Atrial Fibrillation

NEW HAVEN, Conn. -- Older patients with advanced chronic diseases may reject medical or surgical interventions unless clinicians provide a cogent rationale for them.

ROCKVILLE, Md. -- After nine weeks of internal worry about the cardiovascular safety of two prescription proton-pump inhibitors, Prilosec and Nexium, the FDA has issued a limited all clear.

BIRMINGHAM, England -- When seeking to reduce the risk of stroke in older patients by screening for atrial fibrillation, a pulse-based system is an effective approach, found researchers here.

WINSTON-SALEM, N.C. -- One-time percutaneous radiofrequency ablation proved completely successful in eradicating small renal cell carcinomas, found researchers here.

ABSTRACT: Angiotensin-converting enzyme inhibitors and ß-blockers are the cornerstone of heart failure medical therapy; unless contraindicated, start these agents as soon as possible after volume status has been optimized. Aldosterone receptor antagonists, angiotensin-receptor blockers, and a fixed-dose combination of hydralazine and isosorbide dinitrate (the last recommended especially for African Americans) can be used as add-on therapy. Prophylactic implantable cardioverter defibrillators reduce long-term mortality in symptomatic patients with a left ventricular ejection fraction (LVEF) of 35% or less. Cardiac resynchronization therapy improves symptoms and ventricular remodeling in some patients; indications include wide (more than 20 milliseconds) QRS complex on ECG, impaired LVEF (35% or less), and advanced heart failure symptoms (NYHA classes III and IV) despite optimal drug therapy. Measurement of natriuretic peptides and impedance cardiography both show promise for monitoring patients with heart failure and for guiding therapy, but definitive data to justify their routine use are still lacking.

GAITHERSBURG, Md. -- Patients with severe type 2 diabetes who use insulin or those with established heart disease are probably not good candidates for rosiglitazone (Avandia).

LOS ANGELES -- An initiative to integrate evidence-based care into the hospital treatment of heart failure patients met with a modicum of success, found investigators here.

GAITHERSBURG, Md. -- Documents prepared by the FDA for Monday's review of the cardiovascular safety of rosiglitazone (Avandia) support published reports of a significant rise in the risk of myocardial infarction for the diabetes drug.

MINNEAPOLIS -- Presence of just a single risk factor for sudden death may justify implantation of a cardioverter-defibrillator (ICD) in high-risk patients with hypertophic cardiomyopathy, researchers here found.

CHICAGO -- Medicare patients who couldn't read a physician's instructions, or who didn't understand what they read had a higher mortality rate than patients with adequate reading skills.

ROCHESTER, Minn. -- Patients with nonvalvular atrial fibrillation have about a 33% lower risk of stroke and major vascular events when treated with oral anticoagulants rather than antiplatelet therapy, findings from a systematic review of clinical trials suggest.

BOSTON -- If hospitals consistently meet quality targets, mortality rates for three common conditions are 7% to 15% lower than in less rigorous institutions, health analysts here reported.

HAMILTON, Ontario -- Antiplatelet therapy alone is as effective in peripheral arterial disease as adding an oral anticoagulant, and it's safer, researchers reported.

HERSHEY, Pa. -- Diabetes complicates hospital trauma care much as it does for in-patient acute care, researchers here reported.

DALLAS -- For cardiac patients, weight training twice a week may be a good adjunct to aerobic conditioning, according to an updated scientific statement from the American Heart Association.

BALTIMORE -- Older and cheaper oral drugs for type 2 diabetes may be just as effective at controlling glycemia and improving lipid profiles as newer agents, suggested a systematic literature review.

SAN ANTONIO -- Drugs that lower angiotensin II may increase the risk of stroke, contrary to conventional wisdom, an investigator asserted here.

GAINESVILLE, Fla. -- Hispanic women with coronary artery disease and hypertension achieved better blood pressure control than non-Hispanic white counterparts who were treated with the same antihypertensive drugs.

EDMONTON, Alberta -- Phosphodiesterase type 5 (PDE5) drugs, such as sildenafil (Viagra), may improve right ventricular contractility in hearts with right ventricular hypertrophy, an unexpected benefit that looks promising for treatment of right ventricular heart failure.

LORENSKOG, Norway -- B-type natriuretic peptides have earned a new vote of confidence as a prognostic biomarker for low-risk patients with stable coronary disease.

SANTA MONICA, Calif. -- When patients have to pay more for their prescriptions, spending on drugs goes down, but so does adherence, a new study shows.

GENEVA -- Airline travel that lasts four hours or longer is associated with a one in 6,000 absolute risk of developing venous thromboembolism, according to the World Health Organization.

* Vena caval interruption has been used in the treatment of deep venous thrombosis (DVT) to prevent PE since the early 1970s. Filter placement has been increasing in the past decade. We estimate that filters are placed in more than 0.2% of all Medicare recipients annually.

Heart failure is prevalent in both primary care and cardiology practices. It develops in about 1 in 5 persons during their lifetime and in about 1 in 8 of those who have not sustained a myocardial infarction (MI). Heart failure is also the leading cause of hospitalization in the elderly.

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