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Prevalence and antithrombotic management of atrial fibrillation in hospitalised patients
Conclusions This hospital-based study revealed high AF prevalence rates (16.8%). Patients with AF were present in all hospital zones and almost all patients were at high risk for stroke. Anticoagulation management was likely inappropriate in 48.7%, indicating the need for better guideline implementation initiatives to guarantee hospital-wide optimised care for patients with AF.
Source: Heart - May 12, 2015 Category: Cardiology Authors: Berti, D., Moors, E., Moons, P., Heidbuchel, H. Tags: Drugs: cardiovascular system, Hypertension Arrhythmias and sudden death Source Type: research

Diagnosis of an aortic valvular lesion
From the question on page 719 Clinical introduction A 59-year-old woman with hypertension presented with right-sided weakness and vision loss. Her vital signs were normal; cardiopulmonary exam was significant for a systolic and diastolic murmur. MRI of the brain showed multiple chronic bilateral infarctions, and Doppler ultrasound revealed acute left lower extremity deep vein thrombosis. Transthoracic echocardiography (TTE) to determine cardioembolic source of stroke was significant only for severe aortic valve regurgitation. To assess for cardiac vegetations, transoesophageal echocardiography (TEE) was performed (figure 1...
Source: Heart - April 9, 2015 Category: Cardiology Authors: Elboudwarej, O., Wei, J., Siegel, R. Tags: Drugs: cardiovascular system, Echocardiography, Image challenges, Hypertension, Venous thromboembolism, Aortic valve disease, Clinical diagnostic tests Source Type: research

Aspirin use in women for primary prevention
At present, there is no consensus on antiplatelet treatments in primary prevention, particularly for women. European guidelines on cardiovascular disease (CVD) prevention1 do not recommend antiplatelet therapy, while the American Heart Association guidelines for primary prevention2 support a daily treatment of low-dose aspirin in women aged >65 years. The US Food and Drug Administration at the beginning of this year stated that the agency "does not believe the evidence supports the general use of aspirin for primary prevention of a heart attack or stroke. In fact, there are serious risks associated with the use of ...
Source: Heart - February 12, 2015 Category: Cardiology Authors: Ferrario, M. M., Veronesi, G. Tags: Press releases, Drugs: cardiovascular system, Acute coronary syndromes, Epidemiology Editorials Source Type: research

Cardiovascular highlights from non-cardiology journals
Dual Antiplatelet Therapy Beyond 1-year after Percutaneous Coronary Interventions for Stable Coronary Artery Disease Results in Harm The benefit of extended dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is uncertain. The ARTIC-Interruption Trial examined discontinuation of DAPT at 1-year after PCI vs continuation for an additional 6–18 months. The study randomized patients 1-year after PCI to continuation (N=635) or interruption (N=624) groups, and examined the primary composite endpoint of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization over a med...
Source: Heart - January 14, 2015 Category: Cardiology Authors: Bradley, S. M. Tags: Journal scan Source Type: research

How do we improve outcomes in cardiac surgery patients with preoperative anaemia?
Introduction The development of the evidence base to underpin patient blood management, or the safe and effective management of anaemia and severe bleeding, is considered a priority area for research in cardiac surgery. This is because anaemia and severe bleeding are common in this setting, are associated with adverse clinical outcomes and, despite the evaluation of many patient blood management interventions in clinical trials over the last 30 years, few have been shown to be clinically effective in terms of improving prognosis.1 The clinical problem In cardiac surgery, anaemia is a significant health problem; as man...
Source: Heart - January 5, 2015 Category: Cardiology Authors: Murphy, G. J. Tags: Interventional cardiology, Clinical diagnostic tests, Epidemiology Editorials Source Type: research

Periprocedural imaging and outcomes after catheter ablation of atrial fibrillation
Conclusions Periprocedural imaging for AF ablation is increasingly used, although practice patterns vary widely. Our data suggest that periprocedural imaging is associated with better outcomes after catheter ablation; however, prospective studies of periprocedural imaging strategies are warranted.
Source: Heart - November 9, 2014 Category: Cardiology Authors: Steinberg, B. A., Hammill, B. G., Daubert, J. P., Bahnson, T. D., Douglas, P. S., Qualls, L. G., Pokorney, S. D., Calkins, H., Curtis, L. H., Piccini, J. P. Tags: Health policy, Drugs: cardiovascular system, Echocardiography, Clinical diagnostic tests Arrhythmias and sudden death Source Type: research

