Should beta-blockers be recommended after myocardial infarction when left ventricular ejection fraction is normal?
For many years, clinical practice guidelines have recommended beta-blockers after myocardial infarction for all patients without a contraindication. In this issue of Heart, this recommendation is questioned by a propensity adjusted analysis from the SWEDEHEART registry which found no association between long-term beta-blocker use and mortality or major cardiovascular events in 43 618 patients with previous myocardial infarction who did not have heart failure or left ventricular (LV) systolic dysfunction.1 Many clinical trials have evaluated whether beta-blockers improve clinical outcomes after myocardial infarction, but mo...
Source: Heart - July 12, 2023 Category: Cardiology Authors: Evans, T., Stewart, R. Tags: Press releases Editorials Source Type: research
Implantable cardioverter-defibrillator shocks during long-term follow-up in arrhythmogenic right ventricular cardiomyopathy
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy predisposing patients to potentially life-threatening ventricular arrhythmias (VAs) and sudden cardiac death. As a result, most patients will receive an implantable cardioverter–defibrillator (ICD) for primary or secondary prevention. Over the years, many authors have evaluated risk factors for VA and sudden cardiac death in ARVC to optimise patient selection for ICD implantation. This has culminated in the development of a risk calculator for individualised prediction of ‘any sustained VA’ and ‘fast VA’, the...
Source: Heart - July 12, 2023 Category: Cardiology Authors: Muller, S. A., te Riele, A. S. J. M. Tags: Editorials Source Type: research
Heartbeat: Questionable benefit of beta-blocker therapy more than one year after myocardial infarction in patients without heart failure or ventricular dysfunction
Beta blockers (BB) are recommended following an acute myocardial infarction to reduce the risk of adverse cardiovascular outcomes and mortality. However, the evidence supporting this recommendation is based on clinical trials performed before coronary reperfusion, statins, and anti-thrombotic therapy became routine clinical practice. More recent studies confirm the benefits of BB in patients with heart failure (HF) or left ventricular systolic dysfunction (LVSD) after acute myocardial infarction, however it is less clear whether long-term BB are indicated in patients without HF or LVSD. In this issue of Heart, Ishak and co...
Source: Heart - July 12, 2023 Category: Cardiology Authors: Otto, C. M. Tags: Highlights from this issue Source Type: research
Joint British Societies position statement on bullying, harassment and discrimination in cardiology
Inappropriate behaviour is an umbrella term including discrimination, harassment and bullying. This includes both actions and language and can affect any member of the cardiovascular workforce/team. Evidence has suggested that such behaviour is regularly experienced within UK cardiology departments, where inappropriate behaviour may represent longstanding cultural and practice issues within the unit. Inappropriate behaviour has negative effects on the workforce community as a whole, including impacts on recruitment and retention of staff and patient care. While only some members of the cardiology team may be directly impac...
Source: Heart - July 12, 2023 Category: Cardiology Authors: Camm, C. F., Joshi, A., Eftekhari, H., O'Flynn, R., Dobson, R., Curzen, N., Lloyd, G., Greenwood, J. P., Allen, C. Tags: Open access, Press releases Consensus statement Source Type: research
Common origins and shared opportunities for breast cancer and cardiovascular disease prevention
Learning objectives Appreciate the common risk factors for breast cancer and cardiovascular disease that can be modified by lifestyle and preventive treatments. Describe the secondary effects of chemotherapy, radiation therapy and hormone suppression therapy on cardiovascular risk. Outline mechanisms to assess and ameliorate cardiovascular risk in breast cancer survivors. Introduction The contemporary landscape of cardiology, oncology and disease prevention is being shaped by complex paradigm shifts. Cardio-oncology represents one of the most rapidly growing fields of collaborative clinical practice, patient-centred care a...
Source: Heart - June 26, 2023 Category: Cardiology Authors: Henry, S., Vaidean, G., Rege, R., Gianos, E. Tags: Education in Heart Source Type: research
Perioperative care differences of surgical aortic valve replacement between North America and Europe
Conclusion
Contemporary perioperative management of SAVR patients varies between North America and Europe in patient selection, procedural techniques, antithrombotic regimen and discharge management. Furthermore, rehospitalisation differed largely between continents and countries. Hence, geographical setting must be considered during design and interpretation of trials on SAVR.
Trial registration number
NCT02088554. (Source: Heart)
Source: Heart - June 26, 2023 Category: Cardiology Authors: Velders, B. J. J., Vriesendorp, M. D., De Lind Van Wijngaarden, R. A. F., Rao, V., Reardon, M. J., Shrestha, M., Chu, M. W. A., Sabik, J. F., Liu, F., Klautz, R. J. M. Tags: Valvular heart disease Source Type: research
Pulmonary artery compliance in different forms of pulmonary hypertension
Conclusion
PAC was similar between PH groups and was not an independent predictor of transplant-free survival in PAH. RC time was different between PH subgroups, challenging RC time constancy.
Trial registration number
NCT04071327 (Source: Heart)
Source: Heart - June 26, 2023 Category: Cardiology Authors: McCormick, A., Krishnan, A., Badesch, D., Benza, R. L., Bull, T. M., De Marco, T., Feldman, J., Hemnes, A. R., Hirsch, R., Horn, E., Kennedy, J., Mathai, S. C., McConnell, W., Pugliese, S. C., Sager, J. S., Shlobin, O. A., Simon, M. A., Lammi, M. R. Tags: Pulmonary vascular disease Source Type: research
Prognostic modelling of clinical outcomes after first-time acute coronary syndrome in New Zealand
Conclusions
In 2015 patients with first-time ACS, recurrent events were common (20.8%). Increasing NT-proBNP levels and Māori ethnicity were predictors of death/cardiovascular readmission, but not after adjustment for the 20 clinical risk factors represented by the clinical summary score.
