Rutgers State University of New Jersey

MONDAY, Jan. 6, 2025 -- For patients with acute myocardial infarction (MI) and anemia , the primary outcome of 30-day mortality or MI does not differ with a restrictive versus liberal transfusion strategy, but a restrictive transfusion strategy is associated with increased all-cause mortality at six months, according to research published online Dec. 23 in NEJM Evidence . Jeffrey L. Carson, M.D., from the Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, and colleagues examined the effect of restrictive versus liberal blood transfusion strategies in patients with acute MI and anemia. Patients were randomly assigned to a restrictive (transfusion threshold of 7 to 8 g/dL) or liberal (transfusion threshold of 10 g/dL) red cell transfusion strategy; data were included for 4,311 patients from four trials. The researchers found that the primary outcome (composite of 30-day mortality or MI) occurred in 15.4 and 13.8 percent of patients in the restrictive strategy and liberal strategy groups, respectively (relative risk [RR], 1.13; 95 percent confidence interval [CI], 0.97 to 1.30). Death at 30 days occurred in 9.3 and 8.1 percent of patients in the restrictive and liberal strategy groups, respectively (RR, 1.15; 95 percent CI, 0.95 to 1.39), while cardiac death at 30 days occurred in 5.5 and 3.7 percent, respectively (RR, 1.47; 95 percent CI, 1.11 to 1.94). No significant difference was seen in heart failure between the transfusion strategy groups. All-cause mortality at six months occurred in 20.5 and 19.1 percent of patients in the restrictive and liberal strategy groups (hazard ratio, 1.08; 95 percent CI, 1.05 to 1.11). "Giving more blood to anemic patients with heart attacks can save lives at six months," Carlson said in a statement.

Decades before anyone knew him as the CEO and chair who led Edwards Lifesciences as it commercialized transcatheter aortic valve replacement ( TAVR ), Mike Mussallem was a chemical engineering grad in the wrong kind of job. “I probably went into chemical engineering because I liked chemistry and math and I heard they made a lot of money — you know, real substance,” he joked in an interview with Medical Design & Outsourcing. “But didn’t realize they went to work in oil refineries and chemical plants until I graduated and saw where my job offers were from.” His first job was supervising a Union Carbide production line that made and filled Prestone antifreeze bottles. “I became Mr. Blow Molding. … It was interesting, but not overly fulfilling,” Mussallem recalled. That first job taught him a lesson about leadership: “I thought bosses told people what to do, and I found out right away that’s not the way it works. You ask people if they would like to join you on the journey.” He would soon start attending evening business school at Rutgers University, where he was exposed to professionals working in medtech. “That just sounded way more exciting. They were innovating, they were investing,” he said. “I joined Baxter in 1979, and I was nervous about coming into healthcare because I didn’t know anything about healthcare.” His first job in medtech was more of a step down than a step up from his Union Carbide job. He joined Baxter during the 1979 oil crisis and reworked the way the IV bag manufacturer kept water clean. Initially, the company kept its water temperature above 180°F at all times — which wasn’t cheap given the high energy prices at the time. “Then a microbiologist came up with this concept that if you had no drop of water ever get more than 24 hours old in the system, and if every piece of pipe and tank in the system saw sanitizing temperatures over 180°F for at least 15 minutes every 24 hours, you could keep the system clean,” Mussallem said. “That became an engineering project — my first one — and it worked out. It was a success.” He was one of the company’s first manufacturing employees to move over to research and development to improve product manufacturability. “The folks at R&D didn’t have a tremendous amount of respect for a manufacturing guy, so I got the poorest performing product line, which was IV sets, those little tubes that plug into an IV bag and plug into the patient,” Mussallem said. There was “nothing good” about that assignment, he said. The products were low margin, low growth and the “most complained about,” he said. “They were not high quality.” “But it became a theme for me, because it was a chance for a young guy to get a lot of responsibility,” he continued. “And if you put your head down and you put a team around it, you can make some progress — and we made some things happen. It became the story of my career in Baxter. Often I got jobs that weren’t very glamorous, but they were a chance for a young person to stretch and do things that maybe they wouldn’t have been prepared for if it was a thriving business. But if it was in need of help or not really going anywhere, then they’d give you a chance. And it was an opportunity to make a difference. … Baxter was a meritocracy, one of these places that if you got something done, they gave me more to do, and that became the story of my career.” In 1985, Baxter acquired American Hospital Supply in a deal worth $3.8 billion (more than $11 billion when adjusted for inflation). Mussallem was asked whether he’d be interested in working with the cardiovascular businesses that came with it. “I joined Bentley, which made blood oxygenators at the time,” he said. “And Bentley needed a total revamp of everything at that point. It was not competitive in any way. It needed new technology. It needed help.” After working in Baxter businesses that manufactured products by the million, Mussallem said he “fell in love” with the cardiovascular business. “It became personal,” he said. “A patient would lay down multiple times each day and have a successful outcome — or not. That kind of feedback, that kind of palpable feeling was something that really resonated for me personally, and I fell in love with the business.” Once again, Baxter’s cardiovascular business wasn’t a plum assignment. “We were doing poorly, and I probably owned part of that because I was the guy leading it, and we weren’t doing a very good job,” Mussallem said. He took responsibility for the unit in 1994 and led it through its spinoff as Edwards Lifesciences in 2000, where he and his team focused the independent, publicly traded company on structural heart innovation. He and others have attributed the success of Edwards to its commitment to innovation and serving patients — even when it meant disrupting business for heart surgeons, the company’s primary customers. Mussallem retired as CEO in 2023 and chair in 2024. For more, read our January 2025 cover story looking back at Mussallem’s leadership of Edwards, plus perspective from his successor and mentee, Edwards CEO Bernard Zovighian.

FRIDAY, Dec. 27, 2024 -- A blood transfusion following a heart attack could be a life-saving measure for patients with anemia. A new evidence review published in the journal NEJM Evidence shows anemic patients had a slightly lower risk of death within six months of a heart attack if they were given more transfusions. “The results of this analysis show that giving more blood to anemic patients with heart attacks can save lives at six months,” lead researcher Dr. Jeffrey Carson , chair of general internal medicine at Rutgers Robert Wood Johnson Medical School, said in a news release from the college. Anemia is common among people hospitalized with a heart attack, Carson said. In anemia, a person’s blood can’t transport enough oxygen to the rest of the body. Some doctors have speculated that blood transfusions might increase the amount of oxygen to the heart, improving heart attack patients’ chances of survival, Carson said . However, transfusions might also increase the risk of infection or fluid buildup in these patients. For this new study, researchers pooled data from four clinical trials evaluating transfusions in heart attack patients. The trials involved more than 4,300 patients who had both a heart attack and a low blood count, which is a sign of anemia. In the trials, half of the patients received fewer blood transfusions, and the other half received more. About 9.3% of patients who got fewer blood transfusions died within 30 days of their heart attack, compared with 8.1% of patients who were treated with more transfusions, results show. Specifically, heart-related death within 30 days occurred in 5.5% of patients with fewer transfusions and 3.7% of patients who got more, the study says. Overall, the risk of death or a second heart attack was about 2.4% lower in patients who received more blood transfusions, researchers found. However, the results don’t definitively establish that more transfusions are better, because the main findings weren’t statistically significant, researchers noted. Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.