Physician burnout: An Emerging National Epidemic

Results of two studies published in the latest issue of the JAMA have focussed on the syndrome of physician burnout and rates of career choice regret within the US medical establishment. While findings from one study showed that a high prevalence of symptoms of burnout was present with substantial variation with differing specialties, a systematic review found marked variation in the prevalence estimates of burnout among physicians and inconsistency in burnout definitions, thereby underscoring the dilemmas in the assessment of this fast-growing problem. Continue reading

ASPREE: Another Warning Bell for Aspirin, “Wonder Drug”Fails to Work Wonders Results of Aspirin in Reducing Events in the Elderly (ASPREE trial)

The results of the Aspirin in Reducing Events in the Elderly (ASPREE) trial published in the New England Journal of Medicine showcase higher all-cause mortality among apparently healthy older adults receiving daily aspirin as compared to placebo, coupled with the shocking finding of mortality being attributed primarily to cancer, thereby painting a bleak picture of Aspirin (ASA) and heralding an end to its use in primary prevention. Continue reading

Do Valsartan Contaminants NDMA and NDEA Bear A Potential Cancer Risk? Danish nationwide cohort study on N-nitrosodimethylamine (NDMA) contaminated valsartan products and risk of cancer, FDA notes second contaminant

The discovery of Valsartan products that were contaminated with NDMA, in July 2018, in drug products manufactured in China, triggered the withdrawal of all affected products by medical agencies across Europe and the United States. Being one of the most well characterized and potent animal carcinogens known, Pottegard and his colleagues conducted an expedited observational cohort study using the nationwide Danish healthcare registry. They aimed to quantify the potential effects of NDMA contaminated valsartan products in terms of increased cancer risk, in order to provide timely information for regulatory bodies evaluating its carcinogenic effects. Results from this Danish cohort study, published in the BMJ, however, failed to show a significant increase in overall short-term cancer risk due to consumption of NDMA contaminated valsartan. Continue reading

Can TTR levels Determine Long-term Prognosis in AFib Patients on Vitamin K Antagonists? Outcomes Among Patients With Atrial Fibrillation and Appropriate Anticoagulation Control

Findings from a Danish nationwide registry conducted among patients with Atrial Fibrillation (AF), initiated on Vitamin K Antagonists (VKA) for stroke prevention between 1997 and 2011, found that almost one-half of patients with prior good level of VKA control (TTR ≥70%) had TTR <70% during the following year. Additionally, those with a prior TTR of ≥70% had a limited long-term prognostic value for stroke, thromboembolism or major bleeding risk, according to the online publication in JACC. Continue reading

Operator Experience of Atleast 225 Procedures Associated With Improved TAVR Outcomes The Learning Curve and Annual Procedure Volume Standards for Optimum Outcomes of Transcatheter Aortic Valve Replacement

Findings from an international TAVR registry involving 16 centers and spanning over a decade have important implications for operator training and patient care at centers performing TAVR. The study, published in JACC Cardiovascular Interventions, is a testament to the learning curve that still exists with both greater procedural safety and lower mortality rates reported when TAVR is performed by experienced operators. Additionally, TAVR performed at low annual volume (<50 procedures) institutions is associated with decreased procedural safety and higher patient mortality. This stepwise improvement in patient outcomes bears important implications for operator training and patient care at centers performing TAVR. Continue reading

Angiographic Completeness Not Associated With Outcomes Following FFR-guided PCI Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS

Researchers have confirmed that the extent of residual angiographic disease calculated using the residual SYNTAX score (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) or RSS has no association with ischemic events occurring subsequently in patients presenting with ACS. The study, published in JACC, reinforces the concept that functionally complete revascularization is applicable even in ACS patients. Continue reading

UK based RCT Emphasizes on Long Term Cardiovascular Benefits of Antihypertensives and Statins Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy Study: 16 year follow up results

The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy Study is a UK based trial that reports long-term beneficial effects of antihypertensives and statins in terms of mortality and cardiovascular outcomes after 16 years of follow-up in patients with hypertension. Continue reading

Biodegradable Polymer Sirolimus- Eluting Stent Proven Non-Inferior to Durable-Polymer, Everolimus-Eluting Stent BIOSCIENCE 5 Year Outcomes: Results from ESC 2018

Results of the BIOSCIENCE study that were presented at the ESC Annual Congress by Dr. Thomas Pilgrim, University Clinic for Cardiology, Bern, Switzerland, show that the 5-year risk of target lesion failure among patients undergoing percutaneous coronary intervention (PCI) is similar after implantation of the ultrathin-strut, biodegradable-polymer sirolimus-eluting stents as compared with thin-strut, durable-polymer, everolimus-eluting stents. However, higher incidence of all-cause and non-cardiovascular mortality in patients treated with the biodegradable polymer sirolimus-eluting-stents as compared with the durable-polymer stents eluting everolimus warrant careful scrutiny in ongoing clinical trials. The announcement of the results of this trial at the ESC was accompanied by a publication in the Lancet. Continue reading

Coronary Microvascular Dysfunction: A Promising Therapeutic Target in Heart Failure with Preserved EF? PROMIS-HFpEF: Results from ESC 2018

PROMIS-HFpEF (PRevalence Of MIcrovascular dySfunction in Heart Failure with Preserved Ejection Fraction) is an echocardiographic trial showcasing a high prevalence of coronary microvascular dysfunction (CMD) in HFpEF and its association with systemic endothelial dysfunction (RHI, UACR) and markers of HF severity (NT-proBNP and RV dysfunction). The results of the trial were recently published in the European Heart Journal. Continue reading

