Clinical Cardiology
RSSArticles
-
Is it Time to Give Up on Systemic Cooling in ST Segment Elevation MI?
Systemic hypothermia as a means to protect against tissue damage is a strategy that has found its way into clinical practice guidelines in the post-cardiac arrest population, in which cooling has demonstrated a neuroprotective effect in multiple contemporary clinical trials.
-
Angiotensin Receptor Blockade, Renal Function, and Outcomes in Chronic Heart Failure
Renin-angiotensin-aldosterone (RAAS) blockade is an important component of guideline-recommended therapy for heart failure with reduced ejection fraction (HFrEF).
-
Ticagrelor Cost Effective as Well as Efficacious, According to New Analysis
The PLATO trial randomized more than 18,000 acute coronary syndrome (ACS) patients to dual anti-platelet therapy with aspirin plus either clopidogrel or the newer P2Y12 inhibitor ticagrelor. Compared with clopidogrel-treated patients, those on ticagrelor had lower rates of death and myocardial infarction at 1 year. Despite superior ischemic outcomes, both ticagrelor and the thienopyridine prasugrel have been relatively slow to be adopted in the United States. This is at least in part due to the cost differential, as the older clopidogrel is available as a generic, while the newer agents enjoy continued brand exclusivity. The National Average Drug Acquisition Cost data collected by CMS currently reports a 70-fold difference in price between clopidogrel and ticagrelor.
-
Implantable Coronary Sinus Narrowing Device Shows Promise in Refractory Angina
Despite advances in medical therapy and in coronary revascularization techniques, the population of patients with chronic, stable, but debilitating angina continues to grow. The mortality of such patients is surprisingly low, such that patients with this disorder often suffer limiting symptoms for many years. Clearly more options for treatment are needed, but what?
-
Surgical Management of Infective Endocarditis
SOURCES: Chu VH, et al. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: A prospective study from the international collaboration on endocarditis. Circulation 2015;131:131-140; Erbel R. The new strategy in infective endocarditis: Early surgery based on early diagnosis: Are we too late when early surgery is best? Circulation 2015;131:121-123. -
Bridging During Anticoagulation Interruptions Is Associated with Worse Outcomes
Despite the routine nature of discontinuing atrial fibrillation (AF) patients’ long-term oral anticoagulation (OAC) for procedures and “bridging” them with another agent, there is remarkably little data on the safety and benefit of this practice. Guidelines detailing when and how to initiate bridging therapy have been published, but data supporting why we should bridge at all are limited.1 To help fill this void, Steinberg and colleagues used a national, community-based registry of outpatients with AF (ORBIT-AF) to examine current practices around periprocedural OAC management and associated outcomes. Outcomes evaluated included rates of major bleeding, as well as myocardial infarction, stroke or systemic embolism, cause-specific hospitalization, and death within 30 days.
-
Intravenous Fluids in Patients With Acute Heart Failure
MONOGRAPH: Volume overload is a hallmark of acute heart failure. In hospitalized patients, intravenous loop diuretics are the most common treatment for decongestion.
-
Risk of Stroke with Intracardiac Devices and Patent Foramen Ovale
After some case reports of stroke due to electrophysiology (EP) device thrombosis in patients with a patent foramen ovale (PFO), concern has been raised about the risk of stroke with intracardiac devices in patients with known PFO. Thus, these investigators from the Cleveland Clinic did a retrospective database study of 2921 echocardiography-detected PFO patients and categorized them as having an EP device (231) or not.
-
Late Tricuspid Regurgitation After Heart Valve Surgery
Due to the success of left heart valve disease surgical corrections, patients may experience late tricuspid regurgitation.
-
Coronary Stents and Noncardiac Surgery
Contemporary data suggest that approximately one in every five patients will require non-cardiac surgery within two years of coronary stent implantation.