DMS Cardiovascular news is a curated collection of articles, posts & studies related to general & interventional cardiology, cardiovascular & heart health that I found interesting and may be of help or interest to others. All articles are published on reliable and respected sources cited with links to read the original full article. 

Skip These Supplements for Afib Prevention — Long-term results from the VITAL Rhythm study in a large population

16 March, 2021 - MedPageToday
Neither fish oil nor vitamin D supplementation worked in the long-term primary prevention of atrial fibrillation (Afib), according to the VITAL Rhythm study.
 
Adults showed no reduction in incident Afib over a median 5.3 years of daily treatment with omega-3 fatty acids (3.7% vs 3.4% with olive oil placebo, HR 1.09, 95% CI 0.96-1.24) or vitamin D3 supplementation (3.7% vs 3.4% with soybean oil placebo, HR 1.09, 95% CI 0.96-1.25), reported Christine Albert, MD, MPH, of Cedars-Sinai Medical Center in Los Angeles, and colleagues.
 
There was no interaction between the two treatments in the 2×2 factorial randomized trial. Results remained nonsignificant when individuals were censored for nonadherence, they stated in JAMA. Top-line results of the study were reported at the 2020 American Heart Association virtual meeting.
 
Hypothesis-generating subgroup findings included Afib risk being modestly increased in taller individuals taking fish oil, as well as younger people and those who drank less alcohol on vitamin D3 supplementation...

Should Cardiac Rehabilitation Be Standard of Care For HF Patients?

15 March, 2021 - ACC American College of Cardiology
Multiple studies have demonstrated the safety, benefits and cost-effectiveness of cardiac rehabilitation in patients with heart failure (HF), however, it remains underused. A new perspective from the ACC Heart Failure and Transplant Section Leadership Council, published March 15 in the Journal of the American College of Cardiology, reviews existing evidence and guidelines, and provides guidance for the implementation of cardiac rehabilitation in patients with HF.
 
Biykem Bozkurt, MD, PhD, FACC, et al., describe how cardiac rehabilitation programs have shifted from a monitored exercise program to a comprehensive and multidisciplinary program over the past three decades. A cardiac rehabilitation program includes exercise training, patient assessment, education about medication adherence, risk factor modification including dietary recommendation, lifestyle modification, smoking cessation counseling, stress management, and evaluation and management of barriers to adherence.

Uneven Progress Closing Race Gap in Heart Health — Urban areas more successful at narrowing disparities

15 March, 2021 - MedPageToday
More work is needed to close the racial gap in cardiovascular mortality in the rural U.S., one study showed.

From 1999 to 2018, annual age-adjusted rates of mortality from diabetes, hypertension, heart disease, and stroke were consistently higher for Black adults compared with white adults in urban and rural areas alike, with diabetes- and hypertension-related mortality about two to three times higher in rural settings, according to Rishi Wadhera, MD, MPP, MPhil, of Beth Israel Deaconess Medical Center in Boston, and colleagues, who used the CDC Wonder Database for their analysis.

"These marked racial disparities have improved minimally over the last 20 years, although more pronounced improvements have occurred in urban areas," they reported in the Journal of the American College of Cardiology.

Urban areas saw a faster narrowing of the racial gap compared with rural areas when it came to diabetes mortality (change in Black vs white difference -0.94 vs -0.24 deaths per 100,000 per year, P<0.001 for interaction between rural area and time) and deaths from hypertension (-0.30 vs -0.09, P=0.03).

"The striking and persistent racial disparities for diabetes- and hypertension-related mortality in rural areas, relative to urban areas, may reflect structural inequities that impede access to primary, preventive, and specialist care for rural Black adults," according to the authors.

Importance of Frailty and Noncardiac Surgery

9 March, 2021 - ACC American College of Cardiology
Commentary based on George EL, Hall DE, Youk A, et al. Association between patient frailty and postoperative mortality across multiple noncardiac surgical specialties. JAMA Surg 2021;156:e205152.1
 
Geriatric Cardiology Take Home Points:

  • In numerous studies, frailty has been associated with increased risk for perioperative complications, prolonged hospital stays, discharge to a skilled nursing facility, progressive functional decline, and death.
  • Several tools are available for assessing frailty in the clinical setting, including the Fried Frailty Score, the Rockwood Frailty Index, and the Risk Analysis Index (RAI) used in this study.
  • The present study provides compelling evidence that patients undergoing a wide range of non-cardiac surgical procedures who are frail or very frail, as defined by the RAI, are at substantially increased risk for 30- and 180-day mortality relative to non-frail individuals.
  • The impact of frailty on mortality is independent of traditional risk factors, implying that frailty assessment should be integrated into routine preoperative assessment of older individuals and select younger individuals, regardless of the type of surgery.
  • Frailty assessment should also be used to inform pre-operative shared decision-making in determining the potential risks and benefits of surgery in the context of the patient's individual healthcare goals and personal preferences.

 
Study Design:  Retrospective cohort study (N= 2,765,609) conducted over a period of 4 years.
 
Conclusion:

  • Frailty was a consistent, independent risk factor for 30- and 180-day mortality across all specialties irrespective of the surgery intensity.
  • Preoperative objective frailty assessments should be considered for preoperative risk stratification regardless of the surgical specialty as clinically indicated.

 
References:
1. George EL, Hall DE, Youk A, et al. Association between patient frailty and postoperative mortality across multiple noncardiac surgical specialties. JAMA Surg 2021;156:e205152.

Can Time in Systolic BP Target Range Predict Adverse CV Events?

08 March, 2021 - ACC American College of Cardiology
Time in systolic blood pressure (BP) target range may independently predict major adverse cardiovascular event risk, according to a study published March 8 in the Journal of the American College of Cardiology.
 
Nayyra Fatani, PharmD, et al., conducted a retrospective analysis of the SPRINT trial – a randomized controlled trial that compared intensive and standard systolic BP treatment interventions in adults with hypertension and high cardiovascular risk. Target range was defined as 110 to 130 mm Hg and 120 to 140 mm Hg for intensive and standard arms, respectively, and time in target range was estimated over the first three months of follow-up using linear interpolation.
 
Among the 6,162 patients included in the analysis, patients with greater time in the target range were younger, had lower 10-year cardiovascular risk, lower baseline systolic BP, and were more likely women and statin users. Researchers found that each 1-SD increase in time in target range was significantly associated with a decreased risk of first major adverse cardiovascular event.
 
"Time in target range may be a useful metric of [BP] control for population-based quality assessment and clinical trial interventions," the authors conclude...

Sex differences in mortality and 90-day readmission rates after transcatheter aortic valve replacement: a nationwide analysis from the USA

28 February, 2021 - European Heart Journal - Quality of Care & Clinical Outcomes (requires subscription)

Abstract:

Aims:
To assess gender differences in in-hospital mortality and 90-day readmission rates among patients undergoing transcatheter aortic valve replacement (TAVR) in the USA.

Conclusion:
In-hospital mortality and readmission rates for TAVR hospitalizations have decreased over time across both genders.

Despite these improvements, women undergoing TAVR continue to have a modestly higher in-hospital mortality, and 90-day readmission rates compared with men.

Given the expanding indications and use of TAVR, further research is necessary to identify the reasons for this persistent gap and design appropriate interventions...

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