Cardiology
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Research Provides More Support for Antiplatelet Therapy De-escalation
The authors of a single-center study randomized post-acute coronary syndrome patients either to remain on higher-potency antiplatelet agents or to change to clopidogrel after one month. The results showed a benefit to de-escalation in terms of both bleeding and ischemic events, regardless of initial platelet reactivity.
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Clinical Briefs
In this section: Finding the prescription for the best diet, treating severe acute pain in the ED, and reducing falls among older patients.
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Ertugliflozin Tablets (Steglatro)
Ertugliflozin is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
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The Incidence of Dementia May Be Declining
In community-dwelling people from Bronx County, New York, there was a sharp decrease in dementia incidence in those born after mid-1929, which could not be readily explained by changes in the prevalence of cardiovascular diseases, higher education, or increased racial/ethnic diversity.
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CT Calcium Score vs. Stress Testing
A subgroup analysis of the PROMISE trial showed that CT coronary calcium scores in symptomatic patients at low to intermediate risk for coronary artery disease are more sensitive but less specific for major adverse cardiac events over a two-year follow-up period than stress testing. Consequently, both approaches exhibited similar but modest discriminatory ability.
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Hold the Hormones — At Least for Chronic Condition Prevention
The U.S. Preventive Services Task Force reissued a statement on hormone replacement therapy for the prevention of chronic conditions that reiterates its D recommendation from 2012. It recommends physicians do not prescribe hormone replacement therapy (HRT) to prevent medical conditions, but leave the question of using HRT for treatment of menopausal symptoms unanswered.
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Restrictive Transfusion Threshold Non-inferior to Liberal Threshold in High-risk Cardiac Surgery
In patients at moderate to high risk of complications with cardiac surgery, a transfusion threshold of hemoglobin < 7.5 g/dL showed similar outcomes to a threshold of < 9.5 g/dL.
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Targeted Temperature Management: Determining Optimal Hypothermia Duration
In unconscious survivors of out-of-hospital cardiac arrest who are admitted to the ICU, targeted temperature management at 33°C for 48 hours failed to significantly improve neurologic outcomes at six months when compared to 24 hours.
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Atrial Fibrillation in Sepsis: Should We Worry?
New-onset atrial fibrillation (AF) is a common occurrence in the ICU. Over the past decade, there is increasing interest in its epidemiology, specifically in the population of critically ill patients with sepsis. Recent literature suggests that far from a transient complication of sepsis, new-onset AF is associated with worse short- and long-term outcomes. As such, exploring its potential causes and evaluating its overall management is warranted in hopes of discovering ways to prevent and treat AF with the goal of improving outcomes for patients with sepsis.
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How Many Conduction Defects?
The ECG and long lead II rhythm strip in the figure with the article was obtained from a 58-year-old man who was admitted to the hospital with chest pain and weakness. How would you interpret the tracing? How many different types of conduction disturbances can you identify?