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A Perspective on Recent Hospital Strategies to Reduce Heart Failure Readmissions and Improve Outcomes
AbstractPurpose of ReviewHeart failure is a complex and expensive disease that represents an increasing burden to the healthcare system. Regulatory changes that affect payments for inpatient care have influenced the way we practice medicine.Recent FindingsHospitals have struggled to employ strategies to improve publically reported metrics. Resources are available yet there is no clear recommendation on best practice. There is a debate whether the 30-day readmission metric represents favorable patient outcomes.SummaryThere will be continued debate on how to best define quality for heart failure care; provider engagement is ...
Source: Current Cardiovascular Risk Reports - September 11, 2017 Category: Cardiology Source Type: research

Surgical Weight Loss to Treat Atrial Fibrillation Risk and Progression
AbstractPurpose of ReviewThis review aims to examine the breadth of data associating atrial fibrillation (AF) with obesity at epidemiologic, mechanistic, and clinical levels. We then proceed to place surgical weight loss within that context.Recent FindingsEpidemiologic studies have demonstrated a robust correlation between overweight and AF. Various mechanistic factors including concomitant risk factors, diastolic impairment, inflammation, and pericardial fat have been observed to contribute to the atrial substrate for AF. However, weight loss can institute a process of reverse atrial remodeling improving arrhythmias profi...
Source: Current Cardiovascular Risk Reports - September 9, 2017 Category: Cardiology Source Type: research

Prevention of Cardiotoxicity in the Cancer Patient
AbstractPurpose of ReviewThis review discusses the current understanding of cardiotoxicities and prevention strategies for several agents including anthracyclines, HER2 monoclonal antibodies, tyrosine kinase inhibitors, and fluoropyrimidines.Recent FindingsHeart disease and cancer are by far the most common causes of death in the USA and may coincide in a given individual. Life-prolonging therapies for heart disease and cancer continue to evolve, with a particular proliferation of new agents to treat cancer. These advances in the treatment of cancer have led to an expanding population of cancer survivors. Due to the natura...
Source: Current Cardiovascular Risk Reports - September 6, 2017 Category: Cardiology Source Type: research

Can Implantable Cardiac Devices Be Used to Lower Risk of Stroke?
This article provides an overview of the current literature on AHREs, stroke prevention, and evolving areas of investigation.Recent FindingsAHREs predict increased thromboembolic risk at durations of 24  h or less. Shorter cutoffs have been less consistently associated with risk.SummaryThere is clinical equipoise for the use of oral anticoagulation for device-detected subclinical atrial fibrillation alone. Very short episodes may not require action beyond continued monitoring. Studies are ongoing to address the use of oral anticoagulation for device-detected subclinical AHREs alone, as well as tailored anticoagulation in ...
Source: Current Cardiovascular Risk Reports - September 6, 2017 Category: Cardiology Source Type: research

Primary Prevention with Statins: Strategies to Support Shared Decision-Making
AbstractPurpose of ReviewThis paper proposes several strategies for health systems, primary care clinicians, cardiologists, and other members of the healthcare team to better engage individuals in decisions around primary preventive statin therapy.Recent FindingsThe 2013 American College of Cardiology and American Heart Association (ACC/AHA) guidelines for cholesterol management provide an opportunity to better engage patients in decisions about primary prevention of cardiovascular disease, including the initiation of statin therapy.SummaryIn the shared decision making process, clinicians and patients work together to dete...
Source: Current Cardiovascular Risk Reports - August 21, 2017 Category: Cardiology Source Type: research

Left Atrial Appendage Closure: Is the Strategy Enough to Lower Long-Term Stroke Risk?
AbstractPurpose of ReviewLeft atrial appendage closure (LAAC) emerged as a promising site-directed therapy to mitigate stroke risk in patients ineligible for long-term oral anticoagulation. We sought to summarize the current evidence regarding the role of LAAC on long-term risk of ischemic stroke and systemic thromboembolism.Recent FindingsData from EWOLUTION registry provides real world evidence on the 1-year outcomes of LAAC by WATCHMAN device. The annual ischemic stroke rate was 1.1 per 100 patient-years, as opposed to the CHADS2VASC score-predicted stroke rate of 7.2% (84% relative risk reduction). No differences in de...
Source: Current Cardiovascular Risk Reports - August 19, 2017 Category: Cardiology Source Type: research

Ablation of Focal Impulses and Rotational Sources: What Can Be Learned from Differing Procedural Outcomes?
ConclusionsMapping and ablation of AF drivers is a rapidly growing field which, with continued scientific discovery and procedural advances, offers a strong mechanistic foundation to improve patient-tailored ablation for complex arrhythmias. (Source: Current Cardiovascular Risk Reports)
Source: Current Cardiovascular Risk Reports - August 14, 2017 Category: Cardiology Source Type: research

Lp(a) in Childhood
AbstractElevated plasma concentration of lipoprotein (a) (Lp(a)) is an independent risk factor for the development of atherosclerotic coronary vascular disease. There is a causal relationship between Lp(a) elevation and myocardial infarction. In the pediatric population, Lp(a) has been associated with risk for ischemic stroke. However, a consensus regarding the clinical utility of Lp(a) measurement in children has not been established. In this article, we review recent literature regarding Lp(a) metabolism, its role in disease states such as in pediatric thrombosis and familial hypercholesterolemia (FH), and therapy direct...
Source: Current Cardiovascular Risk Reports - August 8, 2017 Category: Cardiology Source Type: research

