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Comment Physical activity lowers mortality and heart disease risks
In The Lancet, Scott A Lear and colleagues1 report results from a large cohort of 130  843 participants from 17 countries (including four low-income countries and seven middle-income countries) investigating the beneficial dose-dependent associations of all forms of physical activity with reduced mortality and cardiovascular disease risks.1 This is another confirmation that physica l activity has definite and dose-dependent benefits for lowering risks of all-cause mortality and cardiovascular disease (heart attacks, stroke, and heart failure).
Source: LANCET - September 21, 2017 Category: General Medicine Authors: Shifalika Goenka, I-Min Lee Tags: Comment Source Type: research

Comment Building evidence for care beyond the medical centre
Digital health has been defined as the “convergence of the digital and genomic revolutions with health, health care, living, and society”.1 The term is often used interchangeably with mHealth or mobile health because of the central role played by mobile devices. Remote patient monitoring and telemedicine constitute a subset of digita l health technologies that enable monitoring of patients outside conventional clinical settings, such as in the comfort of their own homes. Evidence regarding the efficacy, effectiveness, economics, and clinical preferences of remote patient monitoring and telemedicine is growing in many c...
Source: LANCET - July 14, 2017 Category: General Medicine Authors: Thomas A Ullman, Ashish Atreja Tags: Comment Source Type: research

Seminar The future of atrial fibrillation management: integrated care and stratified therapy
Atrial fibrillation is one of the major cardiovascular health problems: it is a common, chronic condition, affecting 2 –3% of the population in Europe and the USA and requiring 1–3% of health-care expenditure as a result of stroke, sudden death, heart failure, unplanned hospital admissions, and other complications. Early diagnosis of atrial fibrillation, ideally before the first complication occurs, remains a ch allenge, as shown by patients who are only diagnosed with the condition when admitted to hospital for acute cardiac decompensation or stroke.
Source: LANCET - April 28, 2017 Category: General Medicine Authors: Paulus Kirchhof Tags: Seminar Source Type: research

Articles Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials
Mean achieved SBP less than 120 mm Hg during treatment was associated with increased risk of cardiovascular outcomes except for myocardial infarction and stroke. Similar patterns were observed for DBP less than 70 mm Hg, plus increased risk for myocardial infarction and hospital admission for heart failure. Very low blood pressure achieved on treatment was associated with increased risks of several cardiovascular disease events. These data suggest that the lowest blood pressure possible is not necessarily the optimal target for high-risk patients, although it is not possible to rule out some effect of reverse causality.
Source: LANCET - April 5, 2017 Category: General Medicine Authors: Michael B öhm, Helmut Schumacher, Koon K Teo, Eva M Lonn, Felix Mahfoud, Johannes F E Mann, Giuseppe Mancia, Josep Redon, Roland E Schmieder, Karen Sliwa, Michael A Weber, Bryan Williams, Salim Yusuf Tags: Articles Source Type: research

Editorial Atrial fibrillation and stroke: unrecognised and undertreated
When did you or your primary care physician last palpate your wrist to check for a regular heart rate? This simple action, followed by an electrocardiogram if the heart rate is irregular, might be crucial in preventing death and disability from ischaemic stroke, heart failure, or myocardial infarction. In this week's issue, we publish a clinical Series of three papers on atrial fibrillation ahead of the annual European Society of Cardiology (ESC) meeting held in Rome, Italy, Aug 27 –31. Atrial fibrillation is estimated to affect 33 million people worldwide.
Source: LANCET - August 19, 2016 Category: Journals (General) Authors: The Lancet Tags: Editorial Source Type: research

Articles Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study
Marked unexplained inter-regional variations in the occurrence of stroke and mortality suggest that factors other than clinical variables might be important. Prevention of death from heart failure should be a major priority in the treatment of atrial fibrillation.
Source: LANCET - August 7, 2016 Category: Journals (General) Authors: Jeff S Healey, Jonas Oldgren, Michael Ezekowitz, Jun Zhu, Prem Pais, Jia Wang, Patrick Commerford, Petr Jansky, Alvaro Avezum, Alben Sigamani, Albertino Demasceno, Paul Reilly, Alex Grinvalds, Juliet Nakamya, Akinyemi Aje, Wael Almahmeed, Andrew Moriarty, Tags: Articles Source Type: research

Articles Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis
Blood pressure lowering significantly reduces vascular risk across various baseline blood pressure levels and comorbidities. Our results provide strong support for lowering blood pressure to systolic blood pressures less than 130 mm Hg and providing blood pressure lowering treatment to individuals with a history of cardiovascular disease, coronary heart disease, stroke, diabetes, heart failure, and chronic kidney disease.
Source: LANCET - December 23, 2015 Category: Journals (General) Authors: Dena Ettehad, Connor A Emdin, Amit Kiran, Simon G Anderson, Thomas Callender, Jonathan Emberson, John Chalmers, Anthony Rodgers, Kazem Rahimi Tags: Articles Source Type: research

Case Report Reversible right heart failure after medullary stroke
In May, 2013, a 73-year-old woman presented to our clinic with drowsiness. She had had a left medullary stroke due to atrial fibrillation 7 months earlier (figure) and was taking oral anticoagulants. Since her stroke she had had fragmented sleep and excessive daytime sleepiness, and during the previous 4 months had developed facial and generalised oedema, which had become much worse in the week before admission, and was associated with anuria and drowsiness. On examination she was afebrile, blood pressure was 141/121 mm Hg, pulse was 80 beats per min and irregular, and jugular venous pressure was raised.
Source: LANCET - April 3, 2015 Category: Journals (General) Authors: Han-Gil Jeong, Dae Lim Koo, Hyunwoo Nam, Hyung-Min Kwon Tags: Case Report Source Type: research

Articles Digoxin use in patients with atrial fibrillation and adverse cardiovascular outcomes: a retrospective analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF)
Digoxin treatment was associated with a significant increase in all-cause mortality, vascular death, and sudden death in patients with AF. This association was independent of other measured prognostic factors, and although residual confounding could account for these results, these data show the possibility of digoxin having these effects. A randomised trial of digoxin in treatment of AF patients with and without heart failure is needed.
Source: LANCET - March 6, 2015 Category: Journals (General) Authors: Jeffrey B Washam, Susanna R Stevens, Yuliya Lokhnygina, Jonathan L Halperin, Günter Breithardt, Daniel E Singer, Kenneth W Mahaffey, Graeme J Hankey, Scott D Berkowitz, Christopher C Nessel, Keith A A Fox, Robert M Califf, Jonathan P Piccini, Manesh R Pa Tags: Articles Source Type: research

Seminar Hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy is a common inherited cardiovascular disease present in one in 500 of the general population. It is caused by more than 1400 mutations in 11 or more genes encoding proteins of the cardiac sarcomere. Although hypertrophic cardiomyopathy is the most frequent cause of sudden death in young people (including trained athletes), and can lead to functional disability from heart failure and stroke, the majority of affected individuals probably remain undiagnosed and many do not experience greatly reduced life expectancy or substantial symptoms.
Source: LANCET - January 18, 2013 Category: Journals (General) Authors: Barry J Maron, Martin S Maron Tags: Seminar Source Type: research