Month: April 2019
Cohort Study with 27 Years of Follow Up Shows Oral Infections in Children Is Associated with Sub-clinical Atherosclerosis
A study led by Dr. Pirkko Pussinen demonstrated that clinical signs of oral infection during childhood were associated with subclinical atherosclerosis in adulthood. The paper published in JAMA Network Open suggests that childhood oral infection may be a modifiable risk factor for adult cardiovascular disease.
Recently Released Joint Statement Proposes New Model of Care for Patients with Valvular Heart Disease
A joint report that proposes an integrated model of care for patients with valvular heart disease (VHD) was recently released by the American Association for Thoracic Surgery (AATS), American College of Cardiology (ACC), American Society of Echocardiography (ASE), Society for Cardiovascular Angiography and Interventions (SCAI) and Society of Thoracic Surgeons (STS). This collaboration was published with the aim of optimizing the care received by patients with VHD.
Nationwide Study Shows Pharmacy Closure Associated with Significant Decrease in Adherence to Cardiovascular Medications
According to a new national study led by Dr. Dima M. Qato that was recently published in JAMA Network Open, among 3.1 million Americans 50 years and older filling cardiovascular medications at pharmacies that eventually closed, there was a significant and immediate decline in medication adherence. This change in adherence persisted over 12 months and was prominent among older adults living in neighborhoods with fewer pharmacies.
Depression Is Associated with More Severe Angina and Dyspnea in Patients with Chronic Total Occlusion
A study led by Dr. Robert Yeh that was published in JACC: Cardiovascular Interventions showed that in the setting of chronic total occlusion (CTO), patients with depression had more significant angina before percutaneous coronary intervention (PCI). However, these patients also had a greater improvement in health status after PCI.
Study Suggests ICU Care May Be Overutilized in Stable STEMI Patients
A study led by Dr. Jay S. Shavadia published in JACC: Cardiovascular Interventions showed that although more than 80% of stable patients with an ST-elevation myocardial infarction (STEMI) were treated in the intensive care unit (ICU), the risk of developing a complication requiring ICU care was around 16%. These findings suggest that implementing a risk-based triage strategy could be a better alternative to the current strategy where patients with STEMI are typically admitted to the ICU.
New Study Reports That 13% of an Internal Medicine Intern’s Time Spent in Direct Patient Care An Assessment of Inpatient Time Allocation Among First-Year Internal Medicine Residents Using Time-Motion Observation
In an observational study published in JAMA Internal Medicine, Dr. Krisda H. Chaiyachati showed that first-year internal medicine residents spent 66% of their time involved in indirect patient care, this included interacting with the patient’s records or recording their work. On average, residents spent 13% of their day directly involved in patient care and 7% doing educational activities. Continue reading
Study in China Indicates Current Practice of Lipid-Lowering Treatment Needs Improvement
In an article published in the American Heart Journal, Dr. Yueyan Xing emphasized the need to improve on current lipid-lowering treatment practices in patients with a history of myocardial infarction or revascularization. Patients with a previous history of acute coronary syndrome are at a high risk of a recurrent coronary event and death. Lowering low-density lipoprotein cholesterol (LDL-C) in these patients is essential in order to reduce the risk of a recurrent event. The authors used the Improving Care for Cardiovascular Disease in China (CCC) Project to assess current lipid-lowering treatment practices in China.
Genetic Epidemiological Study Provides Conflicting Evidence Regarding Protective Effect of Moderate Alcohol Consumption
An article published in the Lancet by Dr. Millwood provided conflicting evidence regarding the apparently protective effect of moderate alcohol consumption and cardiovascular risk. Many conventional epidemiological studies have associated moderate alcohol intake with a reduced risk of stroke and coronary artery disease. To assess whether alcohol truly has a protective effect, the authors conducted both a traditional and genetic epidemiological study in an east Asian population.
A Systematic Analysis Attributes Eleven Million Deaths in 2017 to Dietary Risk Factors
A systematic analysis by Dr. Ashkan Afshin and the Global Burden of Disease (GBD) 2017 Diet Collaborators published in the Lancet showed that in 2017, 11 million deaths and 255 million disability-adjusted life years (DALYs) were attributable to dietary risk factors. The leading dietary risk factors were a high intake of sodium, low intake of whole grains, and low intake of fruits. The study provides a clear image of the potential impact of a sub-optimal diet on death and disability.
Randomized Trial Shows That Transcatheter Aortic-valve Replacement is Non-inferior to Surgery in Low Risk Patients
A study by Dr. Jeffrey Popma and colleagues published in the New England Journal of Medicine showed that transcatheter aortic-valve replacement (TAVR) was non-inferior to surgery with respect to death or the occurrence of a disabling stroke by 24 months in the low-risk group of patients with aortic stenosis. Previous studies showed that in patients with severe aortic stenosis who were at high risk of complications or death from surgery, TAVR with a self-expanding supra-annular bioprosthesis had better outcomes than medical therapy or surgery. However, there was not enough evidence to advocate the use of TAVR instead of surgery in a younger, healthier population. The authors aimed to address this knowledge gap through this study.
Transcranial Ultrasound Used As an Adjunct to tPA Fails To Improve Functionality in Ischemic Stroke Patients Sonothrombolysis with ultrasound delivered transcranially via a headframe shows no clinical benefit in ischemic stroke
A randomized, mutilcenter, placebo-controlled, phase 3 clinical trial which enrolled 676 patients (aged 18-80 years) presenting to the ER with acute ischemic stroke assessed the efficacy and safety of transcranial ultrasound (US) as an adjunctive therapy to intravenous tissue plasminogen activator (IV-tPA, administered over 60 minutes) treatment (CLOTBUST-ER trial). The results from the trial, which was stopped due to futility show that although the use of sonothrombolysis was feasible and most likely safe, no clinical benefit was seen at 90 days. Compared with the control group, the adjusted cOR for an improvement in modified Rankin Scale score (mRSC) at 90 days in the intervention group was 1.05 (95% CI 0.77–1.45; p=0.74). Andrei Alexandrov, MD (University of Tennessee Health Science Center, Memphis), and colleagues reported in the April 2019 issue of the Lancet Neurology. Continue reading
AHA Releases a Scientific Statement Regarding Patients with Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease
The American Heart Association (AHA) released a scientific statement that aims to provide a formal and updated definition for Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease (MINOCA). It also outlines a useful framework for the diagnostic approach and management of patients with potential MINOCA.
Meta-Analysis Affirms Safety and Efficacy of Catheter-Based Renal Denervation for Blood Pressure Reduction
A meta-analysis conducted by Sardar et al. evaluated the change in blood pressure in response to catheter-based renal sympathetic denervation (RSD). The data, published in the Journal of the American College of Cardiology (JACC), suggested that RSD reduces ambulatory systolic blood pressure (ASBP) in patients with hypertension as compared with sham controls. Continue reading
New Study Suggests That Compression Only CPR Is Better Than No CPR
A study by Gabriel Riva and his colleagues published in Circulation assessed the rates of different forms of cardiopulmonary resuscitation (CPR) during three different guideline periods. They showed that there was almost a two-fold increase in the rates of CPR before the arrival of emergency medical services (EMS) as well as a 6-fold higher rate of compression-only CPR (CO-CPR) over time. Additionally, any form of CPR was associated with doubled survival rates when compared to no CPR. These findings support the use of CO-CPR as an option in future CPR guidelines as it is associated with higher CPR rates and higher overall survival in out-of-hospital cardiac arrest when compared to no CPR. Continue reading
