Clinical Cardiology
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Anatomic vs. Functional Testing in Older Coronary Artery Disease Patients
An analysis of the PROMISE trial by age showed that cardiovascular death or myocardial infarction was predicted by a positive stress test in patients with symptoms suggesting myocardial ischemia who were >age 65 years, but only CT angiography or a calcium score was predictive in symptomatic patients < age 65 years.
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Warfarin or DOACs for Atrial Fibrillation in Chronic Kidney Disease?
A large outpatient observational study of patients with atrial fibrillation and chronic kidney disease who were anticoagulated revealed that, compared to warfarin, direct oral anticoagulants exhibited less all-cause mortality and major bleeding with at least equivalent efficacy at preventing stroke.
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What Device-Detected Atrial Fibrillation Burden Reveals About Stroke Risk
In a retrospective analysis of electronic health record data matched with remote pacemaker and implantable cardioverter-defibrillator recordings of atrial fibrillation episodes, a threshold daily arrhythmia burden portending higher stroke risk was determined over a range of CHA2DS2-VASc scores.
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Efficacy of Class I vs. Class III Antiarrhythmic Drugs in Obese Patients
In an observational cohort of patients with atrial fibrillation, obese patients were less likely than nonobese patients to avoid symptomatic recurrence on sodium channel blocking agents in contrast to a roughly equivalent response in both groups to potassium channel blocking agents.
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Heart Failure-Exacerbating Medications
In a large, diverse cohort of Medicare patients hospitalized for heart failure exacerbations, almost half were on medications known to exacerbate heart failure; more than one-third were on these agents at discharge.
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Home Oral Factor Xa Inhibitor Treatment for Pulmonary Embolism
Low-risk pulmonary embolus patients discharged in < 48 hours on rivaroxaban recorded a nominal three-month rate of recurrent emboli or major bleeding, suggesting such patients do not need to be hospitalized for treatment of pulmonary emboli.
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Rivaroxaban After Transcatheter Aortic Valve Replacement
In this randomized trial of post-transcatheter aortic valve replacement patients without a separate indication for anticoagulation, a rivaroxaban-based approach was associated with a higher risk of death and thromboembolic complications compared with dual antiplatelet therapy.
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Heart Rate and Diastolic Blood Pressure in Chronic Aortic Regurgitation Patients
A retrospective observational study of patients with moderate to severe aortic regurgitation showed the independent predictive value of diastolic blood pressure and resting heart rate for all-cause mortality under medical management.
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Optimal Antithrombic Therapy After PCI for Atrial Fibrillation Patients
In three subgroups of coronary artery disease patients with atrial fibrillation, apixaban plus a P2Y12 inhibitor provided superior safety and similar efficacy outcomes as treatment with warfarin, aspirin, or both for six months.
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The Risk of Endocarditis With Bacteremia
Interrogation of the Danish National Patient Registry revealed bacteremia due to Enterococcus faecalis was most likely to be associated with infective endocarditis; thus, echocardiography is warranted in these patients.