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Assessment, Prevention, and Treatment of Delirium in the ICU

A review of the latest Society of Critical Care Medicine clinical practice guidelines.

Clinical Briefs

Clinical Briefs on topics such as: Chronobiology and Insulin Glargine, Dual Add-on Therapy for Type 2 Diabetes When Metformin is Not Enough, and Might Long-term Dual Antiplatelet Therapy Be Better? Not

Are Atrial Premature Complexes Benign?

Atrial premature complexes (APCs) are commonly observed on routine ECGs and believed to be harbingers of atrial fibrillation, especially in patients with cardiovascular disease. However, little is known about the long-term prognosis of APCs in the general population. Thus, these investigators from Japan analyzed the database of a large community-based cohort from 1993 to 2008 to determine the risks of APCs seen on the subjects’ baseline ECGs.

Statins After an MI: Does it Happen?

Following a hospitalization for coronary heart disease (CHD) or acute coronary syndrome (ACS), randomized trials demonstrate that high-intensity atorvastatin is more effective than either placebo or low- to moderate-intensity therapy with either pravastatin or atorvastatin.^1-3 Based on this evidence, the American College of Cardiology and the American Heart Association guidelines recommend high-intensity therapy in cases of an acute cardiac event and that therapy be initiated before discharge.

Is it Worth it? Do “Healthy” Dietary Guidelines Lower the Risk of Heart Disease?

Recent controversy surrounds diet and its impact on cardiovascular disease (CVD). In this study, Reidlinger and her colleagues sought to assess diet by comparing the effects on vascular and lipid CVD risk factors of adhering to a diet consistent with United Kingdom (UK) dietary guidelines (DG group) to a traditional British diet (control group).

Another Reason to Recommend Smoking Cessation

Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, affecting an estimated 2.7 million individuals in the United States.¹ The proportion of strokes attributable to AF increases strikingly from 1.5% at 50-59 years of age to 23.5% at 80-89 years of age.² Approximately 15-20% of all strokes are due to AF. To predict the thromboembolic risk in the individual patient, risk models used most frequently are CHA2DS2-VASc and CHADS2 scores. The CHA2DS2-VASc score may be the better option since both the 2014 American Heart Association, American College of Cardiology, Heart Rhythm Society AF guidelines, and the 2012 European Society of Cardiology AF guidelines prefer it when evaluating the individual thromboembolic risk associated with AF and to determine the risk:benefit ratio of antithrombotic therapy.³

Intravenous Iron Shows Long-term Benefit in Patients with Heart Failure and Iron Deficiency

Iron deficiency (ID) is common in patients with heart failure (HF), and its presence is associated with reductions in functional capacity, quality of life, and survival. Several clinical trials have shown improved outcomes in patients with HF and ID who are treated with IV iron. However, these trials only administered IV iron for short periods of time, and the long-term effects of IV iron in these patients are not well understood.

Paravalvular Leaks and TAVR Outcomes

Moderate or severe paravalvular regurgitation (PVR) has been reported in up to one-quarter of patients following transcatheter aortic valve replacement (TAVR) and has been associated with a higher 1-year mortality. Whether PVR is the cause of increased mortality or is simply associated with mortality is unclear.

Blood Transfusion After Cardiac Surgery

Due to the cost of blood transfusions and the lack of data supporting liberal transfusion policies, newer guidelines recommend more restrictive transfusion thresholds (e.g., hemoglobin < 7 g/dL). However, many believe cardiac surgery is an exception due to the myocardium’s high oxygen requirement.

Unintended Consequences of Public Reporting of Procedure Outcomes

Public reporting of clinical outcomes associated with cardiovascular care has been touted as a means to improve health care delivery and patient outcomes.

Cardiology

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