Cardiology

Who Requires Medication under New ACC/AHA Hypertension Guidelines?

New guidelines dramatically increase the number of patients with hypertension. Do they all need medication?

Patients Most Likely to Die of Cardiac Arrest During Weeknights & Weekends, Study Finds

A new study finds that patients who go into in-hospital cardiac arrest (IHCA) during the weekend have a lower chance of survival compared to those who are admitted to the hospital during a weekday.

Ablation in Patients with Atrial Fibrillation

According to the American College of Cardiology, ablation is the first-line treatment for atrial fibrillation. Dr. Oussama Wazni weighs the pros and cons of this treatment option.

American College of Cardiology Issues New Atrial Fibrillation Treatment Guidelines

  • Use the CHA2DS2-VASc score for determining which patients are at greatest risk of stroke.
  • Clinicians should take an individualized approach to antithrombotic therapy.
  • Strict rate control is preferred over lenient.
  • Catheter ablation is a first-line option.

Treatment Choices in Atrial Fibrillation

Managing atrial fibrillation to prevent stroke: Use nothing or an oral anticoagulant. Use the CHA2DS2-VASc algorithm as well as gender to determine treatment choices. Dr. Wazni presents treatment choices in further detail.

Managing Atrial Fibrillation and Preventing Stroke

Patients with atrial fibrillation are seen with increasing frequency by clinicians. Can it be cured? How must it be managed? How can clinicians prevent stroke in patients with a-fib? Dr. Wazni addresses these questions in our latest video.

Let the Patient Decide: Postoperative A-Fib Rhythm and Rate Strategies Are Equivalent

  • New multinational study of more than 500 patients found no clear superiority of either strategy.
  • The incidence of serious thromboembolic events was low, 2%, and did not differ between the arms.
  • More patients in the rate control arm met protocol-specified indications for anticoagulation compared with the rhythm control arm.

This Procedure Is Now First-Line A-Fib Therapy: New ACC Guidelines

  • Recent guidelines from the American college of Cardiology offer important revisions regarding the management of atrial fibrillation.
  • Ablation is now a first-line therapy.
  • Cardiologists should now use the more precise risk stratification scoring system.
  • Tight heart rate control is preferred over lenient control.
  • Antithrombotic therapy is to be individualized based on shared decision-making between patient and physician.

Predicting Risk in AF: Which Stratification Scheme Performs Best?

  • The CHA2DS2-VASc is better at discriminating truly low-risk patients and finding those at high risk as well.
  • In the first validation study from the EuroHeart survey, CHA2DS2-VASc had a similar C statistic to CHADS2 but improved prediction in truly low-risk patients and classified only a small proportion into the intermediate-risk category.
  • the more precise the risk tool is to assess future risk of stroke, the better the chance that low-risk patients can avoid anticoagulation and that those who will benefit from anticoagulation will be identified accurately.
  • The major weakness of CHADS2 is that a substantial proportion of patients (approximately 60%) are assigned a score of 1, indicating an intermediate risk of stroke, and the benefit of application of anticoagulation to this subset is uncertain.

Weight Loss, The CABANA Trial, and the Future of Atrial Fibrillation

In this video, Dr. Oussama Wazni addresses the implications of weight loss, bariatric surgery, and the ongoing CABANA trial on the future of treatment of refractory atrial fibrillation.

Weight Loss, The CABANA Trial, and the Future of Atrial Fibrillation

In this video, Dr. Oussama Wazni addresses the implications of weight loss, bariatric surgery, and the ongoing CABANA trial on the future of treatment of refractory atrial fibrillation.

New Guidelines Endorse Daily Aspirin, Without a Doubt

  • Daily low-dose aspirin appears to be one of the most cost-effective disease, morbidity, and mortality preventatives available.
  • Updated guidelines from U.S. Preventive Services Task Force (USPSTF) call for the use of aspirin to prevent both cardiovascular disease and gastrointestinal cancers.
  • Major medical societies endorse daily aspirin.
  • Long-term use appears necessary; greatest benefit after 7.5 years of use.
  • Cancer and cardiovascular disease are two of the leading killers of Americans.
  • Vast literature now supports the use of daily aspirin to prevent disease.

Some Antihypertensives May Be Linked to Mood Disorders

  • Patients taking beta blockers and calcium channel antagonists had 2x the risk of being hospitalized with a mood disorder.
  • Patients taking angiotensin converting enzymes for hypertension had a lower risk of developing a severe mood disorder.
  • Patients taking a diuretic had a similar mood disorder risk as did control participants.

Drug-Eluting Stents Do Not Reduce Death Rates but Reduce Rates of Repeat Revascularization

  • Results of largest study to date were published in The New England Journal of Medicine.
  • Randomized trial involved more than 9000 patients who had stable or unstable coronary artery disease.
  • The primary outcome was a composite of death from any cause and nonfatal spontaneous myocardial infarction at 5 years of follow-up.
  • Secondary outcomes included repeat revascularization, stent thrombosis, and quality of life.

Medicare Patients Are Simply Not Taking Antihypertensives as Prescribed

  • Of the 18.5 million Part D beneficiaries receiving hypertensive medications 4.9 million (26%) were nonadherent in 2014, according to Centers for Disease Control and Prevention.
  • Medicare Part D beneficiaries pegged as particularly nonadherent.
  • Misuse of antihypertensives constitutes an important expenditure of national health funds.
  • Nonadherence is linked to significant cardiovascular disease.