred by the latest study, some specialists are issuing a call for strict studies to finally settle the controversy ? and until then, for doctors not to assume that a prescription to take it easy can't hurt.

"Bed rest is misperceived as an inexpensive, innocuous, logical recommendation," Dr. Joseph Biggio Jr. of the University of Alabama at Birmingham wrote in the latest issue of Obstetrics & Gynecology, a journal read by thousands of OB-GYNs.

In a separate review of past studies that failed to support bed rest, a trio of obstetricians and ethicists at the University of North Carolina, Chapel Hill, went a step farther: They said it's not ethical to keep prescribing bed rest unless the women are enrolled in a research study, like they are for other unproven treatments.

So why is rest prescribed so often? There aren't a lot of good treatments to prevent prematurity and other problems.

"Patients want you to do something, and physicians want to do something," explained Dr. Catherine Spong, a maternal-fetal medicine specialist at the National Institutes of Health who co-authored the latest research.

Spong and colleagues took a closer look at a study of treatments for women at risk of premature birth because of an increasingly diagnosed complication called a short cervix. Bed rest is a broad term that doesn't just mean staying in bed all the time ? and during that treatment study, doctors were free to decide if the participants also should restrict their activities, essentially offering a real-world test of the effects. The prescriptions ranged from no sexual activity, to partial or complete work restrictions, to complete restriction of non-work activity as well.

Nearly 40 percent of the 646 pregnant women enrolled in the study were prescribed some type of activity restriction in the second or third trimester. Most were told to restrict all three types of activity ? sexual, work and non-work ? what's usually considered bed rest.

The surprise: Some 37 percent of women who took the precautions had a premature baby, compared with just 17 percent of the women who didn't scale back, the researchers report in Obstetrics & Gynecology.

"The data suggests that bed rest does not prevent preterm birth in this high-risk population, but it doesn't definitively answer that question," cautioned Spong. She wants to see a more strict study ? the kind that randomly assigns women to rest or not ? to prove if there's a difference.

The study also raises questions about harm, although the women who rested merely may have been at higher risk for a preemie. They were older and had somewhat more serious cervical complications. But the researchers pointed to other studies that link bed rest to increased stress and anxiety, both of which are associated with prematurity and smaller babies.

Plus, bed rest is well known to increase a mother's risk of a dangerous blood clot, as well as side effects including bone and muscle loss.

Interestingly, the new study found those who rested were more likely to have private insurance, raising questions about the influence of social rather than medical factors.

The American College of Obstetricians and Gynecologists says bed rest shouldn't be "routinely recommended" for prevention of preterm birth. And women face a tough decision when their doctors do bring it up.

Sandy Lutton spent the last 18 weeks of her pregnancy lying flat in bed, forbidden even to prop up with her laptop, hoping it would prevent her twins from being born too soon.

"I'm not going to sugarcoat it, it was stressful," said the McLean, Va., woman, whose twins, now 2, were born healthy. "I had a lot of time to sit and worry."

Her first son had been born on time, but she'd lost a second baby due to a weak cervix. With the twins, her doctors stitched her cervix closed and recommended strict bed rest, while making it clear there was no proof it would make a difference. Lutton bombarded them with questions, but eventually decided she had to try. Ultrasound exams showed her cervix stayed fine until doctors removed the stitch and delivered her babies; she even cheated with a little extra movement on exam days.

Amid the uncertainty, March of Dimes medical adviser Dr. Siobhan Dolan said women shouldn't hesitate to ask their doctors about the pros and cons of restricting activity.

"Sometimes you feel less regret if you did something even though it didn't change the outcome," acknowledged Dolan, who herself has prescribed bed rest less often in recent years.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/bbd825583c8542898e6fa7d440b9febc/Article_2013-05-13-US-MED-HealthBeat-Pregnancy-Rest/id-b3455b175ba645e6841f4b204daed908

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