Hypertension therapy using fixed-dose polypills that contain at least three medications
Fixed-dose combination (FDC) therapy may provide a solution to treatment gaps by overcoming reasons for therapeutic inertia. To synthesise and report on available evidence on standard or low-dose combination medicines that combine at least three antihypertensive medicines. A literature search was conducted via Scopus, Embase, PubMed and the Cochrane clinical trials database. Studies were eligible for inclusion if they were randomised clinical trials that included adults (>18 years) and examined the impact of at least three antihypertensive medications on blood pressure (BP). A total of 18 trials (n=14 307) were identifi...
Source: Heart - August 11, 2023 Category: Cardiology Authors: O'Hagan, E. T., McIntyre, D., Nguyen, T., Chow, C. K. Tags: Review articles Reviews Source Type: research
Expert consensus statement from the Joint British Societies for provision of infective endocarditis services
Guidelines for management of patients with infective endocarditis (IE) from the European Society of Cardiology,1 American College of Cardiology/American Heart Association2 3 and British Society for Antimicrobial Chemotherapy4 provide detailed recommendations for prevention of IE; diagnosis based on clinical, bacteriological and imaging findings; medical therapy including the type, route and duration of antibiotic administration; and the indications, type and timing of surgical intervention. These guideline documents have the goal to base each specific recommendation on the published evidence and follow a formal development...
Source: Heart - August 11, 2023 Category: Cardiology Authors: Otto, C. M. Tags: Editorials Source Type: research
Pulmonary hypertension in significant aortic valve disease: a dive into real-world data
Left heart disease is the most common cause of pulmonary hypertension (PHT) accounting for over 65% of all diagnosed cases.1 In over half of these patients, PHT is the consequence of valve dysfunction, predominantly mitral regurgitation.2 However, echocardiographic evidence of PHT is not infrequent in the setting of aortic valve disease, particularly in patients with severe aortic stenosis (AS) in whom an estimated systolic pulmonary arterial pressure (eSPAP) >60 mm Hg has previously been reported in up to 34%.3 Data on PHT due to significant aortic regurgitation (AR) has up to now been much scarcer, with one study find...
Source: Heart - August 11, 2023 Category: Cardiology Authors: Cramariuc, D., Urheim, S. Tags: Editorials Source Type: research
Bradyarrhythmias in patients with atrial fibrillation
The increasing burden of atrial fibrillation (AF) and significant morbidity/mortality associated with this arrhythmia encourage screening it in clinical practice, as recommended in current guidelines. It means opportunistic screening (in patients over 65 years) or systematic screening (in people above 75 years) by using clinical examination, followed by an ECG, 24-hour ECG monitoring or continuous rhythm monitoring by a screening tool (including mobile or wearable device). In screen-positive cases, a definitive diagnosis of AF should always be obtained before providing an appropriate management.1 Symptomatic or asymptomati...
Source: Heart - August 11, 2023 Category: Cardiology Authors: Floria, M., Tanase, D. M. Tags: Editorials Source Type: research
Heartbeat: elevated pulmonary pressures in adults with aortic valve disease
Both aortic stenosis (AS) and aortic regurgitation (AR) often are accompanied by some degree of pulmonary hypertension. In a pair of articles in this issue of Heart, Ratwatte and colleagues 1 2 examined the prevalence and prognosis associated with estimated right ventricular systolic pressure (eRVSP) in a retrospective analysis of the National Echocardiography Database of Australia (data from 2000 to 2019). Among the 14 980 adults with moderate or greater AS and normal left ventricular (LV) systolic function, eRVSP (in mm Hg) was <30 in 13.7%, 30-39 in 33.9%, 40-49 in 29.3%, 50-59 in 13.1% and >60 in 10.1%. In additi...
Source: Heart - August 11, 2023 Category: Cardiology Authors: Otto, C. M. Tags: Highlights from this issue Source Type: research
Expert consensus recommendations for the provision of infective endocarditis services: updated guidance from the Joint British Societies
Infective endocarditis (IE) remains a difficult condition to diagnose and treat and is an infection of high consequence for patients, causing long hospital stays, life-changing complications and high mortality. A new multidisciplinary, multiprofessional, British Society for Antimicrobial Chemotherapy (BSAC)-ledWorking Party was convened to undertake a focused systematical review of the literature and to update the previous BSAC guidelines relating delivery of services for patients with IE. A scoping exercise identified new questions concerning optimal delivery of care, and the systematic review identified 16 231 papers of ...
Source: Heart - August 11, 2023 Category: Cardiology Authors: Sandoe, J. A. T., Ahmed, F., Arumugam, P., Guleri, A., Horner, C., Howard, P., Perry, J., Prendergast, B. D., Schwiebert, R., Steeds, R. P., Watkin, R., Wendler, O., Chambers, J. B. Tags: Open access Guideline or consensus statement Source Type: research
Career paths for cardiologists in industry: pharmaceutical, medical insurance, health technology and management consulting
Introduction Cardiologists have opportunities to transition to different roles outside of traditional clinical care. In this article, we describe the potential opportunities for cardiologists in pharmaceutical, medical insurance, health technology and management consulting. We highlight some unique considerations for each industry and discuss a strategic approach to engage in these opportunities. Pharmaceutical industry The pharmaceutical industry presents several opportunities for cardiologists. Those with significant basic research background are well positioned in roles related to drug development and discovery. These r...
