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Source: JAMA

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Total 276 results found since Jan 2013.

Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection Fraction —Reply
In Reply The RAPID-HF study, which was the first randomized trial testing atrial pacing to increase exercise heart rate in patients with HFpEF, demonstrated no benefit in exercise performance, with a decrease in exercise stroke volume preventing gains in cardiac output. Dr Yamamoto speculates that atrial pacing might have been more effective for older patients because diastolic dysfunction worsens with aging. However, shortening of diastole with higher heart rate would be expected to be even more poorly tolerated in these patients. The devices were programmed based on hall walk and each participant ’s prior peak heart ra...
Source: JAMA - June 20, 2023 Category: General Medicine Source Type: research

Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy
This retrospective cohort study assesses the association between recent use of oral vitamin K antagonists and symptomatic intracranial hemorrhage among patients with acute ischemic stroke undergoing endovascular thrombectomy.
Source: JAMA - June 20, 2023 Category: General Medicine Source Type: research

Treating Coronary Artery Disease With Treat-to-Target or High-Intensity Statin —Reply
In Reply We appreciate Dr Kawada ’s comments about our study, which demonstrated that a treat-to-target LDL-C strategy of 50 to 70 mg/dL as the goal was noninferior to a high-intensity statin therapy for the 3-year composite of death, myocardial infarction, stroke, or coronary revascularization.
Source: JAMA - August 1, 2023 Category: General Medicine Source Type: research

Extracranial-Intracranial Bypass Surgery for Stroke Prevention
The concept of performing an extracranial-intracranial (EC-IC) arterial bypass operation for a patient with an internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion is intuitively appealing. In these patients, it is believed that areas of hypoperfusion exist and anastomosis of the superficial temporal artery to the MCA is designed to augment brain perfusion. In vascular territories outside of the brain, bypass procedures performed to augment arterial flow typically improve clinical outcomes. For reasons unknown, however, the brain appears to respond differently to bypass surgery.
Source: JAMA - August 22, 2023 Category: General Medicine Source Type: research

Blood Pressure Management After Successful Thrombectomy
Despite the success of endovascular therapy (EVT) in acute ischemic stroke due to large vessel occlusion, opportunities to further optimize clinical outcomes remain. One such avenue is to reduce hemorrhagic transformation in the infarcted tissue bed after successful reperfusion, which has been shown to be associated with worsened clinical outcomes. Because higher cerebral perfusion pressures may foster hemorrhagic transformation, it has been hypothesized that lowering systemic blood pressure (BP) after successful reperfusion could decrease cerebral hemorrhagic complications. Reducing systemic BP may also lead to a decrease...
Source: JAMA - September 5, 2023 Category: General Medicine Source Type: research

Benefits of Pulmonary Vein Isolation Beyond Rhythm Control
The prevalence of atrial fibrillation (AF) is continually increasing, with major implications for patients and health care systems given the increased morbidity and mortality. Approximately one-third of patients with AF additionally are affected by mental health conditions (notably depression, anxiety, and perceived stress). Psychological distress conditions are independent risk factors for adverse cardiovascular outcomes (including stroke and major bleeding) in patients with AF and promote AF recurrence. Without doubt, these associations add more complexity to comprehensive treatment decisions for patients with AF.
Source: JAMA - September 12, 2023 Category: General Medicine Source Type: research