Do Implantable Cardioverter-Defibrillators Lower the Risk of Sudden Death and Total Mortality in Patients with End-Stage Renal Disease?
AbstractPurpose of ReviewAlthough the risk of sudden cardiac death is high in patients with end-stage renal disease (ESRD), it is not clear if such patients benefit from the implantable cardioverter defibrillator (ICD). This paper reviews data on the risk of sudden cardiac death in ESRD patients and examines data on outcomes of ICDs in such patients.Recent FindingsData from observational studies suggest that primary prevention ICDs may lower the risk of mortality in patients with mild to moderate chronic kidney disease but not in patients with ESRD. Data on secondary prevention ICDs in the setting of ESRD suggest survival ...
Source: Current Cardiovascular Risk Reports - August 4, 2017 Category: Cardiology Source Type: research

Preventive Cardiovascular Health in Schools: Current Status
This report presents a critical review and synthesis of selected school-based research that has been instrumental in demonstrating the feasibility and potential of schools as a population-based venue for preventive cardiovascular care and recent data on the status of school-based cardiovascular disease prevention initiatives.Recent FindingsResults underscore the importance of evidence-based approaches for promoting healthy behaviors and heart health in the school environment, indicate the need for policies that enhance the food and physical environments of schools, and provide data indicating substantial (state, school dis...
Source: Current Cardiovascular Risk Reports - July 10, 2017 Category: Cardiology Source Type: research

Cardiac Arrhythmia Due to Epicardial Fat: Is It a Modifiable Risk?
AbstractPurpose of ReviewObesity and metabolic syndrome are one of the modifiable determinants for the risk of cardiac arrhythmias, especially atrial fibrillation (AF). A strong association between visceral fat and obesity or metabolic syndrome has been established.Recent FindingsRecently, much clinical interest has been focused on epicardial adipose tissue (EAT), as visceral fat and cardiac arrhythmias, especially in AF. Increasing data suggests that EAT is associated with the incidence and severity of AF. Several experimental studies have shown that EAT exerts biochemical effects on the cardiovascular system, including i...
Source: Current Cardiovascular Risk Reports - June 14, 2017 Category: Cardiology Source Type: research

Managing Hypertension in the Elderly: What is Different, What is the Same?
AbstractPurpose of ReviewThe goal is to discuss management of hypertension in the elderly.Recent FindingsAt 3.14-year follow-up of 2636 persons ≥75 years in the Systolic Blood Pressure Intervention Trial (SPRINT), compared with a systolic blood pressure (SBP) goal of<140  mmHg, a SBP goal of<120  mmHg reduced the primary endpoint of myocardial infarction, other acute coronary syndrome, stroke, heart failure, or cardiovascular death by 34% (p = 0.001), all-cause mortality by 33% (p = 0.009), heart failure by 38% (p = 0.003), and the primary outcome or death by 32% (p <  0.001). Absolute cardiovascular ...
Source: Current Cardiovascular Risk Reports - June 6, 2017 Category: Cardiology Source Type: research

The Effects of Bariatric Surgery on the Cardiovascular System
AbstractPurpose of ReviewObesity, which has reached epidemic proportions in industrialized regions, is associated with myriad cardiovascular abnormalities and several different types of cardiovascular disease (CVD). However, the finding of an obesity paradox among patients with prevalent CVD and limited cardiovascular outcomes data from clinical trials of medical weight loss have raised questions regarding the cardiovascular benefits of weight loss, particularly among those with existing CVD. Therefore, in this manuscript, we review recent investigative developments regarding the effects of bariatric surgery on the cardiov...
Source: Current Cardiovascular Risk Reports - June 5, 2017 Category: Cardiology Source Type: research

Implications of Recent Clinical Trials in Cardiovascular Imaging on Primary Prevention Therapies
AbstractPurpose of ReviewThis review aims to provide an overview of how cardiovascular imaging can help individualize preventive cardiovascular care, while focusing on the implications of various recent noninvasive and invasive imaging studies for the field of preventive cardiology.Recent FindingsCoronary artery calcium (CAC) has established itself as a well-validated tool for detecting the presence or absence of coronary atherosclerosis and thus can provide a more precise measurement of risk than many commonly used risk scores. While individuals with no CAC have an excellent prognosis, those with even minimal CAC have an ...
Source: Current Cardiovascular Risk Reports - June 2, 2017 Category: Cardiology Source Type: research

Ablation of Advanced Subtypes of Atrial Fibrillation: Highlighting the Art of When and When Not to Perform Additional Ablation
AbstractPurpose of ReviewThe purpose of this review is to determine the role of pulmonary vein (PV) triggers in different types of atrial fibrillation (AF) as well as to determine based on prospective randomized data which other approaches may increase the success rate of radiofrequency ablation of persistent AF.Recent FindingsSpecial attention must be paid to detect, diagnose, and optimize management of reversible or treatable causes of persistent AF such as obesity, obstructive sleep apnea, hypertension, hypo- or hyperthyroidism, inflammatory and infectious diseases, and stress. Though the role of PVs is more pronounced ...
Source: Current Cardiovascular Risk Reports - May 4, 2017 Category: Cardiology Source Type: research