Source: Heart - July 27, 2023 Category: Cardiology Authors: Gandhi, S., Franke, J., Shrotriya, R. Tags: Cardiology in Focus Source Type: research
Approach to a patient with asymptomatic pre-excitation
Learning objectives Risk stratify a patient with asymptomatic pre-excitation. Counsel patients with asymptomatic pre-excitation, informing them of their risk of sudden death, and risk/benefits of treatment versus observation. Identify intermittent pre-excitation on ECG and counsel the patient on its interpretation. Describe the process of invasive risk stratification in a patient with asymptomatic pre-excitation and counsel patients appropriately. Introduction Ventricular pre-excitation is an electrocardiographic finding characterised by a delta wave and short PR interval. It is estimated that 1 in 1000 people will exhibit...
Source: Heart - July 27, 2023 Category: Cardiology Authors: Antiperovitch, P., Skanes, A., Klein, G., Tang, A. Tags: Education in Heart, Open access Source Type: research
Impact of cardiac surgery on left-sided infective endocarditis with intermediate-length vegetations
Conclusions
Our results suggest that surgery is associated with lower all-cause mortality than medical therapy in patients with uncomplicated left-sided IE with intermediate-length vegetations even in the absence of other guideline-based indications. (Source: Heart)
Source: Heart - July 27, 2023 Category: Cardiology Authors: Scheggi, V., Bohbot, Y., Tribouilloy, C., Trojette, F., Di Lena, C., Philip, M., Hubert, S., Menale, S., Zoppetti, N., Del Pace, S., Stefano, P. L., Habib, G., Marchionni, N. Tags: Valvular heart disease Source Type: research
Morpho-mechanistic screening criteria for the echocardiographic detection of rheumatic heart disease
Conclusion
Our proposed MM approach showed an equal sensitivity to the WHF criteria but with significantly improved specificity. The MM RHD rule-out test excluded RHD-negative cases while identifying all cases within the CRS RHD-positive cohort. This holds promise for the development of a two-step RHD screening algorithm to enable task shifting in RHD endemic regions. (Source: Heart)
Source: Heart - July 27, 2023 Category: Cardiology Authors: Hunter, L. D., Doubell, A. F., Pecoraro, A. J. K., Monaghan, M., Lloyd, G., Lombard, C., Herbst, P. G. Tags: Valvular heart disease Source Type: research
Medications for specific phenotypes of heart failure with preserved ejection fraction classified by a machine learning-based clustering model
Conclusions
Machine learning-based clustering may have the potential to identify populations in which specific medications may be effective. This study suggests the effectiveness of MRA, ACEi or ARB and statin for specific phenotypes of HFpEF.
Trial registration number
UMIN000021831. (Source: Heart)
Source: Heart - July 27, 2023 Category: Cardiology Authors: Sotomi, Y., Hikoso, S., Nakatani, D., Okada, K., Dohi, T., Sunaga, A., Kida, H., Sato, T., Matsuoka, Y., Kitamura, T., Komukai, S., Seo, M., Yano, M., Hayashi, T., Nakagawa, A., Nakagawa, Y., Tamaki, S., Ohtani, T., Yasumura, Y., Yamada, T., Sakata, Y., o Tags: Open access Heart failure and cardiomyopathies Source Type: research
Likelihood reclassification by an acoustic-based score in suspected coronary artery disease
Conclusion
In a large contemporary cohort of patients with low CAD likelihood, the additional use of an acoustic rule-out device showed a clear potential to downgrade likelihood and could supplement current strategies for likelihood assessment to avoid unnecessary testing.
Trial registration number
NCT03481712. (Source: Heart)
Source: Heart - July 27, 2023 Category: Cardiology Authors: Rasmussen, L. D., Winther, S., Karim, S. R., Westra, J., Kirk Johansen, J., Sondergaard, H. M., Hammid, O., Sevestre, E., Onuma, Y., Nyegaard, M., Ejlersen, J. A., Hoj Christiansen, E., Eftekhari, A., Holm, N. R., Schmidt, S. E., Bottcher, M. Tags: Coronary artery disease Source Type: research
Systolic blood pressure, chronic obstructive pulmonary disease and cardiovascular risk
Conclusion
Using deep learning for modelling EHR, we identified a monotonic association between SBP and risk of cardiovascular events in patients with COPD. (Source: Heart)
Source: Heart - July 27, 2023 Category: Cardiology Authors: Rao, S., Nazarzadeh, M., Li, Y., Canoy, D., Mamouei, M., Salimi-Khorshidi, G., Rahimi, K. Tags: Open access Cardiac risk factors and prevention Source Type: research
Recurrent pericardial effusion: a treatable cause not to be overlooked
Clinical introduction A woman in her 60s presented with heart failure. She had a history of diabetes, hypertension and hyperlipidaemia. Surgical history comprised bilateral hydronephrosis requiring ureteric stenting and cholecystectomy. She had undergone three pericardiocentesis procedures within the preceding 2 years at other hospitals. No obvious cause for the recurrent effusions had been identified. Echocardiography demonstrated again a large pericardial effusion with diastolic collapse of the right ventricle. The left ventricular function appeared normal (Figure 1A). Urgent pericardiocentesis was performed. The cytolog...
Source: Heart - July 27, 2023 Category: Cardiology Authors: Teoh, V. W. Y., Kamarulata, I. L., Loch, A. Tags: Image challenges Source Type: research
Primary prevention of cardiovascular disease in women with a Mediterranean diet: systematic review and meta-analysis
Conclusion
This study supports a beneficial effect of the Mediterranean diet on primary prevention of CVD and death in women, and is an important step in enabling sex specific guidelines. (Source: Heart)
Source: Heart - July 27, 2023 Category: Cardiology Authors: Pant, A., Gribbin, S., McIntyre, D., Trivedi, R., Marschner, S., Laranjo, L., Mamas, M. A., Flood, V., Chow, C. K., Zaman, S. Tags: Editor's choice, Press releases Cardiac risk factors and prevention Source Type: research
