Patients With Atrial Fibrillation Have an Average of Five Additional Medical Conditions
Patients with atrial fibrillation have an average of 5 co-existing conditions including high BP, coronary artery disease, HF, obesity and CKD. The EHRA-PATHS consortium has created concise care pathways integrated in a software tool to check for whether a given comorbidity is present and to guide its further evaluation. This leads to better multidisciplinary management of patients with AF.
Physicians Shouldn't Take Hypertension Treatment Decisions Based Solely on In-Office BP Readings
A study found that BP readings taken in a physician’s office fluctuate from visit to visit, based on variations in timing, cuffs used, biological changes and context: Had the patient rushed to the appointment? Did they dine on a high sodium meal? Measuring BP in a standardized way helps, such as asking patients to sit and taking 3 consecutive measurements as 1st reading is always too high.
Extracorporeal Cardiopulmonary Resuscitation (ECPR) Should Be Used in Selective Patients
ECPR may be considered a rescue therapy for select patients with cardiac arrest. These include some combination of variables: < 75 years, absence of severe comorbidities, cardiac arrest characteristics (eg, duration of resuscitation < 60 min, witnessed arrest, bystander CPR, initial shockable rhythm, signs of life during CPR), and physiologic parameters (lactate, end-tidal CO2, and pH).
30 Days Monitoring Detects More Arrhythmias in Hypertrophic Cardiomyopathy
Many patients with hypertrophic cardiomyopathy (HCM) develop atrial fibrillation or have non-sustained ventricular tachycardia (NSVT). TEMPO-HCM study showed that 30 days ECG monitoring using a continuous recording system in patients with HCM detects more arrhythmias VS standard 24-48 hours (65% vs. 11%). NSVT was detected in 62% of patients across 30 days VS 8% in the first 24 hours.
Novel Ablation Strategy Improves Freedom From Arrhythmias in Atrial Fibrillation Patients
An innovative 3 step ablation approach improves the recurrence of arrhythmias in patients with persistent atrial fibrillation than pulmonary vein isolation (PVI) alone (8 vs. 18 patients; p=0.026). The Marshall-Plan ablation strategy consists of 1) PVI; 2) ethanol infusion of the vein of Marshall; and 3) a linear ablation set to block the three main anatomical isthmuses to the pulmonary veins.
Prenatal Depression may Increase the Risk of Cardiovascular Disease After Childbirth
People with prenatal depression have high cardiovascular disease risk within 2 years of delivery.83% higher risk of ischemic heart disease; 60% higher risk of arrhythmia/cardiac arrest; 61% higher risk of cardiomyopathy; and 32% higher risk of new high blood pressure diagnosis. Additional pregnancy-related factors contributing to CVD may include chronic inflammation and stress-related hormones.
Noninvasive Monitoring Identifies Short-term Hemodynamic Changes After TAVR
NICaS is a noninvasive bioimpedance monitoring system helped to identify short-term hemodynamic changes early after transcatheter aortic valve replacement for patients with severe aortic stenosis, researchers reported. It may provide insights into the complex physiologic changes occurring during the periprocedural time in patients and thereby promotes a more precise treatment strategy.
SGLT2 Inhibitor Significantly Reduces Risk of Sudden Cardiac Death in Patients With Heart Failure
Oates and colleagues analyzed data from seven trials SGLT2 inhibitor therapy (n = 10,796) was associated with a significant reduction in risk for sudden cardiac death (RR = 0.68) participants with HF vs. placebo (n = 10,796). There were no significant differences in the incidence of sustained ventricular arrhythmias not associated with sudden cardiac death or atrial arrhythmias.
Does Gender Impact Success or Survival Outcomes After Transcatheter Tricuspid Valve Intervention?
Men and women undergoing TTVI for tricuspid regurgitation differ in comorbidities, etiology and volumetric status; yet, success rates and survival after TTVI were similar between sexes. In fact, male patients have higher mortality rates after TTVI, which can be partially attributed to higher CAD prevalence, left ventricular systolic function impairment & left-sided heart chambers dilatation.