Brain MRI to personalise atrial fibrillation therapy: current evidence and perspectives
Advances in the access to and in the performance of brain MRI have led to an increased detection of asymptomatic abnormalities in the brain of patients with cardiovascular diseases. These may have prognostic impact and could influence management in the future. In this review, we summarise the main findings of brain MRI in patients with atrial fibrillation (AF) and explore the available evidence to better quantify the risk for intracerebral haemorrhage and (recurrent) ischaemic stroke based on brain MRI findings. Treatment decisions in the majority of patients with AF should still be based on data from established validated...
Source: Heart - August 21, 2014 Category: Cardiology Authors: Haeusler, K. G., Wilson, D., Fiebach, J. B., Kirchhof, P., Werring, D. J. Tags: Reviews Source Type: research

Cardiovascular highlights from non-cardiology journals
Warfarin for atrial fibrillation in patients with chronic kidney disease – does the thromboembolic benefit outweigh the bleeding risk? Chronic kidney disease (CKD) predisposes to high risks for both thrombo-embolism and bleeding. As a result, understanding the risk-benefit profile for use of anticoagulation therapies among CKD patients with atrial fibrillation is important to optimize patient outcomes. However, clinical trials evaluating efficacy and safety of anti-coagulants for atrial fibrillation generally exclude CKD patients and observational studies have had conflicting results. Accordingly, this prospective co...
Source: Heart - June 9, 2014 Category: Cardiology Authors: Bradley, S. M. Tags: Journal scan Source Type: research

Associations with anticoagulation: a cross-sectional registry-based analysis of stroke survivors with atrial fibrillation
Conclusions Anticoagulation was underused in this high-risk population, and those at highest risk were less likely to be treated. Strategies need to be developed to improve prescription of anticoagulation treatment.
Source: Heart - March 5, 2014 Category: Cardiology Authors: Abdul-Rahim, A. H., Wong, J., McAlpine, C., Young, C., Quinn, T. J. Tags: Drugs: cardiovascular system Cardiac risk factors and prevention Source Type: research

Aspirin versus vitamin K antagonist treatment guided by transoesophageal echocardiography in patients with atrial fibrillation: a pilot study
Conclusions This hypothesis-generating pilot trial has found that TEE may be used for refinement of stroke risk in paroxysmal atrial fibrillation patients. A larger trial is needed to confirm these data. (ClinicalTrials.gov number NTC00224757).
Source: Heart - March 5, 2014 Category: Cardiology Authors: Dinh, T., Baur, L. H. B., Pisters, R., Kamp, O., Verheugt, F. W. A., Smeets, J. L. R. M., Cheriex, E. C., Lindeboom, J.-E., Heesen, W. F., Tieleman, R. G., Prins, M. H., Crijns, H. J. G. M., for the TIARA investigators, Dinh, Pisters, Tieleman, Prins, Cri Tags: Drugs: cardiovascular system, Echocardiography, Clinical diagnostic tests, Epidemiology Cardiac risk factors and prevention Source Type: research

Stroke prevention by percutaneous closure of patent foramen ovale: a systematic review and meta-analysis
Conclusions Percutaneous closure of PFO in patients with cryptogenic stroke does not appear superior to medical therapy according to currently available randomised data. Furthermore, it is associated with an increased incidence of atrial fibrillation. However, there are signals pointing towards a potential benefit and more research should be strongly encouraged.
Source: Heart - February 10, 2014 Category: Cardiology Authors: Wolfrum, M., Froehlich, G. M., Knapp, G., Casaubon, L. K., DiNicolantonio, J. J., Lansky, A. J., Meier, P. Tags: Drugs: cardiovascular system, Epidemiology Aortic and vascular disease Source Type: research

Current and new oral antithrombotics in non-valvular atrial fibrillation: a network meta-analysis of 79 808 patients
Conclusions In this network meta-analysis, novel oral anticoagulants were the most promising treatments to reduce stroke, stroke or systemic embolism, and all-cause mortality in patients with AF.
Source: Heart - February 10, 2014 Category: Cardiology Authors: Dogliotti, A., Paolasso, E., Giugliano, R. P. Tags: Drugs: cardiovascular system, Epidemiology Arrhythmias and sudden death Source Type: research

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