The benefit of cardiac resynchronization therapy with a defibrillator (CRT-D) relative to implantable cardioverter-defibrillator (ICD) therapy alone has not been evaluated in routine clinical practice. This study used data from the National Cardiovascular Data Registry’s ICD Registry linked with Medicare claims data to compare outcomes after CRT-D and ICD implantation in community practice. The analysis […]
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β-blockers beneficial in some, but not all, ischemic heart disease patients undergoing non-cardiac surgery
Whether β-blockers reduce adverse events among patients with stable ischemic heart disease (IHD) undergoing non-cardiac surgery remains in debate. In this Danish study, the authors retrospectively identified 28,263 IHD patients who underwent non-cardiac surgeries and examined the association between pre-procedural β-blockers use and a major adverse cardiovascular event (MACE) defined as 30-day cardiac death, myocardial […]
Glycemic measurements are not helpful in CVD risk prediction among non-diabetics
Several clinical guidelines recommend measurement of glycated hemoglobin (HbA1c) to guide cardiovascular risk (CVD) risk assessment. In this study, the authors examined the utility of adding HbA1c measurements to conventional risk factors in prediction of CVD among non-diabetic patients. Data from 73 prospective studies with nearly 300,000 non-diabetic patients without known CVD at enrollment was […]
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 […]
Cardiac device deactivation rarely mentioned in advanced directives
The authors retrospectively reviewed medical records of 150 patients who underwent deactivation of a pacemaker or implantable cardioverter-defibrillator in a four-year period at a single tertiary care center. These were older patients (median age 79) and 99% had a poor or terminal prognosis. More than half of the patients had an advance directive, yet only […]
Coronary artery calcium density is inversely associated with coronary risk
Coronary calcium is associated with cardiovascular disease risk. However, it may not only be the volume, but the density of coronary calcium that influences risk as more dense calcium may reflect stable plaque at lower risk of inciting coronary events. The traditional Agatson method of scoring coronary calcium burden does not consider coronary calcium […]
Mesenchymal stem cells may improve quality of life for patients with ischemic cardiomyopathy
In this study, patients with chronic ischemic cardiomyopathy and EF <50% on optimal medical therapy were randomized to autologous culture expanded mesenchymal cells (=22), autologous bone marrow mononuclear cells (n=22) or placebo vehicle (n=21) delivered by transendocardial stem cell injection (TESI). There were no serious adverse events among any patients undergoing a TESI procedure. Rates […]
Pre-hospital cooling with saline infusion does not improve cardiac arrest outcomes
Prior randomized trials have established hypothermia as a promising therapy to improve outcomes of cardiac arrest. It has been suggested that the benefit of hypothermia may be increased through early initiation of cooling in the field prior to hospital arrival. In this trial, 1,364 patients with out-of-hospital cardiac arrest were randomized to usual care or […]
Multivitamins of no benefit for secondary prevention
A healthy diet that includes foods rich in antioxidants and vitamins has consistently been associated with lower risk of atherosclerosis. Whether secondary risk reduction can be achieved with oral vitamin supplementation is unclear. The TACT (Trial to Assess Chelation Therapy) study was a 2×2 factorial design randomized trial to assess the impact of chelation therapy […]
Stenting of atherosclerotic renal artery disease fails to improve outcomes
Atherosclerotic renal-artery stenosis is common among patients with cardiovascular disease and the condition may contribute to hypertension. The impact of renal artery angioplasty or stenting on the risk of clinical events among patients with atherosclerotic renal disease remains poorly defined. In the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) study, 947 patients atherosclerotic renal-artery stenosis […]