Use of Guideline-Recommended Medical Therapy in Patients with Heart Failure

By Connor Emdin
September 26, 2018

Over the past thirty years, survival after the diagnosis of heart failure has improved, with five-year mortality falling from 57% in 1979 to 1984 to 48% in 1996 to 2000.1 Much of this reduction in mortality has been due to the development of novel therapeutics for treatment of heart failure.2 Large randomized clinical trials have demonstrated that angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor neprilysin inhibitors (ARNIs), beta-blockers (BBs) and mineralcorticoid receptor antagonists (MRAs) all reduce the risk of death and re-hospitalization among patients with heart failure with reduced ejection fraction (HFrEF).2 Current guidelines strongly recommend that all eligible patients with HFrEF be treated with a combination of these agents.2 Continue reading “Use of Guideline-Recommended Medical Therapy in Patients with Heart Failure”

Oxygen in Acute MI: Lack of Benefit and Possible Risk?

By Martina McGrath, MD
November 3, 2017

Acute myocardial infarction occurs where there is insufficient supply of oxygenated blood to an area of the heart, leading to myocardial injury and cell death. For decades, clinical guidelines have recommended the administration of supplemental oxygen as a first-line therapy for all patients experiencing myocardial ischemia, regardless of oxygen saturation.1 Continue reading “Oxygen in Acute MI: Lack of Benefit and Possible Risk?”

Sodium Restriction in Patients with Reduced GFR: Blood Pressure Benefits

By Martina McGrath, MD
October 18, 2017

The typical US diet is comprised of 3.4g of sodium per day on average, whereas current recommendations suggest that sodium intake should be limited to <2g/day for the general population1 and possibly lower for those with hypertension or cardiovascular disease.2 Continue reading “Sodium Restriction in Patients with Reduced GFR: Blood Pressure Benefits”

Palliative Care in Advanced Heart Failure

By Connor Emdin
September 20, 2017

Heart failure (HF) is the leading cause of hospitalization for adults over the age of 65 in the United States and is associated with poor short-term survival, with an estimated median survival of 1.5-3 years after diagnosis.1,2 In addition to causing significant morbidity and mortality, HF is associated with reduced quality of life, spiritual distress, depression, and anxiety.3
Continue reading “Palliative Care in Advanced Heart Failure”

Quality of Life & Cost-Effectiveness of Intensive Blood Pressure Lowering

By Connor Emdin
September 6, 2017

In recent years, there has been considerable shift in treatment targets for blood pressure management. In 2014, the Eighth Joint National Commission (JNC 8) guidelines controversially up-revised blood pressure targets and recommended a target blood pressure of less than 140/80mm Hg in adults less than 60 years of age, increasing to less than 150/90mm Hg in those aged over 60 years. They argued that at the time, no randomized trial had demonstrated that lower blood pressure targets were associated with reduced risk of cardiovascular disease or death.1 These recommendations were a cause of heated debate and were inconsistent with recommendations from several other expert bodies, including American Heart Association and American College of Cardiology. Continue reading “Quality of Life & Cost-Effectiveness of Intensive Blood Pressure Lowering”

Cardiac Risk Assessment in Young Adults: Predictive Value via the CARDIA Study

By Martina M. McGrath, MD
August 22, 2017

Metabolic changes leading to the development of atherosclerosis can start early in life, and are frequently unrecognized in their early stages. For example, obesity in childhood and young adulthood has repeatedly been shown to increase the risk of cardiovascular disease (CVD) later in life.1,2 Given the current epidemic of obesity, inactivity, and poor diet, this is an issue of great public health importance. Tools aimed at young people that encourage early recognition of modifiable risk factors could have major clinical impact in the long term. However, estimating a young person’s risk of CVD, in the absence of typical CV risk factors such as diabetes or hypertension has proven challenging. The Framingham risk score and similar cardiac risk estimating equations are useful tools in middle-aged and older adults but are poorly validated in younger people due to their low absolute risk and the frequent lack of traditional CV risk factors. Continue reading “Cardiac Risk Assessment in Young Adults: Predictive Value via the CARDIA Study”

Declining Risk of Sudden Death in Heart Failure with Reduced Ejection Fraction

By Connor Emdin
August 1, 2017

Heart failure is the cause of more than one million hospital admissions in the United States annually1 and is a leading cause of death worldwide.2 Heart failure with reduced ejection fraction (HFrEF), characterized by EF typically <40%, is observed in approximately 50% of individuals with heart failure1 and is associated with an elevated risk of sudden cardiac death due to ventricular arrhythmia.3 While implantable cardioverter-defibrillators (ICD) can reduce the risk of sudden death, substantial risk remains and implantation itself is expensive and associated with risks including infection, and device misfiring.1,4 Therefore identifying the patient population who will gain most benefit from ICD implantation is of considerable interest. Continue reading “Declining Risk of Sudden Death in Heart Failure with Reduced Ejection Fraction”

Chocolate Intake and Risk of Atrial Fibrillation

By Martina M. McGrath, MD
June 7, 2017

Cocoa beans were highly prized by the Aztecs, used in religious ceremonies, traded for goods, and believed to have medicinal purposes.1 While cocoa beans are a rich source of anti-inflammatory flavonols and antioxidants, it is reported that modern manufacturing processes destroy most of these potentially beneficial substances.2 Furthermore, modern chocolate typically contains large quantities of sugar, meaning this popular indulgence is an unlikely health food supplement. Despite this, epidemiological studies have associated moderate chocolate consumption with reduced risk of myocardial infarction and several cardiovascular end points.3,4 Continue reading “Chocolate Intake and Risk of Atrial Fibrillation”

Inclisiran: A Novel Therapeutic for Long-Term Lowering of LDL Cholesterol?

By Connor Emdin
May 18, 2017

Elevated low-density lipoprotein cholesterol (LDL cholesterol) is a leading cause of coronary heart disease and death worldwide.1 When LDL cholesterol particles become oxidized, they can invade the endothelium of blood vessels and attract macrophages, forming atherosclerotic plaques. Over a lifetime, high levels of LDL cholesterol can lead to the formation of numerous unstable atherosclerotic plaques, potentially leading to myocardial infarction, stroke, and death from cardiovascular disease (CVD).2 Continue reading “Inclisiran: A Novel Therapeutic for Long-Term Lowering of LDL Cholesterol?”

Syncope—Are We Missing an Important Cause?

By Adam Schaffer, MD
April 19, 2017

As a hospitalist, syncope is an admitting diagnosis that I consider a challenge. Syncope is a presentation that we see frequently, and so can start to seem routine. Though published estimates of the causes of syncope vary, most have shown that the etiologies of syncope that we are most concerned about—such as bradyarrhythmias or ventricular tachyarrhythmias—make up a minority of cases. In one retrospective cohort study of the causes of syncope in 987 patients who were referred for cardiac electrophysiology evaluation, bradyarrhythmias accounted for 13.6% of cases and ventricular tachyarrhythmias accounted for 12.1% of cases.1  Vasovagal syncope, among the more benign etiologies of syncope, accounted for 47.0% of cases. These numbers come from a population of patients who were referred for electrophysiology evaluation, and so it is very possible that cardiac arrhythmias were overrepresented in this population compared to an unselected group of patients. Thus clinicians who evaluate syncope patients need to remain vigilant in order to correctly identify the minority of syncope patients who have a potentially serious cause of their syncopal episode. Continue reading “Syncope—Are We Missing an Important Cause?”