Trial registration number
ACTRN12615000676516. (Source: Heart)
Source: Heart - June 26, 2023 Category: Cardiology Authors: Earle, N. J., Poppe, K. K., Rolleston, A., Pilbrow, A., Aish, S., Bradbury, K., Choi, Y., Devlin, G., Gladding, P. A., Grey, C., Harrison, W., Henare, K., Howson, J., Kerr, A., Lumley, T., Pera, V., Porter, G., Stewart, R., Troughton, R. W., Wihongi, H., Tags: Coronary artery disease Source Type: research
Elective ascending aortic aneurysm repair outcomes in a nationwide US cohort
Conclusions
The overall rate of in-hospital death, stroke and MI is nearly 5% in patients undergoing elective ascending aortic aneurysm repair. Among several predictors, chronic weight loss is associated with the largest increase in the risk of poor outcomes. Higher hospital volume is associated with a lower in-hospital mortality, highlighting the importance to refer patients to high-volume centres while discussing the risks and benefits of proceeding with repair. (Source: Heart)
Source: Heart - June 26, 2023 Category: Cardiology Authors: Beyer, S. E., Secemsky, E. A., Khabbaz, K., Carroll, B. J. Tags: Aortic and vascular disease Source Type: research
Prediction of short-term atrial fibrillation risk using primary care electronic health records
Conclusions
FIND-AF, a machine learning algorithm applicable at scale in routinely collected primary care data, identifies people at higher risk of short-term AF. (Source: Heart)
Source: Heart - June 26, 2023 Category: Cardiology Authors: Nadarajah, R., Wu, J., Hogg, D., Raveendra, K., Nakao, Y. M., Nakao, K., Arbel, R., Haim, M., Zahger, D., Parry, J., Bates, C., Cowan, C., Gale, C. P. Tags: Open access, Editor's choice Arrhythmias and sudden death Source Type: research
Effect of opioids for breathlessness in heart failure: a systematic review and meta-analysis
Conclusion
Opioids for treating breathlessness in HF are questionable and may only be the very last option if other options have failed or in case of an emergency.
PROSPERO registration number
CRD42021252201. (Source: Heart)
Source: Heart - June 26, 2023 Category: Cardiology Authors: Gaertner, J., Fusi-Schmidhauser, T., Stock, S., Siemens, W., Vennedey, V. Tags: Open access Heart failure and cardiomyopathies Source Type: research
Patient with altered mental status
Clinical introduction A woman in her 60s with history of diabetes mellitus, hypertension and hypothyroidism presented to the emergency department after being found confused, non-verbal and with low urine output in a nursing home. Her last known well was around 6 o’clock in the morning before presentation. Her temperature was 94.5°F, blood pressure (BP) was 179/80 mm Hg, heart rate (HR) was 50/min, and saturation was 97% on room air. She was cold to touch. The lungs were clear to auscultation bilaterally. She was noted to have gaze preference initially to the right, then to the left, right-sided weakness and left ...
Source: Heart - June 26, 2023 Category: Cardiology Authors: Khan, I., Atoot, A. Tags: Open access, Image challenges Source Type: research
National Institute for Health and Care Excellence guidelines on myocardial revascularisation
This article will appraise the current recommendations from NICE regarding myocardial revascularisation and compare them with other major international guidelines. While there are many similarities, subtle differences exist. These differences arise in part due to the evidence base at time of publication, as well as from the different healthcare systems that they are designed for, and from the cost-effectiveness models that dominate the methodology used by NICE. The clinical implications of the differences between the international guidelines will be analysed. (Source: Heart)
Source: Heart - June 26, 2023 Category: Cardiology Authors: Jabbour, R. J., Curzen, N. Tags: Review articles Reviews Source Type: research
Pulmonary arterial compliance: a physiological variable still searching for clinical relevance?
The fundamental physiological disturbance in pulmonary hypertension is an increase in right ventricular (RV) afterload, regardless of disease aetiology. Although a complete description of the arterial afterload can be constructed using complex impedance analysis in the frequency domain, more simple measures are required for clinical use. In general, there are two major factors which modulate the RV afterload, a steady component and a pulsatile component which are often represented by pulmonary vascular resistance (PVR) and pulmonary arterial compliance (PAC), respectively (figure 1). Furthermore, the pulmonary circulation ...
Source: Heart - June 26, 2023 Category: Cardiology Authors: Kearney, K., Lau, E. M. Tags: Editorials Source Type: research
Novel path: FINDing the way forward in screening for atrial fibrillation
Despite many advances in healthcare, mortality and morbidity related to undetected and hence untreated atrial fibrillation (AF) remain a major challenge.1 To reduce downstream consequences of AF, opportunistic screening for AF is recommended in persons older than 65 years, and systematic, invitation-based screening should be considered in older individuals (aged ≥75) or those at high risk.1 The prevalence of AF rises sharply with age, additional cardiovascular risk factors and cardiovascular disease. In line with this, large studies performed in younger individuals with low burden of comorbidities have shown a low yield...
Source: Heart - June 26, 2023 Category: Cardiology Authors: Diederichsen, S. Z., Svennberg, E. Tags: Editorials Source Type: research