Percentage Change in Fractional Flow Reserve After PCI Tied to Less Angina
Understanding patient factors associated with post-PCI angina may support different approaches to revascularization. Post hoc analysis of TARGET-FFR trial showed that increased change in fractional flow reserve at 3-month follow-up after percutaneous coronary intervention (PCI) was associated with less angina. Improved FFR was also linked to improvements in patient-reported quality of life.
Long-term Statin Use Gives More Protection Against Stroke Than Short-term Use
A study in > 50,000 patients with atrial fibrillation has found reduced risks of stroke and transient ischaemic attack in those who started statins within a year of diagnosis compared with those who did not. Statin use was associated with a 17% reduced risk of ischaemic stroke or systemic embolism, a 7% reduced risk of haemorrhagic stroke and a 15% reduced risk of transient ischaemic attack.
Decline in eGFR After Sacubitril-Valsartan Transition Should Not Deter its Continuation
A study showed that the declines in estimated glomerular filtration rate (eGFR) during transition from RASi to sacubitril/valsartan in people with HF are variable but small and partially recoverable for most patients. Treatment benefit of sacubitril/valsartan did not vary across a range of eGFR declines. Clinicians should not stall/discontinue therapy due to “dips” in renal function.
Is Endovascular Thrombectomy Effective in Patients With Large Ischemic Strokes?
In a trial, endovascular thrombectomy resulted in better functional outcomes than medical care in patients with large ischemic strokes. A total of 20% of the patients in the thrombectomy group and 7% in the medical-care group had functional independence (relative risk, 2.97; 95% CI). But thrombectomy was associated with vascular complications. Cerebral hemorrhages were infrequent in both groups.
Renin-angiotensin System Inhibition Polypills Improve Adherence in Hypertensive Patients
START study found that a RAS combination polypill to treat high BP improved adherence by 20-49% and led to better CV outcomes vs. multiple pills. Lower rates of all-cause mortality, MI, CAD, HF, stroke and TIA were also observed with polypill approach. The main barrier hindering a wider use of single pills might be missing awareness and knowledge how profoundly adherence impacts CV prognosis.
Antihypertensive Drugs Vary in Effectiveness Between Individuals
PHYSIC study showed that the BP-lowering effect varied greatly between individuals for some medications. By finding the optimal treatment for an individual, BP levels could be reduced to twice the levels typically achieved by doubling the dose of a suboptimal treatment. Optimizing treatment by personalization also has more than half the effect of adding a second BP medication.
Weekly Red Meat Intake Increases Risk for Ischemic Heart Disease
Increased consumption of red meat (processed or not) was associated with future risk for ischemic heart disease (HR for unprocessed red meat = 1.11; HR for processed red meat = 1.16; P for both < .001). Researchers identified 45 loci associated with lipid and lipoprotein metabolism for unprocessed red meat-related metabolomic signatures and 4 loci for processed red meat-related signatures.
Transcatheter Leadless Pacemakers (TLP) is a Safe Option for Children With Congenital Heart Disease
Wireless pacemakers is a safe and effective short-term option for children requiring permanent pacing. Children who underwent implantation of a TLP experienced implant success, good electrical performance and a low level of major complications, real-world data show. Leadless pacemakers can be implanted successfully from the femoral as well as the internal jugular venous route.
Bempedoic Acid Lowers Risk Of Major Cardiovascular Events In Statin-intolerant Patients
In statin-intolerant patients with CVD, bempedoic acid signifcantly lower - LDL cholesterol level vs. placebo (21.1%); the incidences of a composite of death from cardiovascular causes, nonfatal stroke, or nonfatal myocardial infarction (575 [8.2%] vs. 663 [9.5%]); fatal or nonfatal MI (261 [3.7%] vs. 334 [4.8%]); and coronary revascularization (435 [6.2%] vs. 529 [7.6%].
Societal Variables May Contribute To Gender Inequalities In PAD
A number of societal variables may contribute to gender inequalities in PAD. Lower socioeconomic status increases likelihood of PAD and hospitalisation with PAD. Women have a lower socioeconomic standing in part due to reduced income and education levels, and caring responsibilities. The higher poverty and socioeconomic disparities may contribute to increased rates of PAD in women.