Lorcaserin proven safe as weight loss agent in obese patients CAMELLIA-TIMI 61 trial: Results from ESC 2018, Munich

The selective serotonin 2c receptor agonist, Lorcaserin has been proven to be effective in the promotion of sustained weight loss through appetite suppression in obese and overweight patients, with no increase in cardiovascular events, according to the CAMELLIA-TIMI 61 (Cardiovascular and Metabolic Effects of Lorcaserin in Overweight and Obese Patients–Thrombolysis in Myocardial Infarction 61) trial, presented at the ESC conference in Munich. Continue reading

Transcatheter Interatrial shunt device appears safe at 1 year for heart failure with preserved ejection fraction ESC 2018: REDUCE LAP HF-1, 1 year results from phase 2

The 1-year results of a phase 2, sham-controlled RCT have confirmed the safety of a transcatheter interatrial shunt device (IASD; Corvia Medical) with no significant cardiovascular or renal events as compared to those receiving sham control treatment. It has also confirmed the long-term patency of the device. The findings were presented at the ESC and have also been simultaneously published in JAMA Cardiology. Continue reading

Omega-3 fatty acid Supplements Show No Benefit in Cardiovascular Prevention in Diabetes Says ASCEND, the largest and longest placebo controlled trial of omega-3 fatty acids

A randomized trial in patients with diabetes without evidence of cardiovascular disease has shown there to be no significant difference in the risk of serious cardiovascular events in those administered omega−3 fatty acids as compared to placebo. Continue reading

Aspirin Vs Placebo In Cardiovascular Event Reduction In Diabetes ESC 2018: ASCEND trial

A randomized 15,480 patient strong UK based trial comparing Aspirin (ASA) versus placebo in diabetics has shown that the absolute reduction in cardiovascular events from aspirin is offset by a similar absolute increase in major bleeding. Continue reading

Antithrombotic therapy post TAVR: A double edged sword? ESC 2018: Insights from the French TAVI registry

A multicenter, prospective nation-wide French registry evaluated whether oral anticoagulation therapy was an independent correlate of long-term survival and early bioprosthetic valve dysfunction (BVD) in patients who underwent successful Transcatheter Valve Implantation (TAVI). The French registry was launched in 2007 and involved 11,469 patients with a mean duration follow-up was 495±3.5 days. This registry contained 11 years of data and analyzed patients from January 1, 2013, and December 31, 2015. Continue reading

Conservative Management Should be First Line Therapy for SCAD ESC 2018: Canadian SCAD study

Spontaneous coronary artery dissection (SCAD) is an underdiagnosed, poorly misunderstood condition. The predisposing causes and management of this condition are still unclear. To throw light on this, the CANADIAN SCAD cohort study was a large, prospective, multicenter, observational, natural history study that enrolled 750 non-atherosclerotic SCAD patients from 22 centers (20 from Canada and 2 from the US). The key study objective was the analysis of cardiovascular outcomes within the hospital and long-term. Secondary outcomes included the assessment of clinical and angiographic characteristics of patients presenting with SCAD. Continue reading

High LDL Levels Can Increase Cardiovascular Mortality Even in Low Risk Population Results From the Cooper Center Longitudinal Study

A recent study published in Circulation found that higher levels of low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDLC) increased the relative risk of long-term cardiovascular disease (CVD) mortality by 50% to 80%, in healthy participants that were considered to be at a low 10-year risk prior to the beginning of the study. Continue reading

Modifiable risk factor control can eliminate excess cardiovascular risk in Type 2 Diabetes

A Swedish study has found that type 2 diabetics who have five risk-factor variables within the target ranges have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population. Assessment of risk is based on the presence of five modifiable risk factors: smoking, elevated glycated hemoglobin, elevated low-density lipoprotein cholesterol level, elevated blood pressure and albuminuria. Continue reading

Low Dose Rivaroxaban Plus Aspirin Reduces Major Adverse Limb Events in COMPASS A COMPASS subgroup analysis

According to a new subgroup analysis of the COMPASS trial published in the Journal of the American College of Cardiology, the prevention of Major Adverse Limb Events (MALE) is of utmost importance in patients with lower extremity Peripheral Arterial Disease (PAD) due to its poor prognosis. Additionally, it has been found that the aspirin and rivaroxaban 2.5mg twice daily combination leads to a significant reduction of Major Adverse Limb Events (MALE) in these patients.

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Do Procedure and Coronary Lesion Characteristics Impact Clinical Outcomes in Atrial Fibrillation Patients Undergoing PCI?

According to a post-hoc analysis of the PIONEER AF-PCI trial that was recently published in the Journal of American College of Cardiology,  there was no impact of complex coronary lesions, stent characteristics, or vascular approach on efficacy or safety outcomes among stented atrial fibrillation (AF) patients who received either rivaroxaban or Vitamin K Antagonists (VKA)-based dual or triple therapy. Continue reading

ICON RELOADED: A New Future for NT-proBNP

A multicenter, international, North American study published in the Journal of the American College of Cardiology has indicated that N-terminal pro–B-type natriuretic peptide (NT-proBNP) testing may be valuable in the identification or exclusion of heart failure in emergency department patients with shortness of breath